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Lexapro is the brand name for escitalopram, a prescription selective serotonin reuptake inhibitor, commonly called an SSRI. In the United States, current labeling includes treatment of major depressive disorder in adults and pediatric patients 12 years and older and generalized anxiety disorder in adults and pediatric patients 7 years and older.
Lexapro is not a controlled substance, but it is still prescription-only. A medical assessment is needed because depression and anxiety can overlap with bipolar disorder, substance use, thyroid problems, medication effects, trauma, sleep disorders and other conditions. The prescriber should also review suicide risk, pregnancy, heart history and medicines that can cause serotonin syndrome or bleeding.
Do not promote Lexapro as an instant calming pill or a prescription-free product. Escitalopram is generally taken consistently and may require several weeks for the full benefit to become clear. It is not intended for occasional recreational use, and abrupt discontinuation can cause distressing symptoms.
What a Responsible Prescription Process Includes
- Confirmation of the symptoms, duration, impairment and likely diagnosis.
- Screening for bipolar disorder, mania, psychosis and suicide risk.
- Review of all prescription medicines, nonprescription products and supplements.
- Discussion of alcohol, recreational substances and previous antidepressant responses.
- A plan for early follow-up, side-effect monitoring and what to do if mood worsens.
- Clear instructions for continued use, missed doses and eventual discontinuation.
What Lexapro Treats
Escitalopram increases serotonin signaling by inhibiting serotonin reuptake. Its clinical effect is more complex than simply “adding serotonin,” and a response varies between patients. Benefit should be judged by reduced symptoms and improved function, not by feeling sedated, stimulated or emotionally numb.
Major Depressive Disorder
Major depressive disorder can involve persistent low mood, loss of interest, changes in sleep or appetite, low energy, guilt, difficulty concentrating, slowed or agitated behavior and thoughts of death. Diagnosis requires more than an occasional bad day, and urgent safety assessment is needed when self-harm thoughts are present.
Current Lexapro labeling includes major depressive disorder in adults and pediatric patients 12 years and older. Younger patients require especially careful monitoring during early treatment and after dose changes because antidepressants carry a boxed warning about suicidal thoughts and behaviors in pediatric and young adult patients.
Generalized Anxiety Disorder
Generalized anxiety disorder involves excessive, difficult-to-control worry accompanied by symptoms such as restlessness, fatigue, irritability, muscle tension, poor concentration and sleep disturbance. Current labeling includes GAD in adults and pediatric patients 7 years and older.
Lexapro is not an immediate rescue medicine for a panic episode. Some patients notice early side effects before benefit, and anxiety can temporarily feel different during the first phase of treatment. The prescriber should explain what is expected and which changes require prompt contact.
Off-Label Uses
Clinicians sometimes prescribe escitalopram for conditions not specifically included in the U.S. label. An off-label use can be medically appropriate, but it should be identified honestly and supported by individualized clinical judgment. A seller should not expand the approved indications merely to attract more searches.
Lexapro Forms, Strengths and Prescription Directions
Branded Lexapro tablets have been marketed in 5 mg, 10 mg and 20 mg strengths, and an oral solution is also available. Generic escitalopram products may have different appearances and inactive ingredients. Listing a strength does not establish that it is right for a particular patient.
Current labeling commonly starts adults at 10 mg once daily for approved indications and permits a clinician-directed increase to a maximum of 20 mg once daily when appropriate. Pediatric directions, timing of increases, older age, liver impairment and other patient factors differ. This general label summary must not be used as a self-prescribing instruction.
Take Lexapro Consistently
Follow the patient-specific pharmacy label. Escitalopram is usually taken once daily, in the morning or evening, with or without food. Taking it at a consistent time makes it easier to assess side effects and adherence. If nausea occurs, the patient should ask whether taking it with food is appropriate rather than changing the dose.
If a Dose Is Missed
Follow the instructions from the prescriber or pharmacist. In general, a missed dose should not be doubled. If it is close to the next scheduled dose, the professional may advise skipping it, but the correct response depends on the actual product and schedule.
Do Not Increase It for a Difficult Day
Lexapro does not work like an as-needed tranquilizer. Taking extra medicine cannot safely produce immediate relief and may increase nausea, agitation, sleep disturbance, serotonin toxicity or other adverse effects.
