Escitalopram side effects, including mood

Escitalopram (sold as Lexapro) raises serotonin levels, and most of its side effects come from that same mechanism. They're usually mildest in the first week or two and ease as your body adjusts.

Common side effects include:

• Nausea or an upset stomach
• Headache
• Dry mouth
• Sleepiness during the day, or trouble falling asleep
• Sweating more than usual
• Sexual side effects: lower desire, delayed orgasm, or both

Less common ones include dizziness, tremor, and a dip in appetite. Some people get diarrhea, others get constipated. A smaller number notice yawning spells or unusually vivid dreams, which aren't dangerous, just odd.

Most people tolerate escitalopram well enough to keep taking it, and side effects that start in week one often fade on their own. If nausea or sleep problems are severe, or haven't improved after three or four weeks, tell the doctor who prescribed it rather than stopping on your own.

Yes, in both directions. For premenstrual irritability and anger, a small 2025 crossover trial of 27 women found that taking escitalopram only in the luteal phase reduced self-rated irritability and anger compared with placebo [2]. Some women feel steadier within one treated cycle.

Escitalopram can also cause mood side effects, especially in the first one to two weeks. These can include:

• Feeling emotionally flat or less reactive than usual
• New or worse anxiety or restlessness
• Agitation or trouble sitting still

People under 25 are watched more closely for early mood changes, per NHS guidance on escitalopram, so doctors usually schedule an early check-in. For how the timing usually plays out, see how long does escitalopram take to work?

In the meantime, having somewhere to put a hard moment can help while the medication takes effect. Niyora is a PMS and PMDD support app. Its Moon feature lets you write down what happened, see it from another angle, and draft a reply you can hold onto before sending it. Read more about escitalopram for PMDD specifically.

Weight change with escitalopram is possible but inconsistent. Some people lose a little weight in the first few weeks as appetite dips alongside nausea. Others gain weight gradually over months of use, though this isn't universal and tends to show up later rather than early on.

None of the trials behind this page measured weight directly, so there's no reliable number to give you here. If weight change matters to you, bring it up at your first follow-up appointment.

A doctor can watch for a pattern over a few months and talk through whether to continue as is, adjust the dose, or try a different medication.

Most side effects follow a rough timeline, though it varies by person.

If something hasn't budged after four to six weeks, or it's getting in the way of your day, that's worth a conversation rather than something to just wait out.

A doctor decides when and how to stop escitalopram, not a fixed date on a calendar. Stopping suddenly can bring back the symptoms it was treating, or cause its own short-term discomfort: dizziness, flu-like feelings, or odd sensations some people describe as brain zaps.

Call your prescriber if:

• Side effects haven't eased after four to six weeks
• Your mood feels worse than before you started
• Side effects are getting in the way of work, sleep, or relationships
• You're planning a pregnancy or are already pregnant

If you and your doctor decide to stop, tapering the dose down gradually over a few weeks usually causes fewer symptoms than stopping all at once. Escitalopram dosage explains how doctors usually adjust the amount over time, both starting and stopping.

Escitalopram is one of several SSRIs studied for premenstrual mood symptoms, and it isn't the only option if it doesn't suit you.

• Fluoxetine (Prozac) and sertraline (Zoloft) are the other two SSRIs with the most trial evidence for PMDD; see SSRIs for PMDD for how they compare.
• Taking an SSRI only in the luteal phase, rather than every day, is an option some doctors offer, and it's the dosing pattern used in the escitalopram trial above [2].
• Some hormonal contraceptives are used for PMS and PMDD, though they bring their own tradeoffs in cycle control and side effects [1].
• Magnesium supplements have weak, inconsistent evidence for easing anxiety in PMS; a systematic review found a benefit in about half the relevant trials it reviewed [3].
• Cognitive behavioral therapy (CBT) is recommended in guidelines alongside or instead of medication.

A doctor who knows your history and other medications is the one who can weigh these against escitalopram for you.