What About Lexapro? Can It Cause Insomnia?
“Not long ago, in response to a spell of insomnia, I learned some of the principles of meditation, to empty my mind piece by piece. It was like the old game of jacks – cautiously lifting each jack clear of its neighbor until only the empty background remained.”
Yes. In fact, insomnia is one of the most common side-effects of Lexapro.
Lexapro, also known as escitalopram, is a popular antidepressant used to treat anxiety and depression. This medication was initially approved, by the FDA in the early 2000s, to treat depression; however, it has also become a go-to drug for anxiety. As a result, it is now used by a wide-range of depressed and anxious individuals.
It is important to understand that most antidepressants come with side-effects, like insomnia and other sleep challenges. However, it is equally important to understand that not all people who use Lexapro will experience insomnia. In other words, Lexapro is dependent on the individual and a variety of factors, such as your body chemistry, health, lifestyle habits, and age.
Because insomnia is one of the most common side-effects of Lexapro, it is important to know the ins-and-outs of this medication, if you have been prescribed it for anxiety or depression and/or have a hard time falling and staying asleep at night.
The goal of this article is to help you understand how Lexapro works, the relationship between Lexapro and sleep, and ways to combat “sleeplessness” or insomnia, if you and your doctor deem this medication to be the best course of action for your mental health issues.
What is Lexapro?
Lexapro is a selective serotonin reuptake inhibitor (SSRIs). Lexapro is used to alter your serotonin production. Serotonin is a hormone/neurotransmitter that can ease your nerves and balance your mood, so you don’t feel anxious or depressed. Thus, serotonin is responsible for the happy and joyful feelings you experience.
Serotonin also plays a crucial role in regulating your brain activity. As such, it can impact a wide-range of bodily functions, such as your mood, mental health, and ability to get sound sleep. SSRIs, like Lexapro, prevent your blood from absorbing the high levels of serotonin residing in your brain.
Because serotonin is responsible for feelings of happiness and well-being, a higher level of serotonin in the brain can lead to lower levels of anxiety and depression. Thus, Lexapro is an extremely effective antidepressant. In fact, researchers have found that it is one of the most effective ways to treat clinical depression, mood disorders, and anxiety.
What Does Lexapro Treat?
Although Lexapro is commonly used to treat generalized anxiety disorder (GAD) and clinical depression or major depressive disorder, research suggests that it is also effective for other “off-label” conditions, such as bipolar disorder, disruptive mood dysregulation disorder (DMDD), obsessive-compulsive disorder (OCD), cyclothymic disorder, panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder, migraines, seasonal affective disorder (SAD), premenstrual dysphoric disorder, depression due to a chronic or terminal illness, depression due to substance abuse or addiction, and chronic pain.
How Long Does It Take for Lexapro to Work?
You should start to notice an improvement in your anxiety or depression symptoms within 1-2 weeks; however, it may take 6 weeks or more before you experience the full-effects of Lexapro. Thereby, it is imperative that you take this medication, as prescribed, to reap the full-benefits of it.
Is Lexapro Suitable for Long-Term Use?
Lexapro is suitable for long-term use. Although Lexapro is promoted as a short-term remedy for anxiety and depression, researchers have found that it is also suitable for long-term use (8+ weeks) for these conditions.
What Do the Experts Say?
While some experts assert that Lexapro can help some depressed and anxious individuals, others disagree, highlighting the most common side-effect as insomnia. Thus, the results have been mixed.
Safety & Effectiveness
A 2016 study compared Lexapro and Paxil and found that Lexapro is safer and more beneficial for depression and anxiety than Paxil and other antidepressants. Similarly, a large-scale scientific review found that Lexapro is not only effective for anxiety and depression; but also more effective than other antidepressants.
A previous study found that temporarily using Lexapro for generalized anxiety disorder (GAD) may actually improve insomnia in some people with GAD. Similar to the 2007 study, a 2011 meta-analysis found that depressed insomniacs may experience positive changes in their sleep cycles, such as increased sleep latency and REM sleep, frequent night awakenings, and reduced slow-wave sleep and REM latency after using the medication. Thus, researchers have concluded that antidepressants may help some people with anxiety or depression get uninterrupted sleep, through shortened REM latency and lengthened REM sleep.