How Long Lexapro May Take to Work
Some changes, such as sleep or appetite, may occur before mood and worry improve. A meaningful antidepressant or anxiety response often develops gradually over several weeks. The exact timing varies, and absence of immediate improvement does not justify taking a larger dose without medical advice.
Track Function, Not Only Feelings
Useful treatment targets include returning to essential routines, fewer hours lost to worry, improved concentration, renewed interest, better attendance and reduced avoidance. A simple weekly record can help distinguish gradual benefit from daily fluctuations.
Early Side Effects
Nausea, headache, sleep change, fatigue, sweating or temporary restlessness may emerge before benefit. Some effects improve, while others require a change in plan. Contact the prescriber if symptoms are severe, persistent or associated with suicidal thoughts, mania, fever, confusion or abnormal bleeding.
When There Is No Improvement
The prescriber may review adherence, diagnosis, dose, duration, interacting medicines, alcohol or substance use, bipolar symptoms, sleep, thyroid status and psychotherapy needs. Do not combine Lexapro with another antidepressant or an online “mood” supplement without this review.
Boxed Warning: Suicidal Thoughts and Behaviors
Lexapro and other antidepressants carry a boxed warning about increased risk of suicidal thoughts and behaviors in pediatric and young adult patients. Risk is especially important during the first few months of treatment and after a dose change. Depression itself also carries suicide risk, so the warning is a reason for monitoring—not a reason to leave severe symptoms untreated without help.
Changes That Need Prompt Contact
- New or worsening thoughts of death, self-harm or suicide.
- Severe agitation, panic, restlessness or inability to sit still.
- Marked irritability, aggression or impulsive behavior.
- Very little need for sleep, racing thoughts or unusually elevated mood.
- Sudden withdrawal from others or giving away possessions.
- Any behavior that family members recognize as abrupt and dangerous.
Immediate danger, an attempt, a specific plan or inability to stay safe requires emergency assistance. Do not wait for a routine appointment or rely solely on an online seller’s support chat.
Family and Caregiver Role
With the patient’s involvement, a trusted person can help notice rapid changes, support appointments and protect access to large quantities of medicine when risk is high. Monitoring should be respectful and linked to a clinician-created safety plan.
Serotonin Syndrome and Important Lexapro Interactions
Serotonin syndrome is a potentially life-threatening reaction caused by excessive serotonergic activity. Risk increases when Lexapro is combined with other serotonergic medicines or when interacting treatment changes.
Possible Serotonin Syndrome Symptoms
- Agitation, confusion, hallucinations or coma.
- Rapid heart rate or changing blood pressure.
- Fever, sweating or flushing.
- Tremor, muscle rigidity, overactive reflexes or poor coordination.
- Nausea, vomiting or diarrhea.
Seek urgent medical help when a cluster of these symptoms occurs, particularly after a medicine is started or changed. Do not take another dose while waiting for professional guidance.
MAO Inhibitors
Lexapro must not be used with a monoamine oxidase inhibitor or within the prohibited transition periods stated in current labeling because of serotonin-syndrome risk. This includes certain medicines for depression and Parkinson disease and the antibiotic linezolid or intravenous methylene blue in relevant circumstances.
Other Serotonergic Products
Relevant combinations can include other SSRIs, SNRIs, tricyclic antidepressants, buspirone, lithium, triptan migraine medicines, tramadol, fentanyl, meperidine, methadone, amphetamines, tryptophan and St John’s wort. This is not a complete list. The prescriber should decide whether a combination is appropriate and how it will be monitored.
Pimozide
Current Lexapro labeling contraindicates use with pimozide. The interaction review should identify the exact antipsychotic rather than relying on the patient to recognize a class name.
Bleeding, Sodium, Eye and Heart-Related Precautions
Abnormal Bleeding
SSRIs can increase bleeding risk, especially with aspirin, nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen, antiplatelet medicines and anticoagulants. Report unusual bruising, repeated nosebleeds, blood in urine, black stools, vomiting blood or bleeding that does not stop.
