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What is Lexapro?

Lexapro© (generic escitalopram) is a widely used selective serotonin reuptake inhibitor (SSRI) drug. Lexapro was FDA-approved for the treatment of MDD (major depressive disorder) and GAD (generalized anxiety disorder). SSRIs are also prescribed off-label for a wide variety of conditions such as OCD, PTSD, panic attacks, premenstrual dysphoria, hot flashes of menopause, premature ejaculation, and a host of others, even in children.1 The effects of long-term use (and subsequent discontinuation) are poorly understood and can be potentially serious, as will be discussed below.

One of the more concerning facts about drug-based mental health treatment is that while pharmaceutical companies have proposed theories to explain that SSRIs can help combat the symptoms of depression in some people, drug manufacturers and regulators say they have a very limited understanding of how exactly this mechanism works. The hypothesis of alleviating depression by making serotonin more available through SSRI drug therapy has influenced prescribers for decades but remains highly contested, according to studies like the 2022 scoping review authored by Moncreiff et al, published in the Journal of Molecular Psychiatry.8,9

Whether a person in a depressed state does or does not have a “serotonin deficiency” before commencing drug therapy, what we do know is that serotonin suspended outside the synapse metabolizes quickly, and it is therefore likely that long-term use of SSRIs depletes the store of available neurotransmitters. Neurotransmitters are natural chemicals that are meant to be transported out of the synapse, so they can be reused. Once a neurotransmitter is artificially suspended (blocked from reuptake), these molecules become subject to degradation and become a waste product. The neuroplasticity of the brain is a highly complex mechanism that challenges the most brilliant minds to fully understand. Lexapro is one of a long string of serotonin-targeting medications, whose mechanism of action as yet has not been demonstrated despite thousands of clinical trials. The chemical imbalance theory that forms the basis for prescribing SSRIs simply has not been proven.

About Long-Term Lexapro Effects

So, can you take Lexapro for years? Certainly, some people do, with varying degrees of success, and the typically short-term pharmaceutical company-sponsored drug trials will tell you it’s perfectly safe. The reality, however, is that a majority of longer and larger clinical trial reviews omit negative results from publication, and these long-term effects can be overlooked entirely.16

SSRIs like Lexapro are not expected to start working in any tangible way until the medicine has built up in your body over time, often as your doctor continuously increases the dosage to reach a therapeutic level. Once that level is reached, it is hoped that the patient experiences relief from depression symptoms. However, a large review published way back in 2005 in the Journal of Psychopharmacology looked at dozens of placebo-controlled trials on SSRI efficacy in depressed youth and concluded that the antidepressant effect is too modest to be easily detected.25

Not only were positive effects too modest to detect, but a black box warning was also placed on ALL SSRI drugs for the increased rate of suicide and suicidality in this population, as indicated in many placebo-controlled trials.10

The changes these powerful drugs can inflict on your system can be hard to predict.

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The following summary of the long-term effects of Lexapro is based on clinical research studies. An expanded description below this list is accompanied by references for you to dive into if you would like to continue your own research.

Long-term effects of Lexapro include:
  • Weight gain
  • Elevated colon cancer biomarkers (carcinoembryonic antigens)
  • Insomnia
  • Emotional numbness
  • Sexual dysfunction
  • Addiction/dependence
  • Suicidal ideation
  • Nausea
  • Diarrhea
  • Dry mouth
  • Somnolence
  • Headache
  • Backache
  • Upper respiratory infection
  • Weight gain  — For many patients, long-term antidepressant treatment goes hand in hand with weight gain. In more extreme cases, this can feed back into a loop of negative feelings about one’s own body and health, exacerbating depressive symptoms and thought patterns. There may be other contributing factors to weight changes (loss or gain) during antidepressant treatment, but these are not well understood as yet.17,31
  • Heightened carcinoembryonic antigen levels  — CEA levels are used as an indicator for certain types of cancer.18
  • Insomnia  — Antidepressants alter the mechanisms and patterns of sleep. The changes in REM are thought related to the increase in serotonin suspended in the neuron pathways.19
  • Emotional numbness  — While antidepressants can be effective at chilling negative thought patterns like negativity and despair, they can also desensitize your other emotions. A study out of the Frontiers in Psychiatry Journal found 40-60% of long-term antidepressant users report an inability to feel “real” happiness or even a loss of interest in their close relationships.20.21
  • Sexual dysfunction  — A significant percentage of patients treated with SSRIs report reduced sex drive and problems with sexual performance.22
  • Addiction/dependence  — Long-term antidepressant patients may feel concerned that they are becoming addicted or chemically dependent. A study published in the International Journal of Clinical Psychopharmacology found that the longer a person took antidepressants, the greater the chance of developing psychological dependence.23
  • Suicide, suicidal thoughts  — A paradoxical adverse effect particularly associated with SSRIs is suicide, and suicidal thoughts, often within the first few weeks of starting SSRI therapy. Suicides associated with SSRIs are 5X the number associated with non-SSRI antidepressants. Violent suicides are distinctly more common with SSRIs than with other types of antidepressant drugs. Although suicide is most commonly seen as a short-term (immediate) effect, it should not be ruled out as a long-term effect. Worsened suicidality has been reported as typically peaking at around week #5 of SSRI treatment in adults participating in clinical research trials.24,25
  • Serotonergic effects  — SSRIs are designed to target serotonin. Serotonin is a neurotransmitter with perhaps thousands of functions in the human body. Therefore, dysfunctional effects can be diverse, since serotonin receptors are not found only in the brain, but all over the body. Most of the stores of serotonin are found entirely outside the central nervous system. These effects may include diarrhea, nausea, dry mouth, runny nose, cognitive functions, altered mood, perception, digestive issues, blood pressure, heart rate, platelet formation, pain, immune functions such as T-cell production, sudden infant death syndrome, dysregulation of other interacting hormones, and thousands more.26,27,28

