Lexapro Side Effects First Week: What to Expect and How to Cope

Starting a new antidepressant medication can be both hopeful and challenging. If you’ve recently begun taking Lexapro (escitalopram), you may be experiencing side effects during the first week that leave you wondering what’s normal and what you should be concerned about. Understanding what to expect during this initial adjustment period can help you navigate this important phase of your mental health treatment with confidence.

The first week of taking Lexapro is often the most challenging as your body adjusts to the medication. While these side effects can be uncomfortable, most people find that they decrease significantly within the first few weeks. This comprehensive guide will help you understand what side effects are common during the first week of Lexapro treatment and provide practical strategies for managing them.

Why Do Side Effects Occur in the First Week?

When you start taking Lexapro, your brain chemistry begins to change as the medication works to regulate serotonin levels. This selective serotonin reuptake inhibitor (SSRI) increases the availability of serotonin in your brain, which can help improve mood and reduce anxiety over time. However, this adjustment process can cause temporary side effects as your body adapts to these changes.

The first week is typically when side effects are most noticeable because your body hasn’t yet adjusted to the medication. It’s important to remember that experiencing side effects doesn’t mean the medication isn’t right for you or won’t work. For most people, these initial symptoms are temporary and subside as treatment continues.

Common Lexapro Side Effects During the First Week

Nausea and Digestive Issues

Nausea is one of the most frequently reported side effects during the first week of Lexapro treatment. You may also experience stomach discomfort, upset stomach, or changes in appetite. These gastrointestinal symptoms occur because serotonin receptors are found throughout your digestive system, not just in your brain.

To manage nausea during the first week:

• Take Lexapro with food to minimize stomach upset
• Eat smaller, more frequent meals throughout the day
• Avoid spicy, fatty, or acidic foods that may worsen nausea
• Stay hydrated by sipping water or clear fluids throughout the day
• Try ginger tea or peppermint, which may help settle your stomach
• Avoid lying down immediately after taking your medication

Fatigue and Drowsiness

Feeling unusually tired or drowsy is common during the first week of Lexapro treatment. You may feel like you need more sleep than usual or experience daytime sleepiness that affects your daily activities. This fatigue typically improves as your body adjusts to the medication.

Strategies to manage fatigue include:

• Taking your medication at bedtime if approved by your doctor
• Maintaining a consistent sleep schedule
• Taking short rest breaks during the day if needed
• Engaging in light physical activity, such as a brief walk, to boost energy
• Avoiding driving or operating heavy machinery if you feel excessively drowsy
• Being patient with yourself as your body adjusts

Insomnia and Sleep Disturbances

While some people experience drowsiness, others may have difficulty falling asleep or staying asleep during the first week of Lexapro treatment. You might find yourself lying awake at night or waking up frequently, which can leave you feeling tired during the day.

To improve sleep quality during the first week:

• Take Lexapro in the morning if sleep problems occur, with your doctor’s approval
• Establish a relaxing bedtime routine
• Limit screen time at least one hour before bed
• Avoid caffeine and alcohol, especially in the afternoon and evening
• Keep your bedroom cool, dark, and quiet
• Practice relaxation techniques like deep breathing or progressive muscle relaxation

Headaches

Headaches are a common side effect during the first week of Lexapro treatment. These can range from mild to moderate in intensity and may occur at different times throughout the day. Most headaches related to starting Lexapro improve within the first few weeks.

To manage headaches:

• Stay well-hydrated by drinking plenty of water
• Apply a cold or warm compress to your forehead or neck
• Practice stress-reduction techniques like meditation or gentle yoga
• Ensure you’re getting adequate rest
• Maintain regular meal times to avoid blood sugar fluctuations
• Consult your doctor about appropriate over-the-counter pain relief options

Increased Anxiety or Restlessness

It may seem counterintuitive, but some people experience increased anxiety, nervousness, or restlessness during the first week of taking Lexapro, even though the medication is prescribed to treat anxiety and depression. This temporary increase in anxiety is sometimes called “activation syndrome” and typically resolves within the first few weeks.

