Does Lexapro Cause Anxiety?

Hi Fran and thanks for reaching out!

I'm sorry to hear you've been dealing with anxiety problems since you've started taking Lexapro (escitalopram), a selective serotonin reuptake inhibitor.

Interestingly enough, even though Lexapro is FDA-approved for the treatment of anxiety (specifically generalized anxiety disorder), it can also cause anxiety symptoms, especially when it is first started.

In fact, this is a relatively common side effect, and it has been well-reported, among all drugs in the SSRI (selective serotonin reuptake inhibitors) class, including Lexapro.

Lexapro Causing Anxiety

Anxiety caused by SSRIs, like Lexapro, is just one side effect that is generally lumped into a group of side effects known as 'neuropsychiatric effects'. Sometimes this group of effects is referred to as 'activation syndrome'.

In addition to anxiety, activation syndrome is specifically characterized by:

• Emotional disturbances
• Irritability
• Restlessness
• Impulsivity
• Insomnia

SSRI activation side effects are more commonly associated with children and teens and tend to be more severe in this group, which is why there are such strong warnings with antidepressants and suicide risk in children. Nevertheless, these side effects can happen at any age.

The 'Practice Guideline For The Treatment of Patients With Major Depressive Disorder' specifically discusses 'activation' side effects:

SSRIs sometimes precipitate or exacerbate restlessness, agitation, and sleep disturbances—side effects that often attenuate with time. Anxiety may be minimized by introducing the agent at a low dose.

Most studies report that these activation side effects, like anxiety, typically start within 8 weeks of beginning treatment with the drug and, tend to go away over time.

Studies also report that starting at a very low dose of an SSRI, and slowly titrating your dose up can help reduce the risk of activation side effects.

In your question, you stated that you've been taking Lexapro for 5 weeks, at a low dose, and you have been dealing with problems ever since starting. Being 5 weeks in, you would still be considered to be relatively new to therapy, and your side effects may start decreasing in severity over time. Generally, it is after 2 months or so where you really start to get a good idea of how you are going to tolerate the medication, and if it is providing benefits for you.

Having said that, it sounds like your quality of life has been severely compromised due to lack of sleep and anxiety symptoms. It is important to talk to your doctor about your options. They may temporarily prescribe something to help with your side effects, or, a drug change may also be a consideration.

Additional Information

You also mentioned in your question that you previously took Xanax (alprazolam) for anxiety. It is important to note that Xanax and Lexapro are very different drugs in regard to how they work to treat anxiety.

Xanax is typically used on an as-needed basis for anxiety symptoms and begins working very quickly. It would almost never be used as a preventative medication.

Lexapro, on the other hand, is the opposite...it works well as a preventative and can decrease the severity of your symptoms over time, but it doesn't have immediate effects. It has to be taken consistently for weeks before you'll notice any difference.

I can understand the feeling that Xanax is more effective and doesn't have the side effects Lexapro has...but this has to be weighed against the dangers of long-term use of benzodiazepines (a class of drugs that includes Xanax) and the fact it won't help reduce the frequency or severity of your anxiety symptoms in a preventative manner.

I hope your situation starts to get better soon! Please feel free to reach out with any other questions in the future.