Escitalopram
"Cleanest" SSRI — most selective SERT binding, fewest CYP interactions, generally best-tolerated. | Compound
Aliases (2)
▸ Overview TL;DR
"Cleanest" SSRI — most selective SERT binding, fewest CYP interactions, generally best-tolerated. First-line for GAD and MDD in many guidelines. Not for Dylan absent indication; would be top SSRI choice if needed.
▸ Mechanism of action
S-enantiomer of citalopram (R-enantiomer is largely inactive). Binds SERT at primary site + allosteric site, slowing dissociation. This unique allosteric binding is why escitalopram is not just "half a citalopram" — it's about 2x as potent per mg with fewer off-target effects (less H1, less muscarinic, less Na channel blockade than R-citalopram).
▸ Pharmacokinetics No data
▸ What to expect Generic
- 1Week 1Tolerability and dose-response.
- 2Week 2-4Early effect window.
- 3Week 4-8Peak benefit assessment.
- 4Week 8+Cycle decision point.
▸ Side effects + safety
- Common (>10%): Sexual dysfunction (30-60%), nausea early, somnolence, fatigue, ejaculation delay.
- Less common (1-10%): Insomnia, weight gain (modest, long-term), sweating, bruxism.
- Rare-serious (<1%): Serotonin syndrome, hyponatremia, QT prolongation (FDA limited to 20mg), suicidal ideation <25 yo (FDA black box).
- Specific watch periods: First 4 weeks for activation; baseline + repeat ECG if cardiac risk factors.
▸References5 sources
PMID 29477251
2018Cipriani 2018 network MA.
PMID 19852904
Escitalopram allosteric SERT binding.
PMID 21646573
Escitalopram QT prolongation FDA review.
PMID 22424813
Escitalopram for GAD meta-analysis.
PMID 18316756
SSRI sexual dysfunction.