Major Depression Eased with High Doses of Lexapro

Poor response to treatment is an unfortunate reality for many people with major depression (MDD). By some estimates, as few as 30% of people with MDD achieve complete and lasting remission of symptoms. Primary care physicians deal with this lack of treatment response in one of three ways: They may increase the dosage of an antidepressant medication, add a secondary medication, or switch to an alternative medication.

Dosage increases are often the first choice, assuming higher doses remain within reasonable safety parameters. Because of its unique chemistry, the selective serotonin reuptake inhibitor Lexapro (escitalopram) is an ideal candidate for dose escalation. Whereas other antidepressants reach a sort of effectiveness plateau, Lexapro’s mechanism of action becomes stronger in proportion to dose.

Lexapro is approved for daily doses of not more than 20 mg. In practice, however, doctors have prescribed up to 50 mg for patients showing no response to lower dosages. That said, little evidence exists on whether successively higher doses represent a good balance between efficacy and safety.

A recent investigation in Scotland sought to answer this question. A starting group of 60 people diagnosed with MDD was switched from Celexa (citalopram) to Lexapro for a 32-week period. At regular intervals, Lexapro dosage was increased up to a maximum of 50 mg or until remission of symptoms. Researchers employed standard psychological measures to quantify severity of depression and occurrence of side effects.

Results from the study revealed few problems with safety or tolerability of high-dose Lexapro. However, overall effectiveness was somewhat less than desirable. Of the 60 participants, 18 dropped out because of adverse effects or lack of efficacy. Most of these withdrawals happened earlier in the study, before reaching the higher dose levels.

Half of study participants experienced remission of symptoms. Thirty-eight percent of those required a dosage of 50 mg. At doses higher than 40 mg, side effects became more pronounced although not necessarily more severe. Diarrhea was the most frequent complaint for those at doses of 40-50 mg. Other common side effects included headache, nausea, fatigue, and dizziness.

Larger, more controlled studies will be useful in ascertaining whether the benefits of high-dose Lexapro outweigh the risks. The Scotland study indicated only marginal effectiveness, although participants generally tolerated the high doses of medication. It should be noted, of course, that the population in question has a history of poor response to treatment. It’s unlikely that any one avenue will prove beneficial to all.

References:

  1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Escitalopram. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000214/
  2. Wade, A., Crawford, G., Yellowlees, A. (2011). Efficacy, safety and tolerability of escitalopram doses up to 50 mg in major depressive disorder (MDD): an open-label, pilot study. BMC Psychiatry, 11, 42. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068950/?tool=pmcentrez

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  • 22 comments
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  • Patrice

    Patrice

    June 20th, 2017 at 5:32 AM

    I have been on 40mg for 14 years and it’s the ONLY thing that has ever worked!!!!!

  • Debbie

    Debbie

    July 6th, 2017 at 4:21 PM

    Hi Patrick, did you have any problems with your Dr increasing your levels? I’m on 20mg a day of escitilapram and feel I need it increasing, iv tried Everything I mean everything and it’s the only one that’s worked for me but I feel I’m just not there yet XXX

  • Moira

    Moira

    September 1st, 2017 at 8:45 AM

    Hi Patrice. I have been on 20mg for about same time. Feel I need to increase dose. Do you have any side effects at the higher dose?

  • Kylie

    Kylie

    February 18th, 2018 at 2:43 PM

    I have been on 40mg for 3 years suits me. Was on pristiq 200mg back in 08 as I was in a dark place over the years pristiq and I grew differently I wasn’t in the dark place anymore and it skyrocketed me , I lost family members over my medication, I have uncontrollable out burst, my doctor wouldn’t change my medication he kept saying give it time as I wanted it reviewed. A very dear friend took me to another doctor and he put me on escitalppram was on lower doses at first but before I knew it I was so much happier, a few things have happened and it’s up to 40mg. But I have 90% better days then I us3d too that’s for sure. Even my partner loves the new me even more x

  • ana

    ana

    February 23rd, 2018 at 12:32 AM

    i will increase my dose to 40mg and then iwill offer my response to the change.

  • tom

    tom

    March 18th, 2018 at 8:57 AM

    i’ve been on escitalopram/lexapro for 6.5 years ranging from 20mg-50mg. I can’t really tell a difference between jumping from 40mg to 50mg, but I definitely noticed a benefit from 20 mg to 40mg. Right now I take 30mg, a little bit less than full benefit for me, so I can increase if needed during stressful times.

  • Larry S.

    Larry S.

    March 27th, 2018 at 4:45 PM

    I have been on 20mg of escitalopram for 20+ years for anxiety disorder with no noticeable side effects, But at a healthy 77 I feel I need a higher dose to eliminate Type A “floating hostility”.
    I experimented for a couple of weeks taking 30 mg by cutting the pill in halh and felt great, i.e. normal, no hostility. But I couldn’t continue doing this as I would run short at some point.
    The problem I face is that, as the FDA appoved maximum daily dose is 20mg, my physician refuses to prescribe higher. Also my insurance company will not pay for higher than 20mg. The latter is not a financial issue as I would be willing to pay for an additional 10mg pill of escitalopram or Lexapro out of pocket. But again, I cannot get my doctor to prescribe higher than 20mg.
    Have others faced this problem and solved it? If so I would appreciate your comments. Thank you,
    Larry

  • tom

    tom

    March 28th, 2018 at 7:36 AM

    Hi Larry- some doctors won’t go over the FDA max. If you want to go to a higher dosage you will have to find another doctor that will prescribe higher. There are plenty that do.
    Good luck
    Tom

  • Larry

    Larry

    April 27th, 2018 at 7:34 AM

    Thanks for your response Tom.
    I’m seeing another Dr. today.
    Hope he will prescrbe higher dose.