A 2021 study found that the primary side-effect of using Lexapro is insomnia, especially in females, over the age of 59, who have used the medication less than 30 days. Similarly, a 2014 study found that 60% of its participants experienced at least one side-effect, such as insomnia, while taking Lexapro. Still, researchers suggest that Lexapro is one of the most tolerable SSRIs on the market.
Does Lexapro Have Side-Effects?
Yes, it does.
In fact, Lexapro has a lengthy list of side-effects. But most medications do have side-effects. Regardless, experts generally agree that the possibility of side-effects should not be a reason to avoid from or stop Lexapro – if you need it. If you start to experience side-effects consult your doctor.
The most common side-effects of Lexapro include:
- Sudden weight gain – Weight gain is a common side-effect of most antidepressants and Lexapro is no exception. It is important to note, however, that you may initially experience a sudden loss of weight. SSRIs can lead to reduced hunger; however, this decrease in appetite is usually temporary, lasting no more than a few weeks at the most.
Once your body becomes acclimated to the medication, you may become hungrier and notice an uptick in your weight. If this occurs, do not fret, there are things you can do to manage your weight and limit weight gain. Adopting a healthy diet (limiting fat, salt, and sugar) and ramping up your exercise routine can help you get a grasp on your weight. If you experience sudden weight gain, consult your doctor for tips on how to control your weight.
- A low sex drive – Most, if not all, SSRIs, have the potential to trigger sexual side-effects, such as a low sex drive (libido). When you have a low sex drive it may take you longer to have an orgasm or you may become disinterested in sex and/or sexual activities.
Unfortunately, this side-effect can pop-up at any time while you are on Lexapro – days, weeks, or months after beginning it. It is important to note, however, that depression can also cause sexual dysfunction, so it’s important to know what’s “normal” for you. If you start to notice changes in your sexual function, including your sex drive, consult your doctor.
- Insomnia – If you develop a habit of staying up late, scrolling Facebook, Instagram and/or TikTok because you can’t sleep, it’s probably a side-effect of Lexapro. Insomnia is one of the most reported side-effects of Lexapro, especially in the early stages of treatment. The good news is this side-effect only lasts a short time. Once your body becomes acclimated to the medication, you should be able to get some much-needed zzz.
- A dry mouth – Another potential side-effect of Lexapro is a dry mouth, often referred to as “cotton mouth.” This may not seem like a big deal, and in the grand scope of things, it’s probably not, but feeling like you just chewed a handful of cotton can be quite annoying.
The FDA reports that approximately, 10% of people who take Lexapro for anxiety or depression experience a dry mouth. Keep in mind that the probability that you will experience Lexapro side-effects increases as the dose increases. A good way to keep this particular side-effect under wraps is to use xylitol-based mouthwash to keep things moist.
- Wooziness – Truth-be-told, the last thing anyone wants to feel is woozy, dizzy, and/or disoriented. Unfortunately, however, Lexapro can make you feel drowsy. As a result, experts recommend that you avoid driving or operating machinery if you experience this side-effect.
The wooziness is usually temporary only occurring the first few weeks after beginning the medication. Best course of action? Taking a 30–60-minute nap after using the medication or being active can help ward-off that sleepy feeling.
- An upset stomach – An upset stomach is never pleasant. So, it is important to know in advance that you may get one once you start taking Lexapro. Planning for possible gastrointestinal distress can help ease or alleviate “changes” in your digestive tract (gut), so you don’t end up feeling like you have a “stomach bug,” complete with nausea, vomiting, and diarrhea. The good news is this side-effect is typically mild only lasting 5-7 days. What can you do in this situation? Try taking the medication with food.
- Behavioral changes – Lexapro is designed to ease or alleviate anxiety and depression symptoms, however, sometimes, this medication can aggravate these conditions. Some Lexapro users report feeling hopeless and helpless, irritable, moody, angry, paranoid, and/or suicidal after using the medication, although these serious side-effects are rare. If you experience changes in your behavior after beginning Lexapro, call 911 or contact your doctor asap.
What is the Relationship Between Lexapro and Insomnia?
