When should you take lexapro morning or night

Switching Lexapro From Night to Morning: What to Know

Medically reviewed by Katelyn Hagerty, FNP

Written by Our Editorial Team

Last updated 6/24/2022

If you have major depressive disorder (MDD) or an anxiety disorder such as generalized anxiety disorder, your healthcare provider may prescribe the antidepressant Lexapro® (escitalopram) to help you gain more control over your symptoms.

Lexapro can be taken once per day, either in the morning or in the evening. If you currently take your medication in the evening, switching Lexapro from night to morning is usually a simple and straightforward process.

Below, we’ve explained what Lexapro is, as well as how it works as a medication for depression and anxiety. 

We’ve also explained how you can switch Lexapro from night to morning usage without causing any unwanted side effects or withdrawal symptoms.

Finally, we’ve shared some things that you should know before switching your Lexapro dosage schedule, as well as a few simple tactics that you can use to get the best results from Lexapro going forward.

What Is Lexapro?

Lexapro is an antidepressant that contains the active ingredient escitalopram. It belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants and works by increasing the amount of serotonin in your brain and body.

Serotonin is a neurotransmitter, or natural type of chemical, that plays a major role in managing your moods and feelings. It’s involved in regulating your feelings of happiness and anxiety. Low levels of serotonin are associated with depression, anxiety and suicidal behavior.

By increasing serotonin levels, Lexapro and similar medications can help to reduce the severity of the symptoms of depression, improving your quality of life and letting you focus your attention and efforts on getting better. 

Reasons to Switch Lexapro From Night to Morning

Lexapro should be taken once per day. It’s okay to take Lexapro in the morning or at nighttime, as long as you take your medication on a consistent schedule.

There are a few reasons why you may want to change your dosage schedule for Lexapro. One is that some of the potential side effects of Lexapro can have a bigger impact on your quality of life when they occur at night rather than during the day. 

Common side effects of Lexapro include:

  • Insomnia

  • Nausea

  • Sweating

  • Fatigue

Lexapro can also cause sexual side effects, including a reduced sex drive and difficulty reaching orgasm during sex.

Several of these side effects can be quite an annoyance at night. For example, if you’re prone to insomnia or sleep disturbances from Lexapro or similar antidepressants, taking your medication at night may have a serious impact on your well-being and general health. 

By switching to a morning schedule, you may be able to reduce the impact of Lexapro and other antidepressants on sleep and benefit from improved sleep quality. 

Since it’s more common to have sex at night than in the daytime, any sexual dysfunction caused by Lexapro can quickly become an irritating side effect if you usually take your medication in the evening.  

Switching to a morning dosage schedule may reduce the severity of these side effects and stop them from having such an impact on your quality of life. 

Another reason to switch from a night to a morning dosage schedule with Lexapro is that you find it easier to remember your medication in the morning.

Remembering to take medication at night can be challenging, as it’s easy to slip into “relaxation mode” an hour or two before bedtime. You may find that you miss doses of Lexapro more often if you stick to an evening dosage schedule. 

Finally, if you’re prescribed other medication that you need to take in the morning, switching to a morning dosage schedule with Lexapro can help to keep things simple.

How to Switch Lexapro From Night to Morning

Switching Lexapro from night to morning is a simple process. If you normally take your dose of Lexapro before going to bed, simply skip one dose, then take it the next morning following your new dosage schedule.  

There’s generally no need to adjust your dosage, take a double dose or do anything else overly complicated during the “switching” process. Instead, you can continue to take the same dosage of Lexapro, just in the morning instead of at night. 

If you often forget to take your medication and need help adapting to a new dosage schedule, it may help to set a reminder on your phone letting you know that you need to take Lexapro in the morning. 

After a few days, taking your medication in the morning should become a new habit that you can easily stick to. 

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What to Know When Changing Lexapro Schedule

Although switching Lexapro from night to morning usually doesn’t cause any issues, it’s always best to talk to your healthcare provider before you make any changes to the way you take your medication. 

Your healthcare provider may give you a specific schedule to follow when switching from night to morning usage of Lexapro or give additional instructions to help you use your medication as safely as possible.  