To cope with increased anxiety during the first week:

• Practice deep breathing exercises throughout the day
• Engage in gentle physical activity like walking or stretching
• Use grounding techniques to stay present
• Limit caffeine intake, which can worsen anxiety
• Talk to a therapist or counselor for additional support
• Contact your doctor if anxiety becomes severe or unmanageable

Dry Mouth

Experiencing a dry mouth is common when starting Lexapro. This can be uncomfortable and may affect your ability to eat, speak, or sleep comfortably. Dry mouth occurs because the medication can affect saliva production.

To relieve dry mouth:

• Sip water frequently throughout the day
• Chew sugar-free gum to stimulate saliva production
• Use sugar-free hard candies or lozenges
• Avoid alcohol, caffeine, and tobacco products
• Use a humidifier in your bedroom at night
• Breathe through your nose rather than your mouth
• Maintain good oral hygiene to prevent dental problems

Dizziness or Lightheadedness

Some people experience dizziness or lightheadedness during the first week of Lexapro treatment. This may occur when standing up quickly or during normal activities. These symptoms usually improve as your body adjusts to the medication.

Safety tips for managing dizziness:

• Stand up slowly from sitting or lying positions
• Sit or lie down if you feel dizzy
• Stay hydrated throughout the day
• Avoid sudden movements
• Use support like handrails when available
• Be cautious when driving or operating machinery

Changes in Appetite

During the first week, you may notice changes in your appetite. Some people experience decreased appetite and slight weight loss, while others may feel hungrier than usual. These changes often stabilize after the initial adjustment period.

To maintain healthy eating habits:

• Try to eat regular, balanced meals even if your appetite has changed
• Choose nutrient-dense foods to ensure adequate nutrition
• Keep healthy snacks available
• Don’t force yourself to eat large meals if you’re not hungry
• Stay hydrated, which can sometimes be confused with hunger
• Monitor your weight and discuss significant changes with your doctor

Sweating

Increased sweating, particularly at night, is another potential side effect during the first week of Lexapro treatment. You may notice that you perspire more easily during daily activities or wake up with night sweats.

To manage increased sweating:

• Wear breathable, lightweight clothing
• Keep your bedroom cool at night
• Use moisture-wicking bedding materials
• Stay hydrated to replace lost fluids
• Avoid triggers like spicy foods, caffeine, and alcohol
• Keep a change of clothes nearby if needed

When to Contact Your Doctor

While most first-week side effects are normal and temporary, certain symptoms require immediate medical attention. Contact your healthcare provider right away if you experience:

• Severe or worsening depression
• Thoughts of self-harm or suicide
• Extreme agitation or restlessness
• Panic attacks
• Unusual changes in mood or behavior
• Severe allergic reactions (rash, hives, difficulty breathing, swelling)
• Irregular heartbeat or chest pain
• Seizures
• Severe confusion or hallucinations
• Uncontrollable shaking or tremors

If you’re experiencing side effects that are severe, persistent, or significantly impacting your quality of life, don’t hesitate to reach out to your healthcare provider. They can help determine whether the side effects are normal, suggest strategies to manage them, or adjust your treatment plan if necessary.

Tips for Managing First Week Side Effects

Keep a Symptom Journal

Documenting your experience during the first week can be incredibly valuable. Record what side effects you experience, when they occur, their severity, and what helps relieve them. This information will be helpful for your healthcare provider and can help you identify patterns or triggers.

Be Patient with the Process

Remember that the first week is just the beginning of your treatment journey. Most side effects improve significantly by week two or three, and the therapeutic benefits of Lexapro typically take four to six weeks to become fully apparent. Try to maintain perspective and focus on the long-term goal of improved mental health.

Don’t Stop Taking Your Medication Suddenly

Even if you’re experiencing uncomfortable side effects, never stop taking Lexapro abruptly without consulting your doctor. Suddenly discontinuing an SSRI can cause withdrawal symptoms and may worsen your depression or anxiety. If the side effects are too difficult to manage, your doctor can help you safely adjust your treatment plan.

Maintain Healthy Lifestyle Habits

Supporting your body during this adjustment period can help minimize side effects:

• Eat a balanced, nutritious diet
• Stay hydrated throughout the day
• Get regular, gentle exercise as you feel able
• Prioritize good sleep hygiene
• Limit alcohol consumption
• Avoid recreational drugs
• Practice stress-management techniques

Build a Support System

Let trusted friends or family members know that you’ve started a new medication and may experience some temporary side effects. Having people who understand what you’re going through can provide emotional support during this adjustment period.