Low Sodium
Hyponatremia can occur, with higher risk in older adults, people taking diuretics and those who are volume depleted. Headache, confusion, weakness, unsteadiness or difficulty concentrating requires medical review; seizure, severe confusion or loss of consciousness is an emergency.
Angle-Closure Glaucoma
Pupil dilation can trigger an angle-closure attack in a person with anatomically narrow angles. Sudden eye pain, visual halos, redness, severe headache, nausea or abrupt vision change requires emergency eye care.
Cardiac History
Tell the prescriber about fainting, arrhythmia, congenital long-QT syndrome, heart disease, electrolyte problems and all medicines that affect rhythm. The clinician can determine whether additional evaluation is appropriate.
Common Lexapro Side Effects
Common reactions can include nausea, insomnia, sleepiness, fatigue, increased sweating and sexual side effects. Some patients experience headache, dry mouth, dizziness, appetite change, diarrhea or constipation. Frequency and severity differ between individuals.
Nausea and Digestive Symptoms
Nausea is common early in treatment. Persistent vomiting, dehydration, severe abdominal symptoms or inability to take the medicine should be reported. Do not repeatedly add nonprescription anti-nausea medicines without checking for interactions.
Sleep Changes
Lexapro can cause either sleepiness or insomnia. The prescriber may adjust timing after reviewing the pattern. Do not add a benzodiazepine, alcohol or sedating antihistamine at night without medical advice.
Sexual Dysfunction
Escitalopram can cause reduced libido, delayed orgasm, difficulty achieving orgasm, erectile problems or delayed ejaculation. These effects deserve direct discussion because they can affect adherence and relationships. Do not stop treatment abruptly or buy an unverified sexual-enhancement product.
Emotional Blunting
Some patients describe feeling emotionally muted. This can overlap with residual depression. A clinician can assess whether the symptom is a side effect, incomplete recovery or another issue and decide whether the plan should change.
Mania, Seizures and Other Serious Reactions
Activation of Mania or Hypomania
An antidepressant can precipitate mania or hypomania in a person with bipolar disorder. Warning signs include markedly reduced need for sleep, racing thoughts, unusually rapid speech, grandiosity, risky spending, increased sexual behavior or severe agitation. Contact the prescriber urgently.
Seizures
Disclose a seizure disorder and all medicines that affect seizure threshold. A seizure during treatment requires urgent medical assessment.
Severe Allergic Reaction
Face, lip, tongue or throat swelling, hives with breathing difficulty, collapse or rapidly progressing rash requires emergency care.
Overdose
Suspected overdose requires immediate Poison Control or emergency assistance, even when symptoms are not yet obvious. Do not induce vomiting. Bring the container and report other medicines or substances that may have been taken.
Discontinuation Syndrome and Stopping Lexapro Safely
Abrupt cessation or a large reduction can cause dizziness, electric-shock-like sensations, anxiety, irritability, agitation, headache, nausea, sweating, sleep disturbance, confusion or mood change. These symptoms are called discontinuation syndrome and do not necessarily mean that addiction has developed.
Use a Prescriber-Directed Reduction
Current labeling recommends gradual reduction whenever possible. The pace depends on the dose, duration, symptoms, prior withdrawal experiences and the reason for stopping. Do not copy a taper from another patient or split a tablet unless the exact product is suitable for splitting.
Withdrawal Versus Relapse
Discontinuation symptoms often begin soon after a reduction, while return of depression or anxiety may follow a different pattern. The distinction can be difficult. Record timing and symptoms and contact the prescriber rather than repeatedly stopping and restarting.
Do Not Stop Solely Because You Feel Better
Improvement may reflect treatment effectiveness. Continuing for an appropriate period can reduce relapse risk. The prescriber should decide when the benefits of maintenance treatment and the reasons for discontinuation have been reviewed.
Lexapro in Pregnancy, Breastfeeding and Different Age Groups
Pregnancy
Untreated depression and anxiety can affect pregnancy, while medicine exposure also requires consideration. Late-pregnancy SSRI exposure may be associated with neonatal complications, and labeling discusses a potential risk of persistent pulmonary hypertension of the newborn. A pregnant patient should contact the prescriber promptly but should not stop abruptly without guidance.
