Quick Answer: Escitalopram (brand name Lexapro) is an SSRI antidepressant approved in the U.S. for major depressive disorder (adults and children 12 and older) and generalized anxiety disorder (adults and children 7 and older). For every one of those groups, the FDA label lists 10 mg once daily as both the starting dose and the recommended dose, with a maximum of 20 mg. In the label’s fixed-dose depression trial, 20 mg was effective but did not show a greater benefit than 10 mg. 10 mg is also the recommended dose for most older adults and for people with liver impairment. It can be taken morning or evening, with or without food. Never change your dose or stop suddenly without talking to your prescriber: the label recommends tapering to reduce discontinuation symptoms.
Escitalopram Strengths Compared at a Glance
| 5 mg | 10 mg | 20 mg | |
|---|---|---|---|
| Role on the FDA label | Available tablet strength; not a labeled starting or target dose | Starting dose and recommended dose for adult and pediatric MDD and GAD | Maximum recommended dose |
| Tablet (Lexapro) | Round, not scored, “FL” / “5” | Round, scored, “F L” / “10” | Round, scored, “F L” / “20” |
| When it’s used | Prescriber’s judgment (for example, building up gradually) | Most people; elderly patients; hepatic impairment | Only after at least 1 week at 10 mg in adults (2 weeks for children with GAD), depending on response and tolerability |
| Evidence vs 10 mg | Not studied as a target dose in the label trials | Effective in placebo-controlled trials | Effective, but no greater benefit than 10 mg in the fixed-dose MDD trial |
Source: Lexapro prescribing information, DailyMed. Generic escitalopram tablets from other manufacturers may look different.
What Escitalopram Is
Escitalopram is a selective serotonin reuptake inhibitor (SSRI). Chemically it is the S-enantiomer, the single active “mirror image” half, of the older antidepressant citalopram (Celexa). It was first approved in the U.S. in 2002 and is sold as Lexapro and as many generics. Tablets contain escitalopram oxalate, but the strength on the label (5, 10 or 20 mg) refers to escitalopram itself.
According to the label, escitalopram has a mean terminal half-life of about 27–32 hours, which is why it is dosed once daily. It is broken down mainly by the liver enzymes CYP3A4 and CYP2C19.
Labeled Dosing, Indication by Indication
Depression (major depressive disorder)
Adults: 10 mg once daily. The label says a fixed-dose trial “demonstrated the effectiveness of both 10 mg and 20 mg” but “failed to demonstrate a greater benefit of 20 mg over 10 mg.” If the dose is raised, it should be to a maximum of 20 mg, no sooner than 1 week later.
Ages 12–17: 10 mg once daily, up to 20 mg after at least 3 weeks. Effectiveness has not been established under age 12 for depression.
Generalized anxiety disorder
Adults: 10 mg once daily, up to 20 mg after at least 1 week. Ages 7 and older: 10 mg once daily, up to 20 mg after at least 2 weeks. The pediatric GAD approval rests on adult trials plus an 8-week placebo-controlled study in patients 7 to 17.
Special populations
- Older adults: 10 mg is the recommended dose for most elderly patients. The label reports that escitalopram’s AUC and half-life were about 50% higher in people 65 and older.
- Liver impairment: 10 mg is recommended.
- Kidney impairment: no adjustment for mild or moderate impairment; a dose for creatinine clearance under 20 mL/min has not been determined.
Does a Higher Dose Work Better?
For depression, the label’s own trial data say no clear extra benefit at 20 mg versus 10 mg on average. Individual responses vary, which is why the label lets prescribers increase the dose based on response and tolerability.
Across drugs, the largest comparison is the Cipriani 2018 network meta-analysis in The Lancet, which pooled 522 trials of 21 antidepressants in adults with major depression. All 21 were more effective than placebo, and escitalopram was among the drugs with both relatively higher efficacy and better acceptability (fewer dropouts). These are cross-trial comparisons of averages, so they cannot predict how any one person will respond. For a drug-to-drug comparison, see our Lexapro vs Zoloft guide.
How Long Does 10 mg Take to Work?
The label does not give a single “onset” time, but its pivotal trials ran 8 weeks, and dose increases are spaced at least a week apart. Many prescribers review response after several weeks. If you feel no change or feel worse, contact your prescriber rather than adjusting the dose yourself.