Attend Therapy

Medication works best when combined with therapy. Continue or start working with a mental health professional who can provide coping strategies, support, and tools to manage your symptoms while you adjust to your medication.

What to Expect After the First Week

Most people find that side effects begin to improve noticeably after the first week of Lexapro treatment. By week two, many of the uncomfortable initial symptoms have decreased in intensity or resolved entirely. However, everyone’s experience is different, and some side effects may persist for a few weeks longer.

The therapeutic benefits of Lexapro typically take longer to appear than side effects. Most people begin to notice improvements in their mood, anxiety levels, and overall functioning after four to six weeks of consistent treatment. Some symptoms, like sleep and energy levels, may improve earlier, while others take longer.

It’s important to continue taking your medication as prescribed and maintain regular follow-up appointments with your healthcare provider. They can monitor your progress, assess how well the medication is working, and make any necessary adjustments to optimize your treatment.

Questions to Ask Your Doctor

Before starting Lexapro or during your first week of treatment, consider asking your healthcare provider these important questions:

• What side effects should I expect during the first week?
• Which side effects are normal and which require immediate attention?
• Should I take Lexapro in the morning or at night?
• Can I take over-the-counter medications for symptom relief?
• When should I start to feel better?
• How long do first-week side effects typically last?
• What should I do if side effects become unbearable?
• Are there any foods, drinks, or activities I should avoid?
• When should I schedule a follow-up appointment?

Understanding Individual Variation

It’s crucial to remember that everyone responds differently to medication. Your experience during the first week of Lexapro may be quite different from someone else’s. Factors that can influence your response include:

• Your individual body chemistry and metabolism
• The dosage prescribed
• Other medications you’re taking
• Your overall health status
• Your age and weight
• Whether you’re taking Lexapro with food or on an empty stomach
• Your lifestyle habits and stress levels

Don’t compare your experience too heavily with others’ experiences or online reports. What matters most is how you’re feeling and whether the medication is moving you toward your mental health goals.

The Importance of Compliance

Despite the challenges of first-week side effects, it’s essential to take your medication exactly as prescribed. Consistency is key to allowing the medication to work effectively. Set reminders on your phone, use a pill organizer, or tie taking your medication to a daily routine like brushing your teeth to help ensure you don’t miss doses.

Skipping doses or taking medication irregularly can increase side effects, delay therapeutic benefits, and make it harder for your doctor to assess whether the medication is right for you.

Long-Term Outlook

While the first week of Lexapro treatment can be challenging, most people find that the temporary discomfort is worthwhile when they begin to experience the benefits of improved mental health. Depression and anxiety can be debilitating conditions, and effective treatment can significantly improve your quality of life, relationships, work performance, and overall well-being.

Many people take Lexapro successfully for months or years with minimal side effects once they’ve completed the initial adjustment period. The medication can be an important tool in managing your mental health, especially when combined with therapy, healthy lifestyle habits, and strong social support.

Conclusion

The first week of Lexapro treatment is often the most challenging as your body adjusts to the medication. Common side effects like nausea, fatigue, insomnia, headaches, and increased anxiety are typically temporary and improve within a few weeks. By understanding what to expect, employing practical coping strategies, and maintaining open communication with your healthcare provider, you can navigate this adjustment period more successfully.

Remember that experiencing side effects during the first week doesn’t mean the medication isn’t right for you or won’t help your depression or anxiety. Most people find that these initial symptoms subside while the therapeutic benefits continue to develop. Be patient with yourself, practice self-care, and don’t hesitate to reach out to your healthcare provider with questions or concerns.

Your mental health journey is important, and taking the step to start medication treatment demonstrates courage and commitment to your well-being. With proper support and realistic expectations, you can move through this first week and toward improved mental health.

Disclaimer: This article is for informational purposes only and should not replace professional medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. If you’re experiencing severe side effects or a mental health crisis, seek immediate medical attention or call emergency services.

Sources:

• Mayo Clinic – Antidepressants: Selecting one that’s right for you
• National Institute of Mental Health – Mental Health Medications
• MedlinePlus – Escitalopram
• NAMI – Escitalopram (Lexapro)
• U.S. Food and Drug Administration – Drugs