According to the FDA, approximately 5% of people who use Lexapro for anxiety or depression experience insomnia during the initial stage of treatment. So, if Lexapro is preventing you from falling and/or staying asleep at night, you aren’t alone. Conversely, there is also evidence that Lexapro helps some people with anxiety or depression get sound sleep.
In fact, a 2012 study found that Lexapro can help perimenopausal and menopausal women get the sleep they need to function properly the next day. Lexapro affects your brain function and hormone levels to calm your mind and ease anxiety or depression.
Because this medication alters how your brain and body function, there is a risk that it will also affect your sleep/wake cycle (circadian rhythm) and REM sleep. This can either keep you up at night or help you get the rest your body needs to repair itself. The effect of Lexapro on your sleep quality largely depends on your body chemistry. Thus, ultimately, Lexapro and sleep quality studies have garnered mixed results.
Note: Understand if you experience insomnia after beginning Lexapro treatment for your anxiety or depression, it may not be due to Lexapro. Remember, anxiety and depression can also keep you up at night. However, if it is determined that Lexapro is the cause of your insomnia; this side-effect is usually temporary.
On the flip side, however, this also means that you may continue to experience anxiety, depression, and/or sleep issues for a few weeks after starting Lexapro. Like most antidepressants your body needs time to adjust to the medications before you start “seeing” the results.
When Will Lexapro Insomnia Go Away?
Some anxious or depressed insomniacs reported an improvement in sleep quality within a month of starting Lexapro – regardless of if the insomnia was caused by the medication or the condition. Others have reported suffering from insomnia up to a year or more after starting the medication. If the insomnia persists beyond a month or two, consult your doctor. He or she may prescribe a mild sleep aid like trazodone or hydroxyzine to help you fall and stay asleep at night.
What Are Some Ways I Can Avoid or Lessen the Lexapro Insomnia?
Truth-be-told, being unable to fall and stay asleep each night can be extremely taxing, and even more so, if you struggle with anxiety or depression. The good news is there is hope. In other words, there are ways you can get the sleep you crave.
Listed below are ways you can lessen Lexapro insomnia:
- Take your Lexapro dose in the morning – If getting sound sleep is challenging, try taking the medication in the morning, instead of in the evening or at night. But before you alter your treatment plan, consult your doctor.
- Refrain from indulging in coffee or other caffeinated beverages late in the day – Studies suggest that caffeine has the ability to stay in your system for a long time. As a result, if you consume it too late in the day, it can prevent you from falling asleep at night. A good way to prevent insomnia is to cut-off your caffeine consumption by 2-3 pm each day.
- Move around – A good way to ward-off Lexapro insomnia is to move around – exercise, dance, swim, participate in sports, etc. Staying active not only helps you fall asleep at night (from exhaustion), it can also calm your nerves and trigger a sense of well-being, thereby, reducing anxiety and easing depression – so you can peacefully fall asleep. According to experts, exercise not only eases depression and anxiety symptoms, but also helps you get some much-needed sleep.
- Limit your alcohol intake – If you take Lexapro for anxiety or depression and it is affecting your sleep quality, you may need to limit your alcohol intake, if you want to sleep better at night. Alcohol can worsen anxiety and depression and prevent you from getting sound sleep.
- Put down your smartphone and turn-off your television – If you find yourself up in the middle of the night playing games, watching videos on your phone or scrolling on social media sites – instead of sleeping, you’ll need to put down your smartphone and turn-off your television.
These devices are deceptive. They trick your body into believing its daytime, when it’s not. This prevents your body from producing the melatonin needed to help it shut down for the night. So, about an hour before bed turn-off your devices and take a warm bath or read a good book.
- Invest in an online sleep program – Online sleep programs not only help ease your anxiety and depression, but also help you fall and stay asleep at night – all in the comfort of your home. Sleep tools, like Somnus Therapy, can improve your sleep quality, even if you suffer from Lexapro insomnia.
Somnus Therapy uses cognitive-behavioral therapy for insomnia (CBT-I) to help you identify distressing thoughts and behaviors that could be affecting your sleeping patterns. Thus, the goal of this sleep program is to replace distressing and anxious thoughts with calmer, more positive ones that promote quality sleep.
Note: If you continue to experience Lexapro insomnia after making lifestyle changes, consult your doctor. Your doctor may adjust your Lexapro dosage, depending on the frequency of your insomnia and the severity of your condition. In some cases, your doctor may switch you to another antidepressant – one that can help you fall and stay asleep at night, but also treat your anxiety of depression.
Can Stopping or Reducing Lexapro Also Trigger Insomnia?
It takes time for Lexapro to accumulate in your body. Therefore, it may be a month before you notice an improvement in your depression or anxiety symptoms and/or any side-effects. However, the worst thing you can do at the beginning of treatment is abruptly stop the medication, because doing so could lead to horrible Lexapro withdrawal symptoms (like insomnia).
According to a recent study, approximately 20% of anxious or depressed people experience withdrawal symptoms after abruptly stopping or reducing their use of Lexapro. Because of Lexapro’s slow build-up in your blood and body, you can experience Lexapro withdrawal symptoms, even if you only used it for a few days.
Lexapro withdrawal symptoms stem from its impact on your brain. Keep in mind that the goal of SSRIs is to boost your serotonin levels, the hormone/neurotransmitter responsible for your feelings of happiness and well-being. High levels of serotonin signals to your brain that it’s time to “close up shop for the night.”
Your brain then sends the message to your body, which begins the “shutdown process,” so you can rest. The goal of this process is to cut-off any stimulation that could keep you up. When Lexapro is abruptly stopped, it can cause your serotonin levels to plummet, causing insomnia and wakefulness. Lexapro withdrawal symptoms vary from person-to-person. But, while some people experience these symptoms, others may not.
The following factors can influence if and when you will experience Lexapro withdrawal insomnia:
- Length of time on Lexapro or other SSRIs
- The dosage
- Quickness of reducing or stopping Lexapro
Note: People, who have taken SSRIs, like Lexapro, in the past or who used have used Lexapro for a prolonged amount of time, have the highest risk of withdrawal insomnia. Understand that Lexapro withdrawal insomnia can last for several weeks or months.
How Can I Prevent, Reduce or Alleviate Insomnia Withdrawal Symptoms?
- Do not reduce or stop Lexapro until you have spoken with your doctor and developed an alternative treatment plan. Depending on the severity of your insomnia and other withdrawal symptoms, your doctor may recommend a “tapering process” to help reduce your symptoms. Or, he or she may prescribe an alternate medication.
- Adopt a healthy diet.
- Stay active and busy.
- Exercise regularly.
- Take the medication as prescribed.
- Adhere to the “tapering process.”
- Notate any changes in your mood and behavior and share them with your doctor.
- Tell your doctor about any new withdrawal symptoms that arise as you wean-off the medication.
- Lean on your friends and loved ones for support.
- Join a Lexapro support group.
- Practice mindful meditation, visualization, and/or yoga.
- Spend time with friends and loved ones.
- Engage in an online sleep program.
- Practice deep-breathing exercises.
Antidepressants (SSRIs), like Lexapro, can trigger a host of side-effects, such as insomnia. However, researchers also suggest that it can help some anxious or depressed individuals finally get a good night’s rest. So, although Lexapro can negatively affect your sleep quality, there is a chance it may actually improve it.
It is also important to keep in mind that anxiety and depression can also cause “sleeplessness,” so it is possible that it is not Lexapro that is causing the insomnia. It could be your condition that is keeping you up at night. In this case, the insomnia may not improve until the medication has accumulated in your body and your anxiety or depressions symptoms have abated.
When using Lexapro, patience is the key. There are things (i.e. yoga, deep-breathing, online sleep programs, reading, etc.) you can do to relieve side-effects, like insomnia. The good news is there are ways to relieve your anxiety or depression symptoms and still get a good night’s sleep!
EHealthMe. (2021). Lexapro and insomnia – A phase IV clinical study of FDA data. Retrieved from https://www.ehealthme.com/ds/lexapro/insomnia/
Cochrane, Z. R. (2019). Lexapro withdrawal: Everything you need to know. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/325620
Gabriel, M., & Sharma, V. (2017). Antidepressant discontinuation syndrome. CMAJ: Canadian Medical Association Journal, 189(21), E747. Retrieved from https://doi.org/10.1503/cmaj.160991
Clark, M. S., Smith, P. O., & Jamieson, B. (2011). Antidepressants for the treatment of insomnia in patients with depression. Am Fam Physician, 84(9). Retrieved from https://www.aafp.org/afp/2011/1101/od1.html
Allgulander, C., Jørgensen, T., Wade, A., François, C., Despiegel, N., Auquier, P., & Toumi, M. Health-related quality of life (HRQOL) among patients with generalized anxiety disorder: Evaluation conducted alongside an escitalopram relapse prevention trial. Current Med Res Opinion, 23(10), 2543-2649. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17825130/
Living with Anxiety. (2020). Anxiety medication overview of Lexapro. Retrieved from https://www.livingwithanxiety.com/articles/drugs-and-medication/lexapro-for-anxiety
Wong, J., Motulsky, A., Abrahamowicz, M., Eguale, T., Buckeridge, D. L., & Tamblyn, R. (2017). Off-label indications for antidepressants in primary care: Descriptive study of prescriptions from an indication based electronic prescribing system. BMJ, 356, j603. Retrieved from https://www.bmj.com/content/356/bmj.j603
US Food & Drug Administration. (2014). Escitalopram (marketed as Lexapro) information. Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/escitalopram-marketed-lexapro-information
Drugs.com. (2021). Lexapro. Retrieved from https://www.drugs.com/lexapro.html
Hormone Health Network. (2021). What is serotonin? Retrieved from https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/serotonin
Fink, J. (2018). Selective serotonin reuptake inhibitors (SSRIs): What to know. Healthline. Retrieved from https://www.healthline.com/health/depression/selective-serotonin-reuptake-inhibitors-ssris
Höschl, C., & Svestka, J. (2008). Escitalopram for the treatment of major depression and anxiety disorders. Expert Review of Neurotherapeutics, 8(4), 537-52. Retrieved from https://www.researchgate.net/publication/5435314_Escitalopram_for_the_treatment_of_major_depression_and_anxiety_disorders
Wong, J., Motulsky, A., Abrahamowicz, M., Eguale, T., Buckeridge, D. L., Tamblyn, R., et al. (2017). Off-label indications for antidepressants in primary care: Descriptive study of prescriptions from an indication based electronic prescribing system. BMJ, 356, j603. Retrieved from https://www.bmj.com/content/356/bmj.j603
Kennedy, S. H., Andersen, H. F., & Lam, R. W. (2006). Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: A meta-analysis. Journal of Psychiatry & Neuroscience, 31(2), 122–131. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413963/
Hims. (2020). Lexapro and insomnia: What you need to know. Psychiatry. Retrieved from https://www.forhims.com/blog/lexapro-insomnia
Kupfer, D. J. (1976). REM latency: A psychobiologic marker for primary depressive disease. Biology Psychiatry, 11(2), 159-74. Retrieved from https://pubmed.ncbi.nlm.nih.gov/183839/
National Sleep Foundation. (2020). What is REM sleep? Retrieved from https://www.thensf.org/what-is-rem-sleep/
Stevens, S. & Hening, W. A. (2007). Chapter 2 – Sleep and wakefulness. Textbook of Clinical Neurology (Third Edition), 21-33. Retrieved from https://www.sciencedirect.com/science/article/pii/B9781416036180100025
Peters, B. (2020). Sleep latency and its impact on your sleep. Very Well Health. Retrieved from https://www.verywellhealth.com/sleep-latency-3014920
Ensrud, K. E., Joffe, H., Guthrie, K. A., Larson, J. C., Reed, S. D., Newton, K. M., Sternfeld, B., Lacroix, A. Z., Landis, C. A., Woods, N. F., & Freeman, E. W. (2012). Effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes: a randomized controlled trial. Menopause, 19(8), 848–855. Retrieved from https://doi.org/10.1097/gme.0b013e3182476099
Sleep Foundation. (2020). Alcohol and sleep. Retrieved from https://www.sleepfoundation.org/nutrition/alcohol-and-sleep
Institute of Medicine Committee on Military Nutrition Research. (2001). Caffeine for the sustainment of mental task performance: Formulations for military operations. Pharmacology of Caffeine, 2. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK223808/