  • Larry

    Larry

    May 24th, 2018 at 9:10 PM

    Tom, I found a Dr. that was willing to prescribe 40 mg. Of Escitalopram. I had found 30mg. was needed vs. the 20mg. that I had been taking for years but lately was not enough (see above). But since the new Dr. prescribed 40mg. I tried that dosage for a week thinking more might be better. It was not! It was like I was on nothing. I became more impatient, irritable and more argumentive in general. So I went back to 30 mg. and
    felt more normal as described above.

  • Michael

    Michael

    May 21st, 2018 at 4:52 PM

    I am on 20 mg of Lexapro..not sure it is helping my psychiatric problem..maybe relaxing me abit..maybe.

  • Frances

    Frances

    June 13th, 2018 at 8:28 AM

    I have been on Escitalopram for ten years. I gradually went up to 20 mg, and then when I had my two kids, I went up to 30mg. This past year has been very stressful, so my doctor put me on 35mg, but I’m still feeling out-of-control. Obsessive thinking and anxiety. He won’t put me up to 40mg, but I’m wondering if 35mg is too high and that’s why I’m feeling this way and I should go back down to 30mg or if I am just in a stressful period. I was also thinking of adding Wellbutrin. Anyone combined those two?
    Thanks,
    Frances

  • Thomas Fink

    Thomas Fink

    June 16th, 2018 at 2:06 PM

    Frances
    I didn’t love wellbutrin, it seemed to make me edgy and tenser. However, for some people it works very well. The positives are it doesn’t have the sexual side effects that straight SSRIs have. It acts on some different brain chemicals including dopamine which can decrease appetite , I lost a bunch of weight on it. People also use it help quit smoking,

  • Michael

    Michael

    June 16th, 2018 at 9:21 PM

    I am not sure Lexapro helps my psychiatric problem ..but it is good I am on it..I think..when I gave my life too Jesus..a long time ago I received the Holy Spirit..the Holy Spirit helps me in more ways I can imagine..ministering his Peace and joy..thank God..

  • Debra

    Debra

    June 26th, 2018 at 11:10 PM

    Glad to hear you found Jesus Michael! Praise God!

  • Deidre M.

    Deidre M.

    September 1st, 2018 at 5:48 PM

    I live in Victoria, Australia in rural Ballarat. My GP is an EARTH ANGEL. I have been on 20mg Lexapro for many years. Due to being really unwell with nausea and dreadful brain fog (I have incrable cancer) my GP prescribed Haloperidol for nausea. It is often used for cancer patients for nausea. Sadly it has a side effect of WEIGHT GAIN. For 8 years I took Risperdal for my mental health issues and put on 33 kilos. I was so depressed at the massive weight gain (I have an eating disorder) I weaned off the Risperdal and the weight fell off me and I was back to my normal weight in no time. I took the Haloperidol yesterday. (.5mg twice daily) Today I CANNOT bring myself to take it despite how much it helped. Tomorrow I will speak to my GP and ask if maybe an increase in my Lexapro would help. She is the most caring person I know and so badly wants to help me. I wish everyone could have a GP so caring. Love to everyone reading this and thank you for your comments regarding your experiences with the different dosages of Lexapro. It has been a huge help to me.xxx

  • Tom

    Tom

    September 2nd, 2018 at 10:02 AM

    Hi Deidre. I’m Not familiar with all of those meds. but for me I notice major benefit increasing dose over 20mg even though they say that should be max dose. I’m taking 40mg. Yes 40mg. For me, No additional side effects, just less depression. Lexapro is truly a special drug for depression, and a decent one for anxiety.

  • Sharon

    Sharon

    September 11th, 2018 at 2:27 PM

    It’s been great reading everyone comments. A big help!

  • sharon

    sharon

    September 11th, 2018 at 2:31 PM

    Dear Tom: I am on 30 mg of lexapro and they added Sam-e to try to take. I was concerned about going up on the Lexapro to 40. Did it help you right away way you upped your Lexapro…or did it take a few weeks?

  • Tom

    Tom

    September 11th, 2018 at 2:43 PM

    Hi Sharon
    The increase in dose was felt quickly, within a few days. I’ve never tried that supplement but have heard some good things. If you go the OTC supplement route let us know what you think. It might be a good option for those who can’t or don’t want to increase Lex.

  • Rob

    Rob

    September 19th, 2018 at 5:34 PM

    Hey everyone!!! So glad I came across this string! I have been on lexapro 20mg for 8 years due to panic disorder and anxiety. Recently the lexapro has slowly lost its full effect as I fear my body has become used to it. So my doctor added 300mg if Wellbutrin a day. Worst mistake ever! Day one and two I felt amazing but Day 3 I was tense and anxious and had one of the worst anxiety attacks of my life. It was like I could take control just trembling and shaking. However everyone reacts differently. I have found hundreds of comments from Wellbutrin users that it increases anxiety, causes tension, and puts them on edge like drinking two pots of coffee. Not for me!!! However now we are going to try adding buspar to it to see where that takes it!!! Anyone have success with buspar? If not just say no don’t tell me horrible details bc then I’ll just be that much more anxious!!! Thanks!!

  • Tom

    Tom

    September 20th, 2018 at 8:27 AM

    Hi Rob

    I’m very surprised WB was prescribed for your anxiety. I have no experience with buspar. For breakthrough panic attacks Dr’s usually go to Xanax as long as you don’t have a history of substance abuse. It’s very effective but It’s not something taken daily though, only fir real panic not just daily anxiety.Let us know how buspar is.

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