Quitting Lexapro

If you’re already on a high dose of Lexapro and have decided to end treatment, never attempt to do so abruptly. Just as you build up the drug in your system gradually to start achieving its effects, you will need to reduce your dose slowly over time so that your body can adjust.

After long-term Lexapro or other SSRI medication, serotonin receptors become largely INACTIVE, due to the way the body responds to the onslaught of the drug. This neuroadaptation may explain, in part at least, why doses are often upped in order to “continue working”. The body was designed to build and replenish natural hormones, but if these become compromised then supporting healing through corrected diet and supplementation to aid the process becomes a necessity.28

This is why attempting to transition off Lexapro too quickly or without proper support and guidance can constitute some of the most extreme and unpleasant adverse effects. Cessation can potentially create a scary and drawn-out ordeal for someone who decides Lexapro just isn’t working for them after titrating up to a higher dose, as prescribed by their doctor.

For How Long is Lexapro Prescribed?

Mental Side Effects of Lexapro

SSRIs are not viewed as fast-acting medications to manage symptoms when they arise, like using an inhaler for asthma attacks or taking an aspirin for a headache. SSRIs are typically prescribed for a lengthy period of time, spanning months or years. However, research involving brain scans shows that the effects on brain structure/function can be profound, and immediate.30

  • Lexapro is prescribed long-term, allowing it to create neuroadaptation in the CNS, brain, and body.
  • Long-term effects of Lexapro may develop making continuing treatment untenable.
  • Lexapro is not a cure.
  • Long-term Lexapro treatment often means gradually increasing the dose to adjust for tolerance (neuroadaptation) over time. A patient with serious underlying mental issues may eventually find themselves taking the highest approved dose of Lexapro while no longer feeling any real benefit from it and will then be faced with the equally daunting prospects of switching medications or attempting to get off a high dose of Lexapro.

Frequently Asked Questions about Lexapro Long-term Effects

New patients prescribed SSRI treatment will have a lot of questions. These are some of the most common questions asked.

Q: Will I Gain Weight on Lexapro?

A: As it turns out, yes, it is fairly typical for patients to gain weight. Dysregulation of serotonin is associated with cravings for carb-rich foods such as bread, pasta, sugary treats, and junk food. Weight loss is also associated with antidepressants. There may be other chemical changes incurred that affect metabolism and other functions, but these are not well understood.17,31


Q: Is Lexapro Hard on the Liver?

A: Case reports exist of escitalopram-induced liver injury, including hepatitis. Your liver works hard to keep toxins filtered from your body, and when it must deal with daily doses of chemicals over a long period, the breakdown of function can become life-threatening. Reversing the liver injury has been achieved by stopping the liver-toxic medication.29,30

Q: Is Lexapro Linked to Dementia?

A: The powerful way SSRIs work to change brain chemistry has some researchers concerned about the potential for Lexapro and other SSRI drugs to damage the brain. A study from 2016 published in the Journal of Clinical Psychiatry found an increased risk of dementia associated with SSRI medications.4

Q: What Should I Avoid While Taking Lexapro?