Side Effects: What the Trials Recorded
The label lists adverse reactions that occurred in at least 2% of patients taking 10–20 mg and more often than with placebo. The most common:
| Side effect | Adults with depression (Lexapro / placebo) | Adults with GAD (Lexapro / placebo) |
|---|---|---|
| Nausea | 15% / 7% | 18% / 8% |
| Insomnia | 9% / 4% | 12% / 6% |
| Ejaculation disorder (men) | 9% / <1% | — |
| Diarrhea | 8% / 5% | 8% / 6% |
| Somnolence | 6% / 2% | 13% / 7% |
| Dry mouth | 6% / 5% | 9% / 5% |
| Fatigue | 5% / 2% | 8% / 2% |
| Headache | — | 24% / 17% |
| Decreased libido | 3% / 1% | 7% / 2% |
Source: Tables 2 and 3 of the Lexapro label. A dash means the reaction was not listed in that table.
Serious Warnings and Interactions
- Boxed warning: antidepressants increased the risk of suicidal thoughts and behaviors in children and young adults in short-term studies. Anyone starting or changing a dose should be monitored for worsening mood or suicidal thoughts. If you are in crisis in the U.S., call or text 988.
- Serotonin syndrome: the risk rises with other serotonergic drugs (for example triptans, tramadol, other antidepressants, St. John’s wort). MAOIs are contraindicated with escitalopram and within 14 days of stopping either.
- Bleeding: risk may increase with NSAIDs such as ibuprofen, aspirin, other antiplatelet drugs or warfarin.
- Low sodium (hyponatremia): older adults may be at greater risk.
- Discontinuation symptoms: reduce the dose gradually rather than stopping abruptly.
- Other label warnings: activation of mania in people with bipolar disorder (screen first), seizures, angle-closure glaucoma, sexual dysfunction, and caution operating machinery until you know how it affects you.
- Pregnancy and breastfeeding: escitalopram passes into breast milk, and the label notes reports of sedation, poor feeding and poor weight gain in exposed infants. Decisions should be made with your doctor.
Who Should Choose What
- Starting treatment: 10 mg is the labeled starting point for adults and children with depression or GAD. Some prescribers start lower; that is a clinical judgment, not something to decide yourself.
- Partial response after an adequate trial: your prescriber may consider 20 mg (the maximum), switching, or adding therapy.
- Age 65+ or liver disease: the label recommends staying at 10 mg for most people.
- Bothersome side effects: talk to your prescriber before cutting a tablet; the 10 mg and 20 mg Lexapro tablets are scored, the 5 mg is not.
Talk to your doctor or pharmacist before starting, changing or stopping escitalopram, and tell them about every medicine and supplement you take, including OTC pain relievers and St. John’s wort.
Frequently Asked Questions
What is escitalopram 10 mg used for?
It is the FDA-labeled starting and recommended dose of escitalopram (Lexapro) for major depressive disorder in adults and children 12 and older, and for generalized anxiety disorder in adults and children 7 and older.
Is 10 mg of escitalopram a lot?
No. 10 mg is the standard recommended dose on the label; the maximum is 20 mg once daily. In the label's fixed-dose depression trial, 20 mg did not show greater benefit than 10 mg.
Is escitalopram 20 mg better than 10 mg?
Not on average for depression, according to the label's fixed-dose trial. Prescribers may raise the dose to 20 mg after at least a week based on response and tolerability.
Should I take escitalopram in the morning or at night?
The label says once daily, morning or evening, with or without food. Your prescriber may suggest a time based on whether it makes you drowsy or affects your sleep.
Can I stop escitalopram 10 mg suddenly?
The label recommends reducing the dose gradually whenever possible because discontinuation symptoms can occur. Talk to your prescriber before stopping.
What is the dose of escitalopram for older adults?
The label recommends 10 mg once daily for most elderly patients, because escitalopram exposure and half-life were about 50% higher in people 65 and older.
Sources
- Lexapro (escitalopram) tablets prescribing information, Allergan/AbbVie, via DailyMed (NLM)
- Cipriani A, et al. Comparative efficacy and acceptability of 21 antidepressant drugs. Lancet. 2018
- MedlinePlus: Escitalopram
- 988 Suicide & Crisis Lifeline
Medical disclaimer: This article is for educational purposes and does not replace medical advice. Consult a licensed healthcare provider before starting any supplement, medication, or treatment — particularly if you are pregnant, breastfeeding, taking other medications, or have a diagnosed medical condition.