Breastfeeding
Escitalopram is present in human milk. The clinician and pediatric professional should consider treatment need and monitor the infant as appropriate for sedation, poor feeding, inadequate weight gain or unusual irritability.
Children and Adolescents
Age approval differs by indication: current labeling includes MDD from age 12 and GAD from age 7. Younger patients need developmentally appropriate diagnosis, suicide-risk monitoring and family involvement. A product should never be given to a child merely because another family member takes it.
Older Adults
Older adults may be more vulnerable to low sodium, falls, interactions and altered medicine clearance. The prescriber may use a lower recommended dose and closer monitoring.
Lexapro with Therapy and Long-Term Care
Medicine may be combined with psychotherapy, sleep treatment, activity planning, social support and care for coexisting conditions. The most effective plan depends on the diagnosis and patient preference.
Psychotherapy
Cognitive behavioral therapy and other evidence-based approaches can help patients understand patterns, reduce avoidance, build coping skills and address relapse risk. Therapy is not evidence that medicine has failed; the treatments can serve different functions.
Review Appointments
Follow-up should assess mood, worry, sleep, function, adherence, side effects, sexual health, substance use and safety. A refill should not be treated as a simple commercial transaction when symptoms or medicines have changed.
What to Record
- Daily dose time and missed doses.
- Changes in mood, worry, sleep and functioning.
- Nausea, sweating, sexual effects or restlessness.
- New medicines, supplements, alcohol or substance use.
- Any self-harm thoughts, mania-like symptoms or unusual bleeding.
Assessment Before Starting Lexapro
Depression and anxiety are diagnosed from a clinical pattern, not from one symptom or a request for a specific medicine. The assessment should establish when symptoms began, how they affect function, whether episodes occurred before and what treatments helped or caused problems.
Conditions That Can Resemble Depression or Anxiety
- Bipolar disorder, including previous hypomanic episodes.
- Thyroid disease, anemia, sleep apnea and chronic pain.
- Alcohol, cannabis, stimulant or sedative effects and withdrawal.
- Medication adverse effects, including steroids and some stimulants.
- Trauma-related disorders, OCD, panic disorder and eating disorders.
- Grief, unsafe relationships and severe social stress.
Finding one of these possibilities does not mean escitalopram can never be used. It means the diagnosis and care plan must address the full problem. Treating bipolar depression with an antidepressant alone, for example, may create mania or rapid mood change in a vulnerable patient.
Baseline Questions That Matter
The prescriber should ask about self-harm thoughts, previous attempts, family history of bipolar disorder or suicide, seizures, bleeding, low sodium, glaucoma, heart rhythm problems and pregnancy. The medication list should include migraine medicines, pain medicines, anticoagulants, diuretics and supplements.
Starting Lexapro and the Early Monitoring Period
The first weeks deserve planned contact because benefit may still be limited while nausea, sleep change, activation or suicidal thoughts can emerge. A patient should know who to contact during business hours, what symptoms require same-day advice and when to use emergency services.
Week-by-Week Review Topics
- Adherence and the actual time each dose is taken.
- Sleep, appetite, energy and physical restlessness.
- Mood, worry, panic, irritability and daily functioning.
- Self-harm thoughts, impulsivity or new access to lethal means.
- Mania-like symptoms, including reduced sleep need and racing thoughts.
- Nausea, sweating, sexual effects, headache or abnormal bleeding.
Activation Versus Improvement
Improved energy with a stable sleep need and better function may be an early recovery sign. Agitation, inability to sit still, very little sleep, risky behavior or rapidly accelerating thoughts may indicate activation, akathisia or mania and needs prompt review.
Do Not Judge Treatment from One Day
Mood and anxiety fluctuate. A brief daily score and weekly functional notes provide a more reliable picture than taking extra medicine after a difficult event or stopping after one better day.
Switching to or from Lexapro
Changing antidepressants can create interaction, withdrawal and relapse risk. The correct method depends on the previous medicine, dose, half-life and reason for switching. Some transitions require a gradual overlap, some require a direct switch and MAO inhibitors require specific washout intervals.
Do Not Combine Leftover Antidepressants
Taking Lexapro alongside leftover sertraline, fluoxetine, venlafaxine, