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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  • 44 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?

  • Lisa P.

    Lisa P.

    January 15th, 2019 at 7:21 AM

    My doctor has me on 20 mg of escitalopram and refuse to up my mgs and I’ve spoked to her several times that i feel that it needs to be a higher dose so instead she prescribes another medication to go with it and im still not where i feel where i should be.. So is it safe to take a higher doses escitalopram ??

  • 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

  • Emma

    Emma

    May 3rd, 2019 at 6:37 PM

    Hi Patrice
    I cannot believe it. I’ve been on 20MG Lexapro for about 23 years. It is the only thing that has kept me from going way, way down, but it hasn’t gotten me over either. I was told by my doctor 10 years ago that I could not take more than 20 MGs because it would affect my heart. I told him I needed it. I was feeling worse than usual. Like the others, I’ve used other meds but no help (except a couple of them made me fat). Not good. Today, I was feeling like crap and I had already taken my 20MG pill and I just needed something else so I took another 20. Today, it may have been a little too much, but within 20 minutes, I felt happy, really happy (laughing, too much), but not feeling funky like I was. I couldn’t believe, so that’s when I started looking to see what the highest dosage for Lexapro is. I can’t believe that it can be upped to 50. I had to retire because of my depression. I was no where ready, but I had no choice. I just can’t believe it that maybe it could have been different. I just can’t believe it.

  • 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,

  • Frances

    Frances

    September 23rd, 2018 at 4:39 PM

    Hi again,
    My doctor has now switched me to Zoloft 75mg (we increased slowly) and put me down to 20 mg of Lexapro. I saw a significant change at the beginning and then I started a new job which made my intrusive thoughts return. I was going mad, but I have started extensive cognitive therapy for these intrusive thoughts and I have taken ativan when needed. I read on a zoloft site that it takes 6 weeks to see a change with Zoloft which is right about now for me. Most have suggested taking ativan during that 6 week shift as a lot of people become anxious during that time. All I can say is, after 8 years of being on Lexapro, it just wasn’t working and I think Zoloft might just be my answer. I am still on the lexapro at a lower dosage which my doc is trying out for now. I just thought I’d share.

  • 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!!

  • Frances

    Frances

    September 23rd, 2018 at 4:40 PM

    I’ve tried buspar. Not a great choice. It might be times to switch. I switched to Zoloft after 8 years on Lexapro, but you might need ativan here and there for the first 6 weeks as it causes anxiety before it really kicks in.

  • 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.

  • Sarah

    Sarah

    October 4th, 2018 at 8:04 PM

    I’ve been on generic Lexapro for some time at the 20 mg level, but it is no longer effective. I’ve considered asking for a bump-up of dosage, particularly when I read on one of the national health websites that lexapro at the 20 works best for mild to moderate major depressive disorder but that MDD that is more severe responds better to the higher dosage (40 mg) where it doesn’t for a more moderate form of the disorder. Apparently, that isn’t the case for most SSRIs, they do not usually work differently at higher doses. For those of us with Major MAJOR Depressive Disorder, maybe the higher dose is indicated.
    My concern is the interaction of some of the other drugs I take if I increase my dose, specifically trazodone and hydromorphone. I’ve read there is a warning about too much serotonin if these meds are mixed. I’m not sure what to do and I’m not sure my doctor really knows either. I am just searching the innertubes ;-) for information and found this site.
    It’s interesting to hear from so many of us with similar questions and advice. I appreciate reading your stories, it helps me make up my mind.

  • Thomas F.

    Thomas F.

    October 6th, 2018 at 2:18 PM

    Sarah- Speak to a doctor about mixing these meds, but from what I’ve heard is its quite difficult to develop serotonon syndrom. We’re talking many many multiples of the current max doses. They mention it to cover themselves. But first thing I said, speak to a doctor. Especially since opioids are involved.

  • Sarah

    Sarah

    October 6th, 2018 at 7:04 PM

    thanks for the advice.I will talk to my doc but these days, I have to do most of the research myself. If you want the correct medications and diagnoses, make sure you get a 2nd opinion or look it up, that’s my own advice. If I up the dose and notice a difference, I will come back and report that.

  • Eva K.

    Eva K.

    December 10th, 2018 at 7:35 AM

    My new psychiatrist was uncomfortable keeping me at 60mg of Celexa which was working for my depression and irritability. I’m going through a lot of life stresses right now and since I’m also ADHD and take Adderall XR the prescriptions for Ativan for any anxiety or Ambien for sleepless nights are out….I got them for a few months even though my situation is going to soon be more stressful. I wish I had saved them. Anyway, this is the last month I have in this area so she switched a LOT of my meds. Celexa to Lexapro…weekly drop of 20mgs Celexa to +10 lexapro. Nortryptyline at night…10 mgs start up to 50 if I want…And then Vistaril for anxiety.
    Vistaril gives me severe headache and asthma as well as knocking me out. It would be good for an hour or two of sleep at night if it didn’t cause so much breathing problems.
    Nortriptyline either takes about 8 hours to work or doesn’t work….It does cause some fluid retention and hyperglycemia. I am diabetic. I am at the 20 mg dose and MAY have to cut this one out because of the blood sugars.
    As for the switch to Lexapro, I guess that the final dose will leave me at 30mgs and so I hope that the next psychiatrist in the place I’m moving to will be okay with prescribing the higher dose. I AM having a lot of irritablity and some feelings of being overwhelmed and hopeless. I’ve kept my chin up so WELL besides feeling stressed before all of these changes….I can’t help wondering if I’m experiencing
    some withdrawals from the occasional benzodiazapine I used to take or the Ambien or the switch to Lexapro.
    Our family situation gets more intense in less than two weeks and I see my doctor one more time before leaving. Any thoughts or advice?

  • The Answer

    The Answer

    January 21st, 2019 at 4:44 PM

    SSri medication like lexapro boost serotonin levels, but too much or too little is bad. Too little leads to anxiety, depression, ocd, intrusive thoughts, rumination, panic attacks, etc, but too much will give you akathisia and anhedonia. This is why you need to very slowly increase or decrease your dose to find the right spot. Unfortunately most everyone because tollerant over time, but you want to increase your dose as slowly, 5mg at a time. I started out at 20mg, which for me was too high. I got akathesia, which most physicians cannot distinguish from anxiety and will often increase dosing. I took welbutrin with the 20 mg of lexapro. Welbutrin boosts norepinephrin and dopamine, which made me feel a lot better. However, as the lexapro started to loose affect over the years, the welbutrin began to cause increased anxiety, so I stopped taking it. Ive tried to start taking the welbutrin since, and it has caused panic attacks. So as you can see, it’s all about having every neurotransmitter very finely tuned if you want to feel good, and that’s a very hard thing to do, especially as the body is always changing.

  • Tom

    Tom

    January 22nd, 2019 at 10:12 AM

    The Answer- how do you know all this? Why hasn’t my doctor mentioned any of this? Everyone reacts differently to each med, dose, ect. We’re in the infancy of even understanding exactly how these meds work. They’re kind of guessing at this point, but it’s believed in most cases, the right SSRI can be if some help beyond placebo. With a name like The Answer, I’m not surprised you are confident in stating these things, but you’re probably just misinforming people.

  • Tom

    Tom

    January 22nd, 2019 at 10:40 AM

    The Answer- To add, a lot of your post was interesting. But it should be limited to sharing your own experience. You seemed to step out of that and explain how people will get a certain condition like Akathasia based on their dose. It might be true in some cases, but this isn’t proven , it may be just one thing you read sometime. Again, they are still kind of guessing. If it doesn’t work, try something else. Though they do know WB tends to be stimulating and anxiety producing , others it has exact opposite effect.

  • Eva K.

    Eva K.

    January 22nd, 2019 at 12:13 PM

    True about medications acting differently in different people. My Adderall XR is so calming, not quite sleep inducing, but even my blood pressure drops.

  • Tom

    Tom

    January 22nd, 2019 at 5:32 PM

    We know exactly how Adderall works. Only one way it’s reducing your BP: You have some emotional issues without it that are raising your BP. Adderall, while a ‘stimulatant’, actually tends to be calming because it hits dopamine hard, a feel good chemical. Which will then drop BP that is higher due to emotions; not diet, weight, ect. Ask yourself honestly, does it give you a some good or euphoric feeling? Are you much different if you don’t take it for a few days? Regular use of amphetamine salts (adderall) in the long run leads to worsened well being- emotionally, mentally, physically. Why not focus on what’s causing your emotions to elevate your BP, and use healthier alternatives to heal or manage it, instead of getting doped up? SSRIs, while sometimes difficult to wean off, are far more benign and can be part of a healthy long-term lifestyle, because they are believed to be easy on the body and subtle in mood effects.

    -Tom

  • Rob

    Rob

    March 5th, 2019 at 8:51 PM

    I have bipolar disorder been on Lexapro 30mg along with Lamictal this has helped tremendously. I still get depressed at times, but I can function. I don’t know if I will need to go up any more, but my pdoc says that in places like England they give up to 500mg of Lexapro

  • Tom

    Tom

    March 6th, 2019 at 9:41 AM

    Rob
    Think you meant 50mg not 500mg? And yes it’s not unreasonable to go as high as 50mg. You just get diminishing returns the higher it goes, and more side effects, mainly sexual from my experience. That’s why I keep it at 30mg which still causes side effects. It’s not bad at this level cause it you ‘last’ longer, but I’m still usually able to finish. At 50 I don’t i woukd be able to. And only slight benefit to mood beyond 30.
    I’m surprised your doc prescribed SSri for bipolar. I could see how it could help, but much more so on the depressive end. You can still get manic on SSRI. Maybe the lamictal is for the mania. Lithium usually works for mania too. There is an over counter version of lithium in US, as it’s a mineral, but it’s slightky different then the prescribed form. From studies, they have roughly the same efficacy, but with lower dose required on the otc version. No reason anyone should get a script for it, unless they want their intake strictly monitored by a doc.

  • Tom

    Tom

    March 6th, 2019 at 9:54 AM

    I retract the sentence of being surprised ur doc prescribed Lex for bipolar. I actually that is a common approach. There’s no 1 med solution yet. You need an SSRI like Lex and one for mania like lithium or lamictal

  • Lori

    Lori

    April 2nd, 2019 at 12:04 PM

    I have been on 20mg of lexapro for about 3 years and my doctor is increasing my dose to 30mg. My husband complains about me not being able to have an orgasm. Is this a primary side effect of lexapro and will it get worse with the increased dosage?

  • Thomas F.

    Thomas F.

    April 2nd, 2019 at 3:43 PM

    Of course it is. Not to be rude, but how is that you’re just asking this now after 3 years. Usually when someone starts to have trouble orgasming, its a big deal.. And what made you look into it is your husband complaining about you not? I guess it doesn’t bother you much Maybe sex isn’t that important to you. and yes higher the dose the worse it’ll get. speak with your doc

  • Lori

    Lori

    April 4th, 2019 at 10:07 AM

    Thank you for the feedback. I didn’t initially attribute my decrease in having an orgasm to taking Lexapro until I did some research on increasing you dosage and what some potential side effects may be.. I thought that since I just turned 50 and my libido is not what it used to be, it is to be expected…such is life. I will have a conversation with my doctor to see if there are other alternatives and take it from there. Thank you Debra for the encouragement. Your words were kind and sincere.

  • Debra

    Debra

    April 2nd, 2019 at 10:12 PM

    That is a potential side effect, but it hasn’t caused that with me sweetie. I would say to just relax & try not to think of that & enjoy what is going on at that moment…

  • Debra

    Debra

    April 3rd, 2019 at 8:47 PM

    Hello Thomas, sorry, was just trying to be helpful. Didn’t mean any disrespect. Actually, i think it’s more prominent with males than females, but i am not a doctor…
    Blessings

  • Debra

    Debra

    April 4th, 2019 at 4:58 PM

    Dear Lori, Thank YOU for the kind words! Of course i was addressing Thomas, but if i helped anyone else, that is a good thing! Hope u & ur Dr figure things out so that things may be better for you! God bless!

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