Lexapro Libido

Lexapro Libido

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Escitalopram oxalate , often marketed as Lexapro , is the quintessential Selective Serotonin Reuptake Inhibitor (SSRI) used primarily for the management of symptoms associated with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). Lexapro drug class through its actions increases serotonergic transmission in the central nervous system, which alleviates the symptoms and signs of Major Depression and Generalized Anxiety. Unfortunately, Serotonin doesn’t only act on receptors that regulate functions related to depression and anxiety. It also interacts with receptors that regulate appetite, sexual function, and sleep . Therefore, the increased serotonergic activity affects the regulation of all of the aforementioned physiologic processes within our bodies and produces the associated side effects of escitalopram use. This article will delve into the common Lexapro Side Effects, as well as several warnings and precautions patients should be aware of when taking Escitalopram.
If experienced, Lexapro side effects in the first week tend to be the worst as the body has not had the time to undergo physiological adaptation to the newly elevated levels of Serotonin.
Escitalopram is derived from a slightly older SSRI, Citalopram. The differentiating factor between these two drugs is their composition. Escitalopram contains the most functional and most serotonin-selective enantiomer. Why is this important? This means that the Escitalopram side effects are not related to actions of the drug itself as it only affects Serotonin, but rather to the elevated levels of Serotonin brought about by its therapeutic effect. Thus making most of the Escitalopram side effects dose-dependent. Furthermore, if experienced, Lexapro side effects in the first week tend to be the worst as the body has not had the time to undergo physiological adaptation to the newly elevated levels of Serotonin. However, as the body adjusts, many of the most common Lexapro side effects will abate or at the least become significantly more tolerable.
The Most Common (>2%) Escitalopram Side Effects Include:
As per the prescribing information for Lexapro provided by the Food and Drug Association (FDA), there are various other Lexapro side effects as reported by patients in premarketing and marketing time periods. However, as these adverse reactions occur with very low frequencies (<1%) and are self-reported, the reliable estimation of their frequency and establishment of a causal connection cannot be done.
Life-threatening emergent Lexapro side effects are fortunately rare. The symptoms and signs of these adverse reactions are associated with various conditions and syndromes that can arise as a result of Lexapro therapy and are discussed in the section below on Escitalopram Warnings and Precautions.
If the Following Symptoms Are Experienced, The Patients Should Immediately Contact Their Physician or Emergency Medical Services:
Additional life-threatening side effects of Escitalopram can arise when Lexapro use is suddenly stopped or too much is taken. These two conditions will result in the development of Escitalopram Withdrawal Syndrome and Overdose of Escitalopram . Patients should always remember to take Escitalopram exactly as directed and not to make alterations to their dosage without first consulting their physicians.
As previously mentioned, Serotonin does not only regulate physiological processes related to depression and anxiety. It also regulates physiological processes related to appetite and satiety (a state of being “full” after eating). This Serotonergic regulation, in short, suppresses appetite and curbs hunger. According to the Monoamine Hypothesis in Major Depressive Disorder(MDD), there is a deficiency in the levels of Serotonin, which disrupts the regulation of appetite and hunger. This could explain why certain subsets of Major Depression are associated with increased appetite, hyperphagia, and weight gain. Therefore, it is understandable that Escitalopram therapy, which restores and even elevates the levels of Serotonin within our bodies, would lead to suppressed appetite and decreased hunger leading to weight loss . As such, Lexapro weight loss has been reported during the initial therapy in subsets of patients. Unfortunately, this is only temporary and most patients regain the lost weight within 6 months.
As we have established, Serotonin has definite effects on appetite and hunger regulation. In contrast to the weight loss seen with initial therapy, long-term use of SSRIs has been associated with additional weight gain. The United States National Library of Medicine recognizes increased appetite as one of Escitalopram’s adverse reactions, which could explain the associated Lexapro Weight Gain . However, as Serotonin is a natural suppressor of appetite and hunger, this increase in appetite must be brought on by a different mechanism . Furthermore, peripheral rather than central effects of elevated serotonin levels in the body could better explain why certain patients experience weight gain with continued SSRI therapy.
Appetite Increase: this is thought to be related more to the patient feeling better with alleviation of depressive symptoms rather than a direct effect of the medication or its therapeutic effect, due to Lexapro mechanism of action .
