Escitalopram often sold under the brand name Lexapro, is a common type of antidepressant, belonging to the group of Selective Serotonin Reuptake Inhibitor medications. SSRIs are employed for the treatment of Major Depression and Generalized Anxiety Disorder. A frequently encountered problem that occurs in around 21% of patients who abruptly cease taking Escitalopram after a prolonged period (≥1 month) of use, is the development of Lexapro withdrawal syndrome. This syndrome can cause significant distress to the patient, and abruptly stopping Lexapro use can potentially increase their risk of relapse of depression and anxiety. Therefore education about this syndrome and being informed about possible Lexapro withdrawal symptoms is of paramount importance to the patient’s health and wellbeing. This article tackles exactly these topics, but patients should always consult their medical health care provider before making any decisions regarding their use of Escitalopram.
If SSRI use is abruptly stopped, the patient’s nervous system will experience a transient state of Serotonin deficiency, thus causing Lexapro Withdrawal.
Reason Why Lexapro Withdrawal Develops
People with depression have low levels of Serotonin, which is believed to cause the characteristic signs and symptoms of Major Depression. SSRIs, like Escitalopram oxalate, help alleviate these signs and symptoms by increasing the levels of serotonin and potentiating serotonergic transmission by preventing its reuptake. When SSRIs are used over a prolonged period of time(≥1month), they cause a persistent alteration in the levels of neurotransmitters in the central nervous system, chiefly they increase the levels of Serotonin(5-HT). The elevated levels of Serotonin stimulate neurons at increased rates. Neurons respond to this change by down-regulating the number of serotonergic receptors located on their membranes. This change is a type of physiological adaptive mechanism that ensures that serotonergic overstimulation and possible neurotoxicity will not occur in face of elevated levels of serotonin. However, if SSRI use is abruptly stopped, the patient’s nervous system will experience a transient state of Serotonin deficiency.
This Deficiency Is Related to Two Factors:
- Without the SSRI, the elevated levels of serotonin will fall back to before treatment low levels.
- Neurons, who had previously adapted to elevated levels of Serotonin and in response had downregulated their serotonergic receptors, will not have adequate time to adapt to the low levels of serotonin in the central nervous system by up-regulating the serotonergic receptors on their plasma membranes.
Thus these patients will have low levels of serotonin and a fewer number of serotonergic receptors, which when combined will cause transient deficiency of serotonin and its activity which are related to the development of Lexapro withdrawal symptoms. The patient will experience these symptoms until their central nervous system adapts to the low level of Serotonin by up-regulating the number of Serotonin receptors on Serotonergic neurons.
Lexapro Withdrawal Symptoms
As previously mentioned, withdrawal symptoms start after abrupt cessation following prolonged use. Furthermore, it’s worth noting that this phenomenon is not unique to Escitalopram, and it can occur with even greater frequency in those SSRIs that have shorter durations of action than Escitalopram. The symptoms and signs can occur within days or weeks from stopping Lexapro and are dependent on the duration of usage, the half-life of the medication, and the patient’s individual physiology. There can be over 53 different Lexapro withdrawal symptoms and signs which can occur within 1 to 7 days of stopping or reducing SSRI use as reported by one study which attempted to develop diagnostic criteria for SSRI discontinuation syndrome.
The Most Frequently Encountered Signs and Symptoms Include:
- Gastrointestinal Problems: Nausea, emesis, anorexia, cramps, and diarrhea
- Hyperarousal: jerkiness, anxiety, irritability, mania, agitation, aggression
- Vasomotor Instability: Hyperhydrosis, Flushing, Difficulty tolerating heat
- Flu-like Symptoms: malaise, fatigue, aching, headache
- Paresthesias: sensations of “burning” “tingling” “electric brain zaps”
- Sleep Disturbances: Insomnia, Hypersomnia, Vivid dreams, Nightmares
- Imbalance: Dizziness, Pre-syncope, uneven gait
Furthermore, with continued disuse of SSRI medications, symptoms of anxiety and depression may arise which may be related to the relapse of the patient’s Major Depression or Generalized Anxiety for which they were receiving antidepressant treatment with SSRIs in the first place.
