We look at the different facets of this common antidepressant.
Antidepressants are currently a fundamental part of the treatment of different mental illnesses and disorders.
Despite this, the operation and efficacy of these is not as clear, as in the case of SSRIs ( selective serotonin reuptake inhibitors ), which are under constant scientific scrutiny.
Escitalopram falls under the group of SSRIs, like fluoxetine and citalopram . It is from the SSRI that escitalopram was synthesized, which is nothing more than an enantiomer of citalopram, with different therapeutic effects.
What is escitalopram? And what are SSRIs?
SSRIs are medicines whose mechanism of action is still not entirely clear , but it is currently believed that they work by preventing the reuptake of serotonin , a neurotransmitter that influences sleep and emotional state, by the neurons themselves.
By preventing the reuptake of serotonin by neurons, drugs such as escitalopram would increase the availability of this neurotransmitter, improving communication between neurons.
We cannot attribute to serotonin the role of the main cause of depression, but the latest research indicates that higher levels of serotonin in the brain improve the mental and emotional conditions of people.
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Applications
Escitalopram, like the rest of the SSRIs, has fewer side effects than most antidepressants , so it is often used as the first option to treat cases of:
- Depression
- Generalized anxiety disorder
- Obsessive Compulsive Disorder
- Panic attacks
- Posttraumatic stress
- severe phobias
This type of medicine is usually used in conjunction with spoken therapies, such as cognitive-behavioral type, to improve the condition of the affected in a synergistic way, that is, the effects of the medication facilitate or improve the effects of the therapy and vice versa.
SSRIs such as escitalopram are usually taken orally, in single daily doses in the morning or afternoon, regardless of meals. The effects of this type of medication take between 2 and 4 weeks to appear , and it may take up to a month and a half to improve symptoms.
In the case of not observing an improvement in symptoms after the first 6 weeks of continuous use, our doctor should assess whether this medication is appropriate in dose or type for our case.
Side effects
Despite having fewer side effects than other antidepressants, such as MAOIs (Amino Oxidase Inhibitors), which, being one of the first types of antidepressants developed, have more unwanted effects, escitalopram is not exempt from presenting a certain risk for the patient.
Ironically, the use of antidepressants can in some cases trigger a decline in our mental and emotional condition, worsening our initial pathology. This occurs especially in the period of adaptation to the medication, in the first weeks. For this reason, someone who is taking escitalopram for the first time should maintain communication with their attending physician to avoid the appearance of serious symptoms, such as an increased rate of suicidal ideation.
If at the beginning of our treatment we see that our anxiety, irritability, impulsiveness, aggressiveness increase, if our quality of sleep worsens or we notice a worsening of our condition, it can lead to a greater risk of suicide and we should notify our doctor as soon as possible.
In addition, this type of medication can cause physical symptoms such as:
- Diarrhea
- Confusion
- ejaculation problems
- Insomnia
- Nausea
- Headaches
- Anorgasmia
- Fatigue
- Constipation
- abnormal bleeding
Given the risk assumed by the patient when starting antidepressant treatment, these should only be prescribed when the doctor assumes that the risks of the medication are less than the risks posed by the disease itself.
Withdrawal syndrome, a possible unwanted effect
It is vitally important not to stop taking escitalopram suddenly, as this seriously endangers our health . If it is decided to stop taking the medicine, a medical plan is necessary to slowly taper the dose. Otherwise, we expose ourselves to withdrawal syndrome, a condition that can last for months after discontinuing treatment with SSRIs such as escitalopram.
- SSRI withdrawal symptoms include:
- Decay
- Agitation
- Confusion
- Paresthesia
- Anxiety
- Headaches
- Emotional lability
- tinnitus
These are usually isolated symptoms, but their recurrence and variations in intensity mean that more than half of those affected describe them as unbearable.
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Contraindications
In general, antidepressants are not indicated for minors , since the risks increase at an early age while individuals are developing, but Escitalopram has less risk than other antidepressants, so it can be used in adolescents from 12 years.
It would also not be indicated for pregnant or lactating people, since there is evidence both of harmful effects in babies exposed to escitalopram during pregnancy (due to excess serotonin) as well as traces of antidepressant in breast milk, which may cause effects in the baby. However, as these are small amounts of medication, no problems have yet been found from exposure to escitalopram through breast milk.
If we take more medication, especially some other type of antidepressant, we should notify the doctor to prescribe escitalopram to avoid problems such as excess serotonin or harmful interactions between the different medications.
Despite all its possible side effects, escitalopram remains one of the safest antidepressants today. As we learn more about the mechanisms of depression and the brain, we will have access to more effective and safer medicines.
For now, escitalopram and SSRIs help millions of people around the world with different psychiatric disorders, being a great help for both doctors and their patients, so despite the fear that taking a medication with possible serious side effects may cause , we must trust doctors and prevent our perception of the danger they carry from coming between us and proper mental health.
Bibliographic references
- Burke WJ, Gergel I, Bose A. (2002). Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. J Clin Psychiatry.
- Lazowick AL, Levin GM. (nineteen ninety five). Potential withdrawal syndrome associated with SSRI discontinuation. Ann Pharmacother.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.