ESCITALOPRAM: CHARACTERISTICS, SIDE EFFECTS, FUNCTIONS - NEUROPSYCHOLOGY - 2025

The escitalopram is an antidepressant drug that is part of drugs known as selective inhibitors of serotonin reuptake. It is a variation of a drug in the same category known as citalopram. In fact, it has the left-handed form of this drug and is made up of a mixture of the right and left isomers of the same molecule.

Escitalopram is a psychotropic drug that is mainly used to treat depressive conditions and mood disorders. Likewise, it is also used in certain anxiety disorders such as panic disorder, anxiety attacks or social phobia.

Escitalopram chemical structure

Escitalopram is a drug that was developed by the Lundbeck and Forest laboratories in 1997. It is a psychotropic drug that achieved its development and approval by the United States FDA in March 2001.

The preparation period of this medicine was short, mainly due to the previous preparation of citalopram, another antidepressant drug from which escitalopram was derived.

Since its approval, escitalopram has become one of the most widely used antidepressant drugs in multiple countries. This drug usually generates mild side effects and is a good therapeutic option to intervene in different depressive conditions.

Today, escitalopram is marketed under a number of different names. Ezentius, Ipran or Neuroipran is the nomenclature that the drug receives in different countries in South America.

In Spain, the commercial name of escitalopram is Cipralex, when it is marketed by Lundbeck laboratories, and Heipram when it is marketed by Alter laboratories.

Despite these two brand names, escitalopram can also be marketed generically under the name Escitalopram itself.

What is escitalopram for?

Escitalopram is an antidepressant psychotropic drug. This means that its administration serves to treat the symptoms and manifestations related to depression.

Escitalopram intake produces a notable increase in mood, which is why it is a good therapeutic option to intervene in depressive conditions in which the mood is excessively low.

Specifically, escitalopram is included in the category of selective serotonin reuptake inhibitor (SSRI) antidepressant medications. In this way, it has many similarities with other highly known antidepressants such as fluoxetine or paroxetine.

Selective serotonin reuptake inhibitors are a class of compounds typically used as antidepressants in the treatment of depressive disorders, anxiety disorders, and some personality disorders.

Research shows that the effectiveness of these types of drugs (which includes escitalopram) lies in the increase they produce on the extracellular levels of the neurotransmitter serotonin.

Modes of action

As the name of the pharmacological category of escitalopram indicates, this drug acts at the brain level by inhibiting the reuptake of serotonin.

This means that when escitalopram is ingested, it travels through the blood to cross the blood-brain barrier and reach the brain regions. When it reaches the brain, it acts specifically on the neurotransmitter serotonin, inhibiting its reuptake.

Serotonin is a neurotransmitter in the brain that performs important activities related to mood. Likewise, it plays an important role in the regulation of sleep, sexual response, and neuroendocrine functions.

Serotonin

With regard to the mood, serotonin would be the brain substance that would be responsible for increasing it. When people experience feelings of pleasure or well-being, serotonin levels increase.

From these discoveries came the hypothesis that mood could be markedly regulated by serotonin. The greater the amounts of this neurotransmitter in the brain, the higher the mood and vice versa.

On the other hand, different investigations showed that certain subjects with depression were characterized by presenting a lower amount of serotonin in the intracellular space. Thus arose the development of selective serotonin reuptake inhibitors and escitalopram.

Serotonin neuron releasing its neurotransmitters that reach the postsynaptic dendrite

These drugs inhibit the reuptake of serotonin so that it does not travel to the presynaptic cell. This fact allows to increase the amount of serotonin in the intersynaptic space and thus, increase the mood of the person.

Indications

Escitalopram is a medicine that can only be obtained and consumed with a prescription. For this reason, it should be a medical professional who identifies the need and convenience of taking this psychoactive drug.

Mood disturbances

The use of escitalopram is recommended to treat depressive conditions. Specifically, it is a widely used drug in cases of major depression.

However, it can also be used in other mood disorders such as dysthymic disorders or some adjustment or personality disorders that present with depressive symptoms.

The suitability of this drug must be analyzed by a medical professional based on the individual characteristics that arise in each case.

Anxiety

On the other hand, although it is not the first choice treatment, escitalopram may also be useful in the treatment of some anxiety disorders.

Its use has been approved and used to intervene disorders such as anxiety disorder with or without agoraphobia, social anxiety disorder, generalized anxiety disorder and obsessive-compulsive disorder.

To consider

Regardless of the clinical diagnosis for which escitalopram is used, it is important to bear in mind that this medicine tends to cause slow and progressive effects.

The consumer should be aware that it may take a week or two for them to start feeling better. However, it is important that if treatment has been started, its administration is continued (unless side effects are noted) until the appearance of clinical improvements.

Contraindications

The use of escitalopram is not recommended in people with certain conditions or specific pathologies. These elements must be evaluated by the medical professional before their prescription. Likewise, the user of the drug must take them into account before starting treatment.

In general, the use of escitalopram is not recommended in:

1. People who are allergic, hypersensitive to escitalopram or to any of the components of the drug: microcrystalline cellulose, croscarmellose sodium, hypromellose, talc, anhydrous colloidal silica, magnesium stearate, titanium dioxide and macrogol.
2. People taking other medicines that belong to the group of MAO inhibitors such as selegiline, moclobemide, and linezolid.
3. People who have suffered from episodes of heart rhythm abnormalities or have heart abnormalities from birth.

Warnings and precautions

Beyond the cases in which the use of escitalopram is totally discouraged, this medicine has a series of precautions. The subject who is going to take this medicine should inform their doctor if they have any of the following conditions.

• If you have epilepsy: Escitalopram treatment should be stopped if you have seizures for the first time or if their frequency increases with the administration of the drug.
• If you have liver or kidney failure: on these occasions it may be necessary to adjust the dose to avoid kidney damage.
• If you have diabetes: the consumption of escitalopram can alter glycemic control. In these cases, it may be necessary to adjust the dose of insulin and / or oral hypoglycemic.
• If there is a decreased level of sodium in the blood.
• If there is a tendency to develop bleeding or bruising.
• If you are receiving electroconvulsive treatment.
• If you have a coronary disease.
• If you have a low heart rate at rest.
• If you have low levels of salt in the blood as a result of diarrhea or severe and prolonged vomiting.
• If diuretics are used.
• If you have a fast or irregular heartbeat.
• If you suffer from fainting, collapses or dizziness when getting up frequently.
• If you have eye problems such as glaucoma.

Side effects

Taking escitalopram can cause certain adverse effects. These do not usually appear in all cases but it is important to know them.

The side effects of escitalopram are usually mild and usually disappear after a few weeks of treatment. However, in some situations it is important to see a doctor immediately and review escitalopram treatment. The most important side effects of escitalopram are:

Infrequent

Escitalopram can cause unusual bleeding, including gastrointestinal bleeding. These effects are connoted in approximately 1% of cases, but when they occur it is important to review the treatment.

Rare

Less frequently than bleeding, the consumption of escitalopram can cause other adverse effects. These symptoms occur in approximately 0.1% of cases. The most important are:

• Swelling of the skin, tongue, lips or face, causing in some cases breathing or swallowing difficulties (allergic reaction).
• High fever, agitation, confusion, tremors, and sudden muscle contractions. These effects can be part of serotonin syndrome.

Unknown

With an unknown prevalence due to lack of data, escitalopram may cause some of the following side effects.

• Difficulty urinating.
• Irregularities in heartbeat or fainting. These effects could be part of a life-threatening condition known as torsades de pointes.
• Yellow skin and whitening in the eyes due to impaired liver function.
• Suicidal or self-harming thoughts.

Recommended dosage

Both the duration and the consumed doses of escitalopram should be chosen and prescribed by a medical professional. This drug does not act identically in each person, so its administration may vary in each case.

However, for information purposes, the drug presents a series of indications regarding its dosage. In this sense, the use of escitalopram is indicated for a period of not less than six months.

The therapeutic effects of the drug may take time to appear, and during the first days the user may not notice any improvement. Despite them, it is advisable to continue with the treatment since the effects appear in the long term.

On the other hand, although it is the medical professional who must indicate the administration instructions for escitalopram, the drug presents the following indications for each diagnostic picture.

Depression

The recommended dose of escitalopram for the treatment of depression is 10 milligrams taken as a single daily dose. If required, the dosage can be increased to a maximum of 20 milligrams per day.

Panic disorder

A lower dose of escitalopram is usually used for the treatment of panic disorder. In general, the administration of five milligrams a day as a single dose is recommended for the first week.

Subsequently, the dose can be increased up to ten milligrams a day. As in the case of depression, the administration of more than twenty milligrams per day of escitalopram is not recommended.

Social anxiety disorder

The indicated dose for social anxiety disorder is ten milligrams a day taken as a single dose. If the doctor deems it appropriate, the dosage can be reduced to five milligrams a day or increased to a maximum of twenty.

Generalized anxiety disorder

The daily dose of escitalopram for the treatment of generalized anxiety disorder is also ten milligrams, and the administration of more than twenty milligrams a day is not recommended.

Obsessive compulsive disorder

The indicated dose of escitalopram for obsessive compulsive disorder is five milligrams a day, which can be increased to ten.

Elderly (over 65 years)

The starting dose of escitalopram for people over 65 is five milligrams a day, which can be increased to a maximum of ten.

Children and adolescents

Escitalopram is not recommended for children and adolescents under 18 years of age.

References

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