Makindo Medical Notes

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) widely used in depression and anxiety disorders. Always check the BNF link here for full prescribing advice.

⚡ Mode of Action

• Inhibits the serotonin transporter (SERT) → ↑ serotonin in the synaptic cleft.
• Has high selectivity for serotonin reuptake compared to other SSRIs → lower risk of some side effects.
• Clinical effect takes 2–4 weeks to emerge due to downstream receptor adaptation.

💊 Indications & Dose

• Major depressive disorder: 10–20 mg once daily.
• Generalised anxiety disorder: 10–20 mg once daily.
• Obsessive-compulsive disorder (OCD): 10–20 mg once daily.
• Elderly (>65 years): start at 5 mg once daily due to increased sensitivity to QTc prolongation.

🤝 Interactions

• Other serotonergic drugs (MAOIs, triptans, tramadol) → risk of serotonin syndrome.
• QT-prolonging drugs (e.g. antipsychotics, macrolides, antiarrhythmics) → ↑ arrhythmia risk.
• See BNF for full list.

⚠️ Cautions

• Ischaemic heart disease (IHD) or arrhythmias → risk of QT prolongation.
• Hyponatraemia risk (esp. elderly, diuretics, low body weight).
• Epilepsy (lowers seizure threshold).
• History of mania/hypomania (risk of switching).

🚫 Contraindications

• Known allergy to escitalopram.
• Concurrent or recent (within 14 days) use of MAOIs → serotonin syndrome risk.
• Congenital or acquired long QT syndrome.

💥 Side Effects

• Common: GI upset (nausea, diarrhoea), headache, insomnia, sexual dysfunction, sweating, anxiety/agitation initially.
• Electrolyte: Hyponatraemia (SIADH).
• Cardiac: QT prolongation, arrhythmias.
• Haematological: Bruising, purpura (platelet dysfunction).
• Withdrawal/discontinuation symptoms: Dizziness, irritability, “electric shock” sensations if stopped abruptly.

🩺 Clinical Pearls

• Start low and review after 2–4 weeks; may increase to 20 mg if tolerated.
• Counsel patient: effects build gradually, not immediate.
• Monitor mood and suicidality closely in first weeks, esp. in young adults.
• Check ECG if cardiac risk factors, and monitor sodium in elderly.
• Withdrawal should be gradual taper over weeks to months.

📚 References

• BNF – Escitalopram
• NICE Depression & Anxiety Guidance

📝 Revisions

• Last updated: 05/09/2025