Peripheral effects of Serotonin on the gastrointestinal tract could explain why patients could experience some weight gain. Although the mechanism of these effects is complicated below are listed some of the effects serotonin has on various gastrointestinal organs that could lead to weight gain:
Collectively, Serotonin promotes lipid synthesis and fatty tissue deposition which could account for the Lexapro weight gain seen in some patients with prolonged use.
Previously, the topic of Lexapro Withdrawal Syndrome was mentioned. This syndrome occurs in those patients who have been taking Escitalopram, or other SSRIs, for a prolonged period of time, and in whom physiologic adaptations have occurred. As a result, sudden cessation of Escitalopram would cause a transient deficiency of serotonin and its activity resulting in the characteristic signs and symptoms of Escitalopram Withdrawal . Patients wishing to discontinue Escitalopram because of its adverse reactions should remember to never discontinue use on their own and should consult their physician for information on how to best discontinue Lexapro use.
It is worth noting that experiencing adverse reactions associated with SSRI use is quite variable and not all patients will experience weight changes during therapy. However, if patients do experience weight changes that are distressing to them, the following recommendations can be taken to cope with them:
Due to Lexapro Withdrawal, patients wishing to discontinue Escitalopram because of its adverse reactions should remember to never discontinue use on their own and should consult their physician for information on how to best discontinue Lexapro use.
Sexual Dysfunction is one of the most common, yet under-discussed and reported side effects of Selective Serotonin Reuptake Inhibitors (SSRIs) such as Lexapro. The cause of the sexual dysfunction associated with Selective Serotonin Reuptake Inhibitor use is unknown. However, the effects of elevated levels of Serotonin on other hormones (testosterone), peptides (Nitric Oxide), and Neurotransmitters (Dopamine) are thought to play a role as these molecules play an important role in sexual desire, arousal, and orgasm.
As high as 40-65% of patients taking SSRIs report experiencing sexual dysfunction as a side effect within days to weeks from starting therapy.
The Various Reported Adverse Reactions Include:
Whatsmore, the kind and severity of sexual dysfunction are purported to vary by gender. Meaning that sexual Lexapro side effects in men differ from the sexual Lexapro side effects in women.
Women with Major Depression are more likely to have a greater reduction of sexual desire and difficulties with orgasm than men . Women tend to experience a variable degree of remission of these effects with continued therapy with SSRIs. By comparison, men are more likely to experience anorgasmia, delayed ejaculation, and erectile dysfunction. Also, these effects in men are less likely to remit with continued therapy with SSRIs.
The acknowledgment of Escitalopram-induced sexual dysfunctions is important, as 41.7% of men and 15.4% of women have been purported to stop taking psychiatric medications as a result of sexual side effects . This is especially alarming as the sexual dysfunction may itself act as an instigator of Major Depression and act as an impediment to long-term therapy adherence, which is ever so important for SSRIs.
Effective management should begin with an assessment to ascertain whether the sexual dysfunction reported is caused by the antidepressant treatment itself or rather attributed to Major Depression, as it too can have similar effects. Thus, establishing a baseline level of sexual functioning prior to the initiation of SSRIs is optimal. Once this is established, the next big challenge is to manage the dysfunction without causing undesirable mental consequences on the patient.
There Are five general approaches to Managing the Sexual Dysfunction Associated With Escitalopram Use:
Beyond the aforementioned five strategies, patient education about the sexual adverse reactions of antidepressants like SSRIs remains one of the most important strategies to successful treatment and long-term adherence.
Regardless of the side effects and no matter its severity, it is of paramount importance for patients to remember to never stop taking or alter the dose of Escitalopram on their own.
Escitalopram oxalate is listed as a Pregnancy Category C which means that “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans to provide conclusive information, but potential benefits may warrant use of the drug in pregnant women despite potential risks.” Regardless, it is generally viewed that there is no need to discontinue antidepressants , including Escitalopram, during pregnancy as they are not teratogenic (causing birth defects).
Furthermore, very rare reports of non-teratogenic symptoms of SSRI use in pregnancy have been reported following delivery. However, it is unknown whether these symptoms are caused by the toxic effects of SSRIs on the newborn’s health or are related to SSRI withdrawal syndrome.
As with most medications, a small percentage of Escitalopram is secreted in breast milk. Regardless, no information regarding contraindication between Escitalopram use and breastfeeding is currently provided by the United States Food and Drug Administration. However, caution should still be utilized and breastfed infants whose mothers are taking Lexapro should be monitored as a precaution for increased somnolence, decreased feeding, and weight loss.
Patients taking antidepressants, including Escitalopram, may experience worsening of the clinical signs and symptoms of Major Depression, causing the development of suicidality during the early phases of treatment. Lexapro can also trigger rapid cycling of manic/depressive episodes, the development of serotonin syndrome, hyponatremia, and other complications that can be dangerous .
Worsening of the symptoms of Major Depression and suicidal thoughts in patients who use Lexapro seem to be more prominent in adolescents (<18) and young adults (18-24), whereas in the elderly populations (>65) they seem to be less prominent. Family members and caregivers of patients receiving SSRIs should be given adequate information regarding this phenomenon and should be instructed to monitor their loved ones for new and sudden changes in mood, behavior, actions, thoughts, or feeling, especially when Lexapro is just started or dose is altered.
Furthermore, They Should Be Instructed to Contact Emergency Medical Services if the Following Symptoms and Signs Develop:
SSRIs, like Escitalopram, if incorrectly used to treat the depressive phase of Bipolar disorder, have the propensity to trigger rapid cycling of manic/depressive episodes which can be detrimental to the patient’s health. Therefore, before starting treatment, all patients with episodes of major depression should be screened for Bipolar disorder.
Serotonin Syndrome refers to a life-threatening syndrome of excessive serotonergic signaling that can result if Escitalopram is used concomitantly with other serotonergic medications such as Selective Serotonin Norepinephrine Reuptake Inhibitors (SSNRIs), Monoamine Oxidase Inhibitors (MAOIs), Cyclobenzaprine, Tramadol, Vilazodone, Trazodone, Buspirone, Vortioxetine, Ondansetron, MDMA, Dextromethorphan, Meperidine, Triptans, or Linezolid. Patients and their families should receive information about this syndrome, and be told that if any of the following symptoms are experienced they should immediately discontinue their medications and contact emergency medical services:
Hyponatremia, or low sodium levels, are commonly seen in elderly patients using Lexapro. The low sodium levels seem to be related to an inappropriate release of a hormone called Vasopressin/Antidiuretic Hormone in response to Escitalopram therapy, which causes increased resorption of sodium from urine by the kidneys.
All SSRI antidepressants, which include escitalopram, can increase the risk of both internal and external bleeding. As such, any abdominal pain and nausea should be taken seriously. Furthermore, patients should be counseled not to use Escitalopram concomitantly with Aspirin, NSAIDs, or other medication (warfarin) with effects on coagulation.
Severe, life-threatening allergic reactions may occur in a subset of patients. These reactions often occur shortly after taking the drug for the first time, but in some cases, it may be delayed.
Signs of Symptoms of an Allergic Reaction to Escitalopram Include:
If any of these symptoms present in a patient, they should seek immediate emergency medical attention.
Lexapro side effects are idiosyncratic and their emergence in every patient is variable. This is because there are many factors at play that impact the emergence of side effects.
Factors That Can Impact Side Effect Emergence Include:
The majority of these variables are “unmodifiable”, meaning that they cannot be altered by the patient or their physician, and thus the ability to limit Escitalopram side effects is limited.
However, there are still some steps that can be taken that can make the side effects more tolerable or eliminate them in certain situations.
There Are Only a Few Side Effects That Can Be Reduced and Mitigated:
Regardless of the side effects and no matter its severity, it is of paramount importance for patients to remember to never stop taking or alter the dose of Escitalopram on their own. If the patients desire to discontinue Escitalopram due to experiencing intolerable side effects, they should consult their physician.
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After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.
8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care. He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.
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Im not sure how but my libido actually increased significantly since im on it, it's not really an issue but just seems weird? I've read that SSRI's for a lot of people kill the sex drive so i just thought this might be interesting. Did this happen to anyone else?
It generally has a negitive effect on sex drive. But as I felt less depressed, I felt like my drive increased.
I'm at the end of my 2nd month and I've read that it's the opposite that is a side effect. What I've noticed personally is that I have a slightly lowered libido, i just cant climax with someone else. I have days when i'm actually quite randy, but i still cant climax unless i'm alone. that is completely uncharacteristic for me as i'm usually a sure thing.
Yeah that's what i meant usually it kills peoples sex drive but mine is trough the roof haha.
How long have you been on it? I remember in the beginning when the lexapro caused side effects and an increase in anxiety for me, my libido was through the roof...but then again, whenever I had extreme anxiety this happened. I've known a ton of people who briefly got more depressed and it triggered their libido to shoot up in order to try to help them feel better. Then it went through the period of time where I felt nothing emotionally and libido wise, then final
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