Here are a few other things to keep in mind when changing your Lexapro dosage schedule:

  • There’s no “best time of day to take Lexapro” for every person. The side effects of Lexapro can vary from person to person, meaning there’s no perfect time of day to take this medication.
    If you’re prone to insomnia or sexual health issues from Lexapro, taking it in the morning will usually be best for you. However, if you get nausea or fatigue from Lexapro, you may prefer to take Lexapro before you go to bed.

  • Lexapro may take several weeks to start working. Many antidepressants take several weeks to start working. You may need to take Lexapro for four weeks or more before you notice any improvements in your sleep, appetite, concentration or mood.
    Your healthcare provider may suggest waiting for Lexapro to start working before making any changes to your dosage schedule.

  • Many side effects of Lexapro are temporary. It’s far from uncommon to deal with side effects during the first few weeks or months of taking Lexapro, only to have these issues become less severe over time.
    If you’ve just started to use Lexapro, make sure to talk to your healthcare provider about side effects before changing your dosage schedule.

  • Lexapro can cause withdrawal symptoms if it’s stopped abruptly. It’s okay to switch from taking Lexapro at night to in the morning, or vice-versa. However, it’s important not to suddenly stop taking Lexapro, as this may trigger withdrawal symptoms.
    If you want to stop taking Lexapro, talk to your healthcare provider first. They’ll give you a special tapered dosage schedule to follow so that you can limit withdrawal symptoms and stop using your medication safely.

Our detailed guide to Lexapro explains more about how Lexapro works, as well as how you can use it safely and effectively to treat depression or anxiety. 

What to Do if Lexapro Still Isn’t Right for You

Changing from a night to morning dosage schedule can make some side effects of Lexapro less severe. However, if you have persistent side effects that don’t improve, or if you simply don’t feel like Lexapro is working for you, then you may need to make further changes.

It’s common to use several antidepressants before finding one that provides the right balance of effectiveness and manageable side effects for you. 

If you’ve switched your Lexapro dosage schedule and still have side effects, or if you don’t think that Lexapro is helping you, it’s important to let your healthcare provider know.

In order to better treat your depression or anxiety symptoms, they may adjust your dosage, ask you to wait for longer, switch you to a different type of SSRI or, in some cases, switch you from Lexapro to a different class of antidepressant. 

They may also suggest that you make certain changes to your habits and lifestyle to reduce the severity of your depression symptoms. These may include:

  • Exercising on a regular basis, even if it’s just a short walk or bike ride

  • Spending more time with your friends, family members and other supportive people

  • Meeting with a therapist in your area or taking part in online therapy from your home

  • Participating in a support group to learn new strategies for coping with depression

  • Limiting the number of major life decisions you make until you’re feeling better

Our guide to dealing with depression goes into more detail about how good habits and therapy can help you to overcome depressive symptoms and improve your life.  

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Learn More About Treating Depression

Major depression is a serious mood disorder that can have a real impact on your well-being and quality of life. For many people, medications like Lexapro make dealing with depression a much easier process. 

If you’re prescribed Lexapro for depression, it’s okay to take your medication during the daytime or at night. It’s also alright to switch between different Lexapro dosage schedules if you often get side effects at night but not in the day, or vice versa.

You can find out more about Lexapro, SSRIs and other types of antidepressant medication with our full list of antidepressants. 

If you think you might have major depression or an anxiety disorder and want to seek treatment, you can connect with a provider from home using our online mental health services. 

4 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Escitalopram. (2022, January 15). Retrieved from https://medlineplus.gov/druginfo/meds/a603005.html
  2. Brain Hormones. (2022, January 23). Retrieved from https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/brain-hormones
  3. Lexapro® (escitalopram oxalate) Tablets. (2017, January). Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021323s047lbl.pdf
  4. Depression. (2018, February). Retrieved from https://www.nimh.nih.gov/health/topics/depression

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

How and when to take escitalopram

Take escitalopram exactly as your doctor tells you, and follow the directions on the label. If you're not sure, check with your pharmacist or doctor.

Dosage and strength

Escitalopram tablets come in different strengths ranging from 5mg to 20mg.

The usual dose of escitalopram is 10mg a day. But your doctor may start you on a lower dose and increase it to a maximum dose of 20mg a day.

If you have liver problems, the maximum recommended dose is 10mg a day.

With liquid drops, 1 drop is equivalent to 1mg of escitalopram, 10 drops is 10mg, and 20 drops is 20mg.

How to take it

Take escitalopram once a day. You can take it with or without food.

You can take escitalopram at any time of day, as long as you stick to the same time every day.

If you have trouble sleeping, it's best to take it in the morning.

How long to take it for

Once you're feeling better it's likely that you'll keep taking escitalopram for several more months to prevent the symptoms returning.

The decision to stop your treatment or carry on will depend on what symptoms you have and how serious they are. It will also depend on whether it's a one-off problem or one that keeps coming back, how well escitalopram works for you, and whether you have had any bad side effects.

If you forget to take it

If you forget to take a dose and remember before you go to bed, take it straight away. Carry on as usual the next day.

If you only remember during the night or the next day, leave out the missed dose and carry on as usual.

Do not take a double dose to make up for forgotten doses.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

Stopping escitalopram

If you have been feeling better for 6 months or more, your doctor may suggest coming off escitalopram.

Your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking escitalopram for a long time.

This is to help prevent any withdrawal side effects you might get as a reaction to coming off the medicine. These can include:

  • dizziness
  • feeling sick
  • numbness or tingling in the hands or feet
  • trouble sleeping
  • feeling agitated or anxious
  • headaches
  • shaking


Do not stop taking escitalopram suddenly or without talking to your doctor first.

If you take too much

The amount of escitalopram that can lead to an overdose varies from person to person.

Urgent advice: Contact 111 for advice now if:

  • you take more than your prescribed dose of escitalopram

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the escitalopram packet or the leaflet inside it, plus any remaining medicine, with you.

Immediate action required: Call 999 or go to A&E if:

Page last reviewed: 24 February 2022
Next review due: 24 February 2025

  • ◊ Expected result
  • ◊ If you do not work
  • ◊ How to stop taking
  • ◊ therapeutic combinations
  • Contraindications and contraindications
  • Special groups of patients
    • ◊ Patients with patients
    • ◊ ◊ Heart patients
    • ◊ Elderly patients
    • ◊ Children and adolescents
    • ◊ Pregnant women
    • ◊ Breastfeeding
  • Interaction with other substances
  • Analyzes during treatment
  • Side effects and other risks
    • ◊ Side effects Mechanism
    • ◊ Side effects
    • ◊ What to do with side effects
    • ◊ Long use
    • ◊ Baptism Blacket ◊ Overdose
  • Benefits
  • Weaknesses
  • Expert advice
  • Footnotes
  • Pharmacological group

    ◊ FDA Guidelines

    • Major Depressive Disorder (Adults and Children 12+)
    • GTR

    ◊ UK Medicines and Healthcare Products Regulatory Agency recommendations

    • Major depressive episode
    • Panic disorder with/without agoraphobia
    • Social phobia
    • GTR
    • OKR

    ◊ Off-label use

    • Vasomotor symptoms in menopause
    • Insomnia
    • Dysmorphophobia
    • Bulimia [5].

    Target symptoms

    • Depressive mood
    • Anxiety
    • Panic attacks, avoidance behavior
    • Sleep disorder

    Mechanism of action and pharmacokinetics

    Escitalopram is the S-isomer of citalopram. Selectively inhibits the reuptake of serotonin, increasing the concentration of this neurotransmitter in the synaptic cleft. Escitalopram, like other antidepressants from the SSRI group, practically does not bind to dopamine (D 1 and D 2 ) receptors, α-adrenergic, m-cholinergic receptors, as well as benzodiazepine and opioid receptors [4]. Long-term use of escitalopram leads to desensitization of somatodendritic 5-HT1A and terminal autoreceptors. nine0016

    • Bioavailability - 80%.
    • Half-life 27-32 hours
    • Stable blood concentration is maintained for one week
    • Metabolized by CYP3A4, CYP2C19; inhibits CYP2D6

    Treatment regimen

    ◊ Dosage and dose adjustment
  • Start at 10 mg/day if necessary increase to 20 mg
  • Take once a day, morning or evening
  • 10 mg escitalopram comparable to 40 mg citalopram but no side effects
  • 30-40 mg is suitable for some patients [1]
  • 10 mg/day is sufficient for relief of vasomotor symptoms in menopause, but may be increased to 20 mg/day if failure occurs within 4 weeks
  • If anxiety, insomnia, agitation, akathisia occur at the start of treatment or after interruption of treatment, consider the possibility of bipolar disorder and switch to a mood stabilizer or atypical antipsychotic
  • ◊ How fast works

    • Starts working after 2-4 weeks
    • If there is no effect after 6-8 weeks, increase the dose or switch to another drug
    • May be taken for many years to prevent relapse.

    ◊ Expected result

    • Complete remission.
    • After the disappearance of symptoms of depression, you should continue taking 1 year if it was the treatment of the first episode. If this is a re-episode treatment, treatment can be extended indefinitely. nine0037
    • Use in the treatment of anxiety and chronic pain may be indefinite.

    ◊ If not working

    • Change dose, switch to another drug, or add an ancillary drug;
    • Connect psychotherapy;
    • Review diagnosis for comorbid conditions;
    • Patients with undiagnosed bipolar affective disorder may be less effective, in which case switching to a mood stabilizer should be considered [1]. nine0037
    • Electroconvulsive therapy should be considered in the acute phase of a severe depressive disorder that is accompanied by psychotic or catatonic symptoms, as well as in patients with actual suicidal ideation [7].

    ◊ How to stop taking

    It is not usually necessary to taper off gradually, but taper off gradually to be sure to avoid withdrawal symptoms. Gradual reduction scheme: dose reduced by 50% - 3 days, again reduced by 50% - 3 days, complete cessation. If withdrawal symptoms appear, increase the dose, wait for the withdrawal symptoms to subside, and continue to decrease [1]. nine0016

    ◊ Treatment combinations

    • For insomnia: trazadone
    • For fatigue, drowsiness, loss of concentration: modafinil [3].
    • Combinations with other antidepressants may activate bipolar disorder and suicidal ideation
    • For bipolar depression, psychotic depression, resistant depression, resistant anxiety disorder: mood stabilizers, atypical antipsychotics
    • nine0036 For anxiety disorder: gabapentin, tiagabine

    Warnings and contraindications

    • Use caution if patient has had seizures;
    • Use caution if patient has bipolar disorder;
    • Do not use if patient is taking pimozide;
    • Do not use if allergic to citalopram or escitalopram [1].

    Special patient groups

    ◊ Patients with diseased kidneys

    Use caution if patient has severe kidney disease [1].

    ◊ Patients with diseased liver

    The recommended dose is 10 mg/day [1].

    ◊ Patients with heart disease

    There are no systematic data on the use of escitalopram in people with pathology of the cardiovascular system. Presumably safe. Useful in recovery after a heart attack [1]. nine0016

    ◊ Elderly patients

    A dose of 10 mg is recommended for elderly patients [1].

    ◊ Children and adolescents

    • Recommended for depression aged 12-17
    • It is necessary to regularly and personally check the patient's condition, especially during the first weeks of treatment.
    • Use with caution in view of the risk of undiagnosed bipolar affective disorder and suicidal tendencies. nine0037
    • Inform adults of the risks.

    ◊ Pregnant women

    • There have been no adequate studies in pregnant women [1].
    • Not recommended for pregnant women, especially during the first trimester
    • All risks should be weighed and compared
    • Bleeding can be expected during childbirth

    ◊ Breastfeeding

    • The drug passes into breast milk. nine0037
    • If the infant shows signs of irritation or sedation, stop feeding or taking escitalopram
    • However, postpartum treatment may be necessary and the risks should be weighed.

    Interaction with other substances

    • Tramadol increases the risk of seizures
    • Do not use with MAO inhibitors. After the end of taking MAO inhibitors, 14 days should pass. Start treatment with MAO inhibitors 7 days after the end of escitalopram. nine0037
    • Together with warfarin, probably increases the risk of bleeding [1].

    Tests during treatment

    Not required.

    Side effects and other risks

    ◊ Mechanism of occurrence of side effects

    Side effects are caused by an increase in serotonin. Most side effects occur immediately after the start of treatment and go away over time.

    ◊ Side effects

    • Gastroenterological (decreased appetite, nausea, diarrhea, constipation)
    • Insomnia, sedation, agitation, tremor
    • Sweating
    • Urination disorder
    • Dry mouth
    • Dangerous side effects: convulsions, mania, suicidal ideation
    • Weight gain: very rare
    • Sedation: very rare
    • Sexual dysfunction: yes

    ◊ Dealing with side effects

    1. Wait
    2. Switch to another antidepressant [1].
    3. No

      ◊ Overdose

      • There are very few reports of overdose. nine0037
      • Very rare cases of fatal overdoses.
      • Vomiting, sedation, cardiac arrhythmia, dizziness, tremor.


      • Good for patients on other medications - very few dangerous interactions;
      • Gives relatively fast results [1].


      High price

      Expert advice

      • Best tolerated antidepressant
      • The weakest effect on the sexual sphere compared to other SSRIs
      • Lack of response to escitalopram in elderly patients may be indicative of Alzheimer's disease
      • In postmenopausal women, escitalopram works better in combination with estrogen [1]
      • Escitalopram and fluoxetine show a similar effect in the treatment of depression. The only difference noted is that escitalopram significantly improves microinflammation in the patient's body [6]. nine0015 6. Xiaoling Z, Yunping H, Yingdong L. Analysis of curative effect of fluoxetine and escitalopram in the depression treatment based on clinical observation. Pak J Pharm Sci. May 2018;31(3(Special)) 1115-1118.

        7. American Psychiatric Association. Guideline Watch: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Second Edition. American Psychiatric Association Practice Guidelines .

        What you need to know about antidepressants

        Ekaterina Kushnir

        treats anxiety disorder

        I have generalized anxiety disorder.

        For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

        The doctor prescribed an antidepressant from the SSRI group - these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my illness. nine0016

        The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

        At the same time, it must be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control. nine0016

        See a doctor

        Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

        Fact No. 1

        Antidepressants may make symptoms worse at first

        Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation - this is the name for causeless motor arousal, the inability to sit still. It's not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it. nine0016

        Antidepressant-induced anxiety syndrome - a systematic review in the British Journal of Psychiatry

        There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

        Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks. nine0016

        The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

        Everything was fine the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic - I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken. nine0016


        8 myths about antidepressants

        I have never had such panic attacks before medication - my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

        After that, I already expected these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of the drugs. And they ended faster, and then they completely disappeared.

        My letter to a psychiatrist. I was scared: I expected an increase in background anxiety, but not panic attacks. I even thought about giving up the medicine

        Fact No. 2

        The effect of antidepressant treatment will not be immediate

        Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient "sertraline", the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

        SSRI dosage - NHS

        What doses of antidepressants will be optimal - an article in The Lancet

        The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

        The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work. nine0016

        It is better to get ready for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember - this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

        Fact No. 3

        Antidepressants are usually taken in combination with other drugs

        Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer. nine0016

        Antidepressants together with benzodiazepines work better for depression - BMJ magazine

        My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned - even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby. nine0016

        As a result, I simply endured all the side effects of therapy - they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

        My prescriptions for drugs. I never used one, because there was no such medicine in pharmacies

        Fact No. 4

        Side effects are not always, but they are

        Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs - tricyclic antidepressants and monoamine oxidase inhibitors - cause more side effects. Doctors usually use them when milder first-line drugs don't work or when they can't be prescribed. nine0016

        For the first couple of weeks of taking it, there is a risk that you will not feel well - it's worth thinking about. It may be worth scheduling the start of therapy on vacation.

        I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

        It was hard to work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i. e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy. nine0016

        There are mixed data on how common the side effects of antidepressants are. If we summarize them, then the numbers look something like this:

        • nausea - about 25% feel it;
        • diarrhea - it happens in 15% of people, and 5%, on the contrary, will have constipation;
        • sweating and a feeling of heat occur in about 20% of people;
        • sexual dysfunction, decreased libido may occur in 80% of cases;
        • insomnia - in 11% of cases;
        • headache and dizziness - in about 10-11% of cases; nine0037
        • weight gain - not all drugs give this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

        It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

        Side effects not listed above are very rare. I was "lucky", and I faced one such - a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses. nine0016

        I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened - it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1.5, and it became -3.5.

        I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses. nine0016

        Side effects should not be tolerated - if something greatly worries, scares or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

        If there is no danger, the doctor can adjust the dose or increase it more gradually - this often helps to cope with unpleasant effects. nine0016 I wrote to the doctor again when my visual acuity decreased

        Fact No. 5

        Antidepressants need to be taken long term

        Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

        Anxiety Therapy - UpToDate

        For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years - it depends on how long it takes to reach the working dosage of the medicine. nine0016

        The cost of a package of the most famous antidepressant "Zoloft" is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R - maybe more or less, depending on which drug is selected.

        Psychotherapy review - UpToDate

        Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru

        The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often. nine0016

        You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance - it's free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

        Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and consolidate the effect of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more. nine0016


        How psychotherapy works

        Fact No. 6

        Antidepressants should not be stopped abruptly

        Antidepressants are not addictive. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images. nine0016

        Withdrawal symptoms after taking serotonin reuptake inhibitors - Journal of Clinical Psychiatry

        How difficult it is to stop taking antidepressants - American Psychological Association

        Stopping antidepressants in adults - UpToDate

        treatment, they should be canceled only under the supervision of a doctor.

        Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake. nine0016

        Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days - it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

        Fact No. 7

        If you need to change the drug, everything will start over

        It is far from always possible to immediately find the right antidepressant - sometimes the side effects do not go away and you need to take a new one. nine0016

        Changing antidepressants in adults - UpToDate

        Serotonin syndrome - MSD

        Most often it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects - the same or different. We will have to wait again until they pass.

        You won't be able to change the drug on your own, since all antidepressants are sold only by prescription - and that's good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs. nine0016

        For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors - due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

        If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.


        How to choose a psychotherapist

        Fact No. 8

        Among antidepressants there are original drugs and generics

        Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

        Theoretically, the effect of generic drugs should not differ from the effect of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials. nine0016

        Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy, so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.


        Psychoneurological complications after covid: memory problems and depression

        As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug - and, indeed, the side effects softened. nine0016

        In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics does not always differ greatly.

        Originals and generics of some SSRIs

        Active ingredient Original Original cost Generics Cost of generics
        Sertraline Zoloft About 700 R, 100 mg tablets Serenata, Sirlift 500-600 R 100mg tablets
        Escitalopram Cipralex 3000 R, tablets 10 mg "Selektra", "Elycea" 500-1300 R, 10 mg tablets
        Fluoxetine Prozac About 350 R, 20 mg tablets Profluzak, Fluoxetine 100-200 R, 20 mg tablets




        The cost of the original

        about 700 r, tablets 100 mg



        , tablets 100 mg




        Original price

        3000 r, tablets 10 mg


        "Selectra", "Elice"

        The cost of generics

        500-1300 r, tablets 10 mg


        " original

        About 350 R, tablets 20 mg


        Profluzak, Fluoxetine

        Cost of generics

        100-200 R, tablets 20 mg

        one remained unclaimed

        Fact No. 9

        Do not take alcohol along with antidepressants

        Drinking alcohol while taking antidepressants may exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

        Why you shouldn't mix antidepressants and alcohol - Mayo Clinic

        Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet - it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited. nine0016

        With other antidepressants, moderate use may not be dangerous and may even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.

        The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.


        How I Treated Generalized Anxiety Disorder under CHI

        Fact No. 10

        Antidepressants are incompatible with certain drugs and have contraindications nine0122

        It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed to those who have recently had a heart attack, suffer from glaucoma or porphyria.

        Antidepressant Warnings - NHS

        Drug Compatibility Test - Drugs.com

        It is also important to be careful if you are about to take any over-the-counter medicine. For example, ibuprofen, which people often take on their own to relieve pain and reduce fever. It should not be taken with SSRIs as it increases the risk of gastrointestinal side effects.

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