Serotonin syndrome is a potentially life-threatening consequence of serotonergic medications. Drug interactions that target serotonin can trigger this condition. Other complications can occur if taking drugs that affect blood flow, or that act on the CNS, including alcohol. Taking certain drugs while also taking Lexapro can affect their rate of metabolism, enhancing their serotonergic effects. Always coordinate with your prescriber to ensure harmful drug interactions are avoided. The following are examples of what to avoid if you are taking any SSRI including Lexapro.

What to avoid while taking Lexapro:
  • Other SSRIs
  • SNRIs (serotonin + norepinephrine targeting medications)
  • MAOIs (deactivate enzymes that metabolize serotonin, norepinephrine, and dopamine)
  • NSAIDs (pain relievers such as aspirin and ibuprofen) work by deactivating certain enzymes that would otherwise cause pain or inflammation as an immune system response.
  • Warfarin (a medication that blocks enzymes that would otherwise clot the blood)
  • Lithium (mood stabilizer that blocks dopamine)
  • Carbamazepine (an epilepsy drug)
  • Alcohol (temporarily increases the availability of GABA which is an inhibitory neurotransmitter)
  • Tryptophan (precursor to serotonin production)

This is by no means an exhaustive list of medications that can interact with Lexapro. If you’re ever uncertain about taking another prescription drug or over-the-counter (OTC) medication while on Lexapro, reach out to your doctor for clarification before making any decisions that could risk your health.

Ceasing Lexapro Use

When a patient feels uncomfortable taking Lexapro, or it doesn’t seem to be helping their depression, they will naturally have questions about the option of stopping, especially if they’ve read or heard horror stories from those who stopped abruptly. If you’re ready to end your Lexapro treatment, you may have all sorts of questions and concerns. Here are some of the most common.

Can Lexapro Cause Brain Fog?

Yes. Brain fog is a common symptom for many patients, both when starting and stopping Lexapro. Much like Lexapro’s therapeutic function, it is unknown how exactly this occurs. A 2014 study of escitalopram’s mechanisms concluded that the drug not only “changes brain architecture” but can do so in just a matter of hours.30

How Long Can I Stay on Lexapro?

This is between you and your doctor, and ultimately will be your own deeply personal decision about your health. If you decide you are uncomfortable taking Lexapro, feel it isn’t working for you, or would like to try treatments that rely less on powerful and poorly understood pharmaceuticals, and more on healthy drug-free approaches to improved mental wellness, be upfront with your health providers about your concerns and intentions.

Can Lexapro Change Your Personality?

This question cannot be easily answered because “personality” is a fluid, philosophical concept rather than something with a fixed medical definition. If personality can be defined as the average of someone’s mental and emotional state over time, then you might easily argue that the entire point of treatment with escitalopram and other antidepressants is, in fact, to change someone’s personality permanently. Whether medicinally altering someone’s personality constitutes an ethical “cure” for depression is another philosophical debate in and of itself.  The effectiveness of antidepressant treatment for producing positive personality changes a person is seeking has been found questionable according to a study published in the Expert Review of Neurotherapeutics Journal.32

Other research has concluded that the statistically small positive effects of antidepressant treatment are more likely attributable to the placebo effect, and not to the drug itself.33

How Can I Get Off Lexapro Naturally?

Unfortunately, it is dangerous to simply quit taking Lexapro, especially if you’re taking a high dose or have been on it for a long time. Quitting Lexapro and similar drugs should always involve working with a medical professional on a comprehensive plan to slowly reduce your dose over time. Some of the natural strategies former Lexapro patients have turned to for treating clinical depression range from correcting the diet, using probiotics and other means to support gut health, and counseling, to yoga and art therapy. Just like mental health struggles themselves, the best treatments can be a deeply personal matter that varies from patient to patient. CBT in particular has shown great efficacy in the resolution of insomnia, depression, and anxiety.2

Why Shouldn’t You Stop Taking Lexapro Suddenly?

While the long-term effects of taking Lexapro can be significant, some of the worst negative effects have actually been reported by patients who attempt to quit Lexapro “cold turkey” and suffer the harsh effects of escitalopram leaving their body too abruptly.

British psychologist, researcher, and author, Dr. Joanna Moncrieff once noted that the symptoms experienced when reducing the dosage are often quite similar to original symptoms, including depression, creating a sort of futile, debilitating spiral for clinically depressed patients who don’t respond well to SSRI treatment. She also notes that the drug trials themselves have been cherry-picked for favorable outcomes, and have largely omitted harmful effects, ignoring the worsened outcomes experienced by most long-term antidepressant treatments.38

This can be a brutal realization for someone who has struggled with serious depression and then comes to realize their Lexapro treatment isn’t working for them. There is hope. We, at Alternative to Meds Center, are here to help.

