Escitalopram is an antidepressant that belongs to the class of drugs known as serotonin-reuptake inhibitors (SSRIs). It is the S-stereoisomer of another common antidepressant, citalopram, which is a bicyclic phthalane derivative.1 Like citalopram and other SSRIs, escitalopram works by blocking the reuptake of the neurotransmitter serotonin into the presynaptic neuron. However, compared to all other SSRIs, escitalopram is the most selective for the serotonin transporter protein rather than the norepinephrine transporter protein, so the drug has fewer side effects.2 Also, escitalopram has a low affinity allosteric binding site on the serotonin transporter, which stabilizes the binding to its main high-affinity site, thereby increasing the duration of its effectiveness. Escitalopram is used to treat depression and anxiety disorders.3
Common side effects of escitalopram include:8
Patients who experience signs of an allergic reaction should contact a physician immediately. These signs include:
Patients should also contact a doctor if they experience serious side effects, such as:
Patients who experience new or worsening symptoms of anxiety or depression, or who have suicidal thoughts or ideation, should seek medical help as soon as possible.
Escitalopram should not be taken alongside a monoamine oxidase inhibitor (MAOI) such as furazolidone, isocarboxazid, phenelzine, rasagiline, selegiline, or tranylcypromine. It should also not be taken with other SSRIs.
Other medicines that may interact with escitalopram include:
Escitalopram may cause drowsiness, and other drugs that cause drowsiness can add to this effect. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) alongside escitalopram may cause patients to bruise or bleed more easily. Drinking alcohol may increase the side effects of escitalopram. Patients should also avoid taking tryptophan supplements.9
The development of escitalopram began in 1997. It received FDA approval for treating depression in August 2002 and generalized anxiety disorder in December 2003. The development process was unusually fast because developers had already studied the pharmacological effects of citalopram, of which escitalopram is a stereoisomer.10 Because of its chemical similarity to citalopram, some have accused the developers of “evergreening”—that is, trying to extend the patent on the original drug by filing for a patent on a “new” version that is essentially the same.11 However, this claim remains controversial because studies have indicated that escitalopram is indeed more effective for treating depression than citalopram, likely because of its higher selectivity for the serotonin transporter protein and its allosteric binding site.12
Recent studies have sought to determine whether escitalopram is effective for treating specific anxiety disorders. For instance, one showed that escitalopram relieved symptoms and reduced the risk of relapse in patients with body dysmorphic disorder.13 A study designed to assess the potential of escitalopram for treating alcoholism showed that when mouse models were fed a combination of escitalopram and acamprosate, they consumed less alcohol.14 Another clinical study has shown that escitalopram can decrease the severity of binge-eating disorder and help patients lose weight, but it does not reduce the obsessive-compulsive symptoms of the disease.15 The drug may also reduce stress-related heart problems in patients with stable coronary heart disease.16
There is also ongoing research to assess the safety of escitalopram use. In particular, studies have focused on the dangers of stopping use too abruptly, which can result in Antidepressant Discontinuation Syndrome.17 Many studies have also sought to assess the benefits and risks of using escitalopram while pregnant or breastfeeding, but results are mixed so no definitive conclusions can yet be drawn.
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