Escitalopram

Escitalopram ( /ˌɛsəˈtæləˌpræm/ ^ⓘ eh-sə-TA-lə-pram), sold under the brand names Lexapro and Cipralex, among others, is an antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class. It is mainly used to treat major depressive disorder, generalized anxiety disorder, panic disorder, obsessive–compulsive disorder (OCD), and social anxiety disorder. Escitalopram is taken by mouth. For commercial use, it is formulated as an oxalate salt exclusively.

Common side effects include headache, nausea, sexual problems, mild sedation, and trouble sleeping. More serious side effects may include suicidal thoughts in people up to the age of 24 years. It is unclear if use during pregnancy or breastfeeding is safe. Escitalopram is the (S)-enantiomer of citalopram (which exists as a racemate), hence the name es-citalopram.

Escitalopram was approved for medical use in the United States in 2002. Escitalopram is rarely replaced by twice the dose of citalopram; escitalopram is safer and more effective. It is on the World Health Organization's List of Essential Medicines. In 2023, it was the second most prescribed antidepressant and fourteenth most commonly prescribed medication in the United States, with more than 37 million prescriptions. In Australia, it was one of the top 10 most prescribed medications between 2017 and 2023.

Other first-line SSRIs that have similar results include sertraline, paroxetine, and fluoxetine, among others.

Escitalopram is approved by the US Food and Drug Administration (FDA) for the treatment of major depressive disorder in adolescents and adults, and generalized anxiety disorder (GAD) in adults, in dosage from 5 to 20 mg. In European countries including the United Kingdom, it is approved for depression and anxiety disorders; these include: generalized anxiety disorder, social anxiety disorder (SAD), obsessive–compulsive disorder (OCD), and panic disorder with or without agoraphobia. In Australia it is approved for major depressive disorder.

Escitalopram is among the most effective and well-tolerated antidepressants for the short-term treatment of major depressive disorder in adults. It also seems to be the safest one to give to children and adolescents.

Controversy existed regarding the effectiveness of escitalopram compared with its predecessor, citalopram. The importance of this issue followed from the greater cost of escitalopram relative to the generic mixture of isomers of citalopram, prior to the expiration of the escitalopram patent in 2012, which led to charges of evergreening. Accordingly, this issue has been examined in at least 10 different systematic reviews and meta analyses. As of 2012^[update], reviews had concluded (with caveats in some cases) that escitalopram is modestly superior to citalopram in efficacy and tolerability.

Escitalopram appears to be effective in treating generalized anxiety disorder, with relapse on escitalopram at 20% rather than placebo at 50%, which translates to a number needed to treat of 3.33. Escitalopram appears effective in treating social anxiety disorder as well.