Does Lexapro Damage the Brain?

The most concerning aspect of extended treatment with Lexapro and other SSRIs is that it may actually worsen depression in the long run, defeating the purpose of treatment entirely. Viewing depression as a “brain disease” compounds the issue in many ways. There can be many reasons for dysregulated mood, which highlights the importance of finding the correct cause or causes (which according to a massive set of research studies published in 2022 by Moncrieff likely have nothing at all to do with a serotonin deficiency.) 8

If one were sprayed in the eye with vinegar, putting on sunglasses, or worse, taking a pill that disables the tear ducts, is not going to fix it.

Studies comparing the short and long-term use of SSRIs over time could not produce any evidence to support using SSRIs over an extended period. A massive review of clinical trials showed that long-term SSRI use actually produced harm to chronically depressed patients. Neuroadaptation of the CNS after drug treatment can affect not only the brain but the entire network of neurons that support human health. Increased incidence of dementia, a doubling of the risk of suicidality and violence in healthy adults, and much other evidence of damage documented in published medical literature around the world.4,34,35

Alternative Drug-free Treatments

Lexapro Alternatives

If you’re looking for a way out of an unsuccessful cycle of antidepressant-based treatment that never seems to truly overcome your depression symptoms, you aren’t alone. Many nonpharmacological treatments exist that have shown positive results for depression, insomnia, anxiety, and other troublesome symptoms. These can help avoid the long-term effects of Lexapro that block your journey to improved mental wellness.

Transitioning to drug-free treatment can be assisted with:
  • CBT and other forms of counseling.
  • An orthomolecular approach to healthy eating, testing for food allergies, and gut microbe health.
  • Herbal supplements like valerian, kava, and St. John’s Wort.
  • Omega-3 fatty acids (try fish, nuts, and seeds) and other amino acids important to mental health (leafy greens, raw fruits, quality animal proteins).
  • Vitamins including vitamin D (sunlight is a great source of vitamin D if you prefer to avoid lab-produced supplements) and all of the B vitamins, vitamin C, and many others support optimal mental and physical health.
  • 5-HTP (5-hydroxytryptophan) is a precursor for serotonin production and is present in poultry, leafy greens, and certain vegetables.
  • Meditation, yoga, mindfulness exercises.37
  • Acupuncture, massage, and learned relaxation therapies have been shown to improve mood and provide physical comfort.
  • Physical exercise.36
  • Neurotoxin removal
  • Neurotransmitter rehabilitation

Alternative to Meds Center — Treatment After Long-term Lexapro Use

Alternative to Meds Center can implement a plan uniquely designed for you, to gradually reduce your Lexapro regimen safely and effectively, while implementing holistic strategies to improve unwanted psychological symptoms. Medical, psychotherapeutic and holistic therapies provide you with the natural alternatives required to overcome a dependence on hazardous medications. There is much information we would like to provide you. Call us to find out how a program can help you to reverse and eliminate long-term Lexapro effects.

1 (800) 301-3753 for Lexapro Alternatives Help

Sources:

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6. Szegedi A, Kohnen R, Dienel A, Kieser M. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): Randomised controlled double-blind non-inferiority trial versus paroxetine. BMJ. 2005;330:503. [cited 2022 Sept 13]

7. Hypericum Depression Trial Study Group, Davidson JR, Gadde KM, Fairbank JA, Krishnan KRR, Califf RM, Binanay C, Parker CB, Pugh N, Hartwell TD, Vitiello B, Ritz L, Severe J, Cole JO, de Battista C, Doraiswamy PM, Feighner JP, Keck P, Kelsey J, Lin KM, Londborg PD, Nemeroff CB, Schatzberg AF, Sheehan DV, Srivastava RK, Taylor L, Trivedi MH, Weisler RH. Effect of Hypericum perforatum (St John’s wort) in major depressive disorder: a randomized controlled trial. JAMA. 2002 Apr 10;287(14):1807-14. doi: 10.1001/jama.287.14.1807. PMID: 11939866.

