Escitalopram: This is how the antidepressant works
Escitalopram is an active ingredient that is often used in depression , anxiety and obsessive-compulsive disorders and other psychiatric disorders. But how does escitalopram work? What should be considered when taking or stopping, what dosages are recommended and what side effects are to be expected? Everything you need to know about the antidepressant can be found here.
What is escitalopram?
Escitalopram is an active ingredient that is used in particular to treat depression and is marketed in Germany as Cipralex®, among others. It is one of the antidepressants.
Within this large group, the active ingredients are further subdivided. Escitalopram belongs to the subgroup of monoamine reuptake inhibitors. Different groups of substances are distinguished within this group, whereby escitalopram belongs to the category of selective serotonin reuptake inhibitors (SSRI ). Serotonin is also known as the happiness hormone and a lack of it is considered a possible trigger of depression.
How does escitalopram work?
The complex name of selective serotonin reuptake inhibitors describes the effects of escitalopram very well. Escitalopram ensures that only (i.e. selectively) the neurotransmitter (messenger substance) serotonin is not reabsorbed – the reuptake is therefore inhibited.
This happens at a synapse (i.e. a connection between two nerve cells) that uses serotonin as a messenger substance – this is called a serotonergic synapse. At such a synapse, two nerve cells meet, which are referred to as pre- and postsynapse. The stimulus that is transmitted at such a synapse comes from the direction of the presynapse and is forwarded to the postsynapse. There is a small space between the pre- and postsynapses called the synaptic cleft. The nerve cells bridge this gap by releasing messenger substances – in this case serotonin.
Serotonin is released at the presynapse, which migrates through the synaptic cleft to the postsynapse, where it activates special receptors. Serotonin is then reabsorbed into the presynapse via certain transporters (carriers). Escitalopram and other SSRIs prevent this reuptake, thereby increasing serotonin levels in the synaptic cleft.
The serotonergic system, as all serotonergic synapses in the human body are called, is said to be jointly responsible for numerous mental illnesses. However, the exact causes have not yet been fully clarified. It is known, however, that an increase in the serotonin concentration in the synaptic cleft of such serotonergic synapses can lead to an improvement in mood in depressed patients.
When is escitalopram used?
Like other active ingredients from the group of SSRIs, escitalopram is considered the preferred agent for the treatment of depressive episodes that are associated with a reduction in drive. In addition, escitalopram is used to treat anxiety and obsessive-compulsive disorders and so-called somatoform disorders – physical symptoms that have no organic cause.
Escitalopram – when to take it?
Escitalopram absorption is not affected by previous eating. Escitalopram can therefore be taken with or without food. Escitalopram is usually taken once a day , depending on the dosage and preparation .
When does escitalopram work?
The effect of preparations with escitalopram such as Cipralex® is usually delayed. It usually takes between two and four weeks for Cipralex® to take full effect . After ingestion, escitalopram reaches its maximum active level within four hours.
What dose of escitalopram?
The usual dose of escitalopram in adults is 10 mg per day. In the case of panic disorders, it is also possible to start with 5 mg per day and later increase the dose to 10 mg. However, a general insinuation of the medication is not necessary. If the effectiveness is insufficient, the dose can also be increased individually to up to 20 mg per day in consultation with the doctor.
Accordingly, tablets in dosages of 5, 10 and 20 mg as well as escitalopram drops are available on the German market.
Discontinuation and duration of treatment
After the symptoms have improved, it is recommended to continue the treatment for at least six months to ensure the success of the therapy.
Discontinuation of the drug should be done carefully and only under medical supervision. It is advisable to taper off the drug with a gradual reduction in dose. Abrupt discontinuation is strongly discouraged, as otherwise a so-called rebound phenomenon can occur. This means that if you stop abruptly, your symptoms will get worse again.
Caution is advised in patients over 65 years of age, with impaired renal function or a disturbed metabolism. Here the dose should be adjusted by a doctor and the therapy monitored.
Escitalopram side effects
The side effects of the antidepressant usually appear in the first few weeks and decrease in intensity and frequency over the course of treatment. Possible side effects of escitalopram include:
- headache
- nausea
- Decreased or increased appetite
- weight gain
- Anxiety, restlessness, abnormal dreams
- decreased libido
- insomnia or drowsiness
- dizziness
- paraesthesia (abnormal sensations), tremor (shaking)
- Sinusitis (sinus infection)
- Diarrhea , constipation , vomiting, dry mouth
- Arthralgia ( joint pain ), myalgia (muscle pain)
- Fever
- Sexual disorders: anorgasmia in women; in men: ejaculation disorders, impotence
There is usually no reason to fear that therapy with Cipralex® will cause long-term damage. In any case, long-term therapy should only be carried out after consulting a doctor.
escitalopram and alcohol
You are strongly warned against consuming alcoholic beverages in combination with taking escitalopram or other antidepressants. There can be unpredictable interactions between alcohol and medication.
Escitalopram can increase sensitivity to alcohol, which can cause severe discomfort and a hangover even with small amounts of alcohol . Alcohol, in turn, may weaken or increase the effect of escitalopram by affecting its metabolism in the liver.
The exact consequences vary from person to person and depend on the amount you drink. In principle, the consumption of alcohol is not recommended when taking any antidepressant.
Citalopram and escitalopram – what’s the difference?
The difference between citalopram and escitalopram is due to the chemical structure of the two active ingredients. Citalopram and escitalopram have the same chemical formula, which means that both substances differ neither in the type of their atoms nor in their number. This phenomenon is called isomerism – substances that exhibit it are also called isomers.
However, the two molecules differ in their spatial structure and behave like an image and a mirror image. These particular forms of isomers are called enantiomers . The two molecules are related to each other in a similar way as the right and left human hand. This type of isomerism is therefore also referred to as chirality (handedness).
The name escitalopram comes from the fact that the enantiomers can be divided into an R form and an S form according to their chemical formula. In the R form of the molecule, the R stands for right or right, in the S form, the S stands for left (Latin: sinister). The directions given here refer to the arrangement of the individual atoms in the molecule (configuration). With drugs, it is often the case that this R or S form is reflected in the name of the active ingredient. The prefix Ar- for the R form (for example: armodafinil) and Es- for the S form (for example: esomeprazole, esketamine , escitalopram).
There are also mixtures (racemates) of the two forms. This is also the case with citalopram. Citalopram is a mixture of R- and S-citalopram.
Often only one enantiomer of a molecule occurs in nature or only one enantiomer is biologically active and has an effect in the human body. In the case of citalopram, R-citalopram is hardly active and has hardly any antidepressant effect. If the racemate, i.e. a mixture of R- and S-citalopram, is taken, the antidepressant effect is attributed to S-citalopram. So escitalopram is the actually effective substance. This is also reflected in the fact that 10 mg of pure escitalopram per day are sufficient, while about 40 mg of the citalopram mixture must be taken to achieve the same effect.