Lexapro Withdrawal Timeline
How long the symptoms last depends on various factors such as how long a patient has been taking the SSRI medications and in what amounts, given the fact that a person can overdose on Lexapro if not following the doctor’s prescription. Unfortunately, there is no concrete Lexapro withdrawal timeline or duration of symptoms. Usually, the symptoms last for a few (1-2) weeks but they may occasionally persist for months or years. Furthermore, if symptoms persist for over a month, it is worth considering that this may be a manifestation of relapse of Major Depression rather than withdrawal.
Stopping SSRIs can be difficult for many patients, but with adequate education and preparation, patients can have an easier time transitioning off of SSRIs.
Escitalopram Warnings and Precautions
Patients should be counseled and warned to never abruptly stop taking their antidepressants as this can cause the development of Lexapro Withdrawal Syndrome. Besides this warning, there are two more considerations as to why antidepressant medications, like Escitalopram, should not be abruptly discontinued.
The setback of treatment for Major Depression or Generalized Anxiety: these conditions require sustained (months-years) therapy in order to help patients. Thus, discontinuing therapy will hinder the attainment of treatment goals set by the patient and their physician.
Cessation of antidepressant use including Escitalopram, before a specific therapeutic regimen date, has been linked with a prominent risk for suicidal ideation or attempt.
Patients should immediately seek medical help if you or someone you know displays any of the following signs after cessations of Escitalopram use:
- Talking about: Wanting to die; Great guilt or shame; Being a burden to others
- Feeling: Empty, hopeless, trapped, or without reason to live;
- Feeling: Very sad, increasingly anxious, agitated, or filled with rage
- Feeling: Intolerable emotional or physical pain
- Behavioral: Making a plan or researching ways to die
- Behavioral: Withdrawing from friends, saying goodbye, giving away important items, or making a will
- Behavioral: Taking dangerous risks such as driving extremely fast
- Behavioral: Displaying extreme mood lability
- Behavioral: Eating or sleeping more or less
- Behavioral: Increasing use of drugs and alcohol
How To Stop Taking Lexapro Safely
Patients may have a variety of reasons for wanting to stop taking their antidepressant medications, for example, when experiencing Escitalopram side effects. Regardless of the reason, before Escitalopram can be stopped, patients should always consult their physician for advice. The physician will determine if the patient’s desire to stop taking Escitalopram is appropriate, and will recommend the safest route of how to wean off Lexapro.
General Recommendations for Avoidance and Management of Escitalopram Withdrawal Include:
- The drug dosage should be slowly tapered down, meaning that the dosage of the medication taken should be reduced in small increments every two to six weeks.
- If required, patients can be switched to a longer-acting SSRI, which is easier to taper.
- Proper patient education and reassurance that if symptoms of discontinuation and withdrawal are experienced, they are non-life-threatening, self-limited, and reversible.
- Patients should understand that if withdrawal occurs, it does not mean that they are addicted.
- If the patient experiences severe withdrawal reactions, the drug can be reintroduced which should alleviate the symptoms of withdrawal rather quickly, and tapering off can be done at even smaller increments.
Tips for Coping With Lexapro Withdrawal Symptoms
The process of stopping Escitalopram may be distressing to many patients. To minimize patient discomfort when weaning off the drug, patients should follow the general recommendations mentioned above, as well as keep in mind the following tips.
- Patients need to have proper knowledge and understanding of Lexapro drug interactions and what may happen if they stop taking Escitalopram. Research shows that patient education can reduce the risk of withdrawal.
- Patients should also be made aware that if they wish to discontinue Escitalopram use, they should first discuss it with their health care provider and keep in touch with them throughout the process.
- Patients should also know that if they choose to discontinue Escitalopram, the process can be done safely.
- During withdrawal, regular exercise, eating healthy, and paying attention to one’s mental health can ease the symptoms of withdrawal.
- Relaxation techniques can be useful for reducing anxiety and bringing about a calmer mind.
- Tacking alterations in their mood throughout the process using a mood calendar can also be helpful. Not only is it helpful but it can also allow physicians to detect possible signs of Major Depression relapse.
- Support of family and friends is also beneficial during the withdrawal process.
- Taking inspiration from similar success stories can motivate and give peace of mind to some as well.
Stopping SSRIs can be difficult for many patients, but with adequate education and preparation, patients can have an easier time transitioning off of SSRIs. However, always remember that the first step to discontinuing Lexapro or any other antidepressant is to speak with your doctor and to never cease taking these medications on your own.
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