8. Joanna Moncrieff, Ruth E. Cooper, Tom Stockmann, Simone Amendola, Michael P. Hengartner, Mark A. Horowitz. The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry, 2022; DOI: [cited 2022 Sept 13]

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14. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361016/ [cited 2022 Sept 13]

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16. Hedin RJ, Umberham BA, Detweiler BN, Kollmorgen L, Vassar M. Publication Bias and Nonreporting Found in Majority of Systematic Reviews and Meta-analyses in Anesthesiology Journals. Anesth Analg. 2016 Oct;123(4):1018-25. doi: 10.1213/ANE.0000000000001452. PMID: 27537925. [cited 2022 Nov 12]

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18. Ceylan ME, Evrensel A, Önen Ünsalver B. Long-Term Use of Escitalopram and a High Level of Carcinoembryonic Antigen. Korean J Fam Med. 2016 Nov;37(6):359. doi: 10.4082/kjfm.2016.37.6.359. Epub 2016 Nov 18. PMID: 27900076; PMCID: PMC5122670. [cited 2022 Nov 12]

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20. Goodwin GM, Price J, De Bodinat C, Laredo J. Emotional blunting with antidepressant treatments: A survey among depressed patients. J Affect Disord. 2017 Oct 15;221:31-35. doi: 10.1016/j.jad.2017.05.048. Epub 2017 Jun 6. PMID: 28628765. [cited 2022 Nov 12]

21. Ma H, Cai M, Wang H. Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research. Front Psychiatry. 2021 Dec 14;12:792960. doi: 10.3389/fpsyt.2021.792960. PMID: 34970173; PMCID: PMC8712545. [cited 2022 Nov 12]

22. Opbroek A, Delgado PL, Laukes C, McGahuey C, Katsanis J, Moreno FA, Manber R. Emotional blunting associated with SSRI-induced sexual dysfunction. Do SSRIs inhibit emotional responses? Int J Neuropsychopharmacol. 2002 Jun;5(2):147-51. doi: 10.1017/S1461145702002870. PMID: 12135539. [cited 2022 Nov 12]

23. Fujii K, Suzuki T, Mimura M, Uchida H. Psychological dependence on antidepressants in patients with panic disorder: a cross-sectional study. Int Clin Psychopharmacol. 2017 Jan;32(1):36-40. doi: 10.1097/YIC.0000000000000143. PMID: 27496597. [cited 2022 Nov 12]

24. Juurlink DN, Mamdani MM, Kopp A, Redelmeier DA. The risk of suicide with selective serotonin reuptake inhibitors in the elderly. Am J Psychiatry. 2006 May;163(5):813-21. doi: 10.1176/ajp.2006.163.5.813. PMID: 16648321. [cited 2022 Nov 12]

25. Mann, J., Emslie, G., Baldessarini, R. et al. ACNP Task Force Report on SSRIs and Suicidal Behavior in Youth. Neuropsychopharmacol 31, 473–492 (2006). https://doi.org/10.1038/sj.npp.1300958 [cited 2022 Nov 13]

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27. Herr N, Bode C, Duerschmied D. The Effects of Serotonin in Immune Cells. Front Cardiovasc Med. 2017 Jul 20;4:48. doi: 10.3389/fcvm.2017.00048. PMID: 28775986; PMCID: PMC5517399. [cited 2022 Nov 13]

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30. Wabont G, Ferret L, Houdre N, Lepied A, Bene J, Cousein E. Escitalopram-induced hepatitis: A case report. World J Clin Cases. 2022 Mar 16;10(8):2468-2473. doi: 10.12998/wjcc.v10.i8.2468. PMID: 35434055; PMCID: PMC8968601. [cited 2022 Nov 13]

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33 Kirsch I. Antidepressants and the Placebo Effect. Z Psychol. 2014;222(3):128-134. doi: 10.1027/2151-2604/a000176. PMID: 25279271; PMCID: PMC4172306. [cited 2022 Nov 13]

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36. Schuch FB, Vancampfort D. Physical activity, exercise, and mental disorders: it is time to move on. Trends Psychiatry Psychother. 2021 Jul-Sep;43(3):177-184. doi: 10.47626/2237-6089-2021-0237. Epub 2021 Apr 21. PMID: 33890431; PMCID: PMC8638711. [cited 2022 Nov 13]

37. Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev. 2011 Aug;31(6):1041-56. doi: 10.1016/j.cpr.2011.04.006. Epub 2011 May 13. PMID: 21802619; PMCID: PMC3679190. [cited 2022 Nov 13]

38. Moncrieff J, Kirsch I. Efficacy of antidepressants in adults. BMJ. 2005 Jul 16;331(7509):155-7. doi: 10.1136/bmj.331.7509.155. PMID: 16020858; PMCID: PMC558707. [cited 2022 Nov 13]

Originally Published July 7, 2022 by Diane Ridaeus


This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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