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Starting Lexapro: the first week, and how long it takes to work

Lexapro (escitalopram) is one of the most prescribed antidepressants for both depression and anxiety, and one of the best tolerated — which does not mean the first week is nothing. Most people feel something before they feel better, and knowing in advance what is normal, what passes, and what is worth a message stops a rough first few days from ending a treatment that would have worked. This page covers the first week, the timeline, the side effects that matter, and what starting Lexapro at NCNE actually involves.

A calm, private space set up for a telehealth psychiatric appointment

Who this is for: Adults 18–65 in Connecticut, Massachusetts, New Hampshire, Maine, Rhode Island, Virginia, and Kentucky who have just started Lexapro, are about to, or are deciding whether to — and want to know what the first weeks are really like.

The first week on Lexapro

Escitalopram is started low and, for most people, the first days bring some mixture of mild nausea, a headache, feeling slightly wired or slightly sleepy, dry mouth, sweating, and changed sleep — lighter, or more vivid dreams. For anxious people there’s often a short window of feeling more anxious, not less, which is the medication's activating effect arriving before its calming one. These are the common early effects listed on the prescribing information, they are the reason the dose starts low, and for most people they fade within the first one to two weeks.

What the first week doesn’t usually bring is improvement in mood or anxiety. That comes later, and the gap between side effects arriving and benefit arriving is exactly where people give up. The early follow-up exists to cover that gap.

How long Lexapro takes to work

Sleep, appetite and energy are often the first things to shift, sometimes within the first week or two. Mood and anxiety usually take longer — several weeks at a steady dose before the change is clear, and the full effect can take longer still. If nothing at all has changed after a proper trial at an adequate dose, the plan is adjusted: the dose, or the medication. What is not done is stopping after ten days because nothing has happened yet.

Side effects that matter

  • Sexual side effects — reduced desire, difficulty with arousal or orgasm — are common with SSRIs, often persist while the medication continues, and are worth raising rather than enduring; there are ways to address them
  • Escitalopram carries the antidepressant class warning about suicidal thoughts in children, adolescents and young adults; new or worsening thoughts of self-harm at any age are a reason to contact your prescriber the same day, or 988 or 911 if you are in danger
  • Marked agitation, restlessness, a racing heart, high fever, confusion or muscle twitching are not normal first-week effects and need urgent contact — especially if you take other medications that act on serotonin
  • Escitalopram can affect heart rhythm in some people and interacts with certain other medications, which is why your full medication list, including supplements, is reviewed before it is started
  • Alcohol is best avoided while starting it; it worsens the side effects and undercuts the benefit

What starting Lexapro at NCNE involves

The evaluation decides whether an antidepressant is the right step at all, and if so which one; escitalopram is often chosen for anxiety because it’s well tolerated and has few interactions. The prescription goes electronically to your pharmacy. A follow-up is scheduled early — in the first few weeks, when side effects are peaking and benefit hasn’t yet arrived — and then at the point where the effect should be clear. Dose changes happen at visits, not by guesswork, and nothing is stopped abruptly: escitalopram has a discontinuation syndrome, which is why there’s a separate page on coming off it.

Common questions

What are the first-week side effects of Lexapro?
Mild nausea, headache, feeling slightly wired or slightly drowsy, dry mouth, sweating, lighter sleep or vivid dreams, and — for anxious people — often a brief increase in anxiety before it settles. These are the common early effects on the prescribing information; most fade within one to two weeks.
How long does Lexapro take to work?
Sleep, appetite and energy often shift within the first week or two. Mood and anxiety usually take several weeks at a steady dose, and the full effect can take longer. Judging it before then is judging it too early.
Does Lexapro make anxiety worse at first?
It can, briefly — the activating effect tends to arrive before the calming one. That’s why it’s started low, why the first follow-up is early, and why an as-needed non-habit-forming option is sometimes provided for the first couple of weeks. It usually settles.
Can I drink alcohol on Lexapro?
The prescribing information advises against it. In the first weeks alcohol worsens the side effects — the drowsiness and the nausea — and over the longer term it undercuts the benefit. It’s a conversation worth having honestly at the evaluation rather than a rule to break quietly.
What if I miss a dose?
Take it when you remember unless the next one is nearly due, in which case skip it; do not double up. A single missed dose is usually noticed as mild discontinuation symptoms the next day and nothing more. Repeated missed doses are worth mentioning, because they may mean the timing or the medication isn’t working for your day.
Lexapro or Zoloft?
Both are SSRIs with similar effectiveness for depression and anxiety. Escitalopram is often chosen for anxiety and for people on other medications, because it has few interactions; sertraline has more evidence in some specific conditions and a slightly different side-effect profile. The choice is made at the evaluation from your history, not from a general ranking.
How do I find out whether this is right for me?
At an evaluation. NCNE's first visit is a 60-minute video appointment that covers your symptoms, history, past treatments and what you’re hoping will change; Lexapro is one of the options weighed there, against the alternatives and against not medicating at all. You leave with a plan you helped write, and nothing is started until you understand what it does and doesn’t do.

Sources

  • U.S. Food and Drug Administration. Prescribing information for escitalopram (Lexapro) — indications, warnings and adverse reactions. DailyMed

This page is general information, not a prescription or a recommendation for you. Whether any medication is right for you, and how it would be started, adjusted or stopped, is decided at an evaluation with a prescriber who knows your history. Do not start, change or stop a medication on the strength of a webpage.

Related: Starting Zoloft · How to taper off Lexapro · Your first psychiatric evaluation

If you are in immediate danger, call 911. For urgent emotional support at any hour, call or text 988(Suicide & Crisis Lifeline). Telehealth visits and this website are not an emergency service.

Thinking about starting an antidepressant, or struggling with the first week of one? Book a telehealth evaluation with Laura Gabriel, PMHNP-BC, or send a message and we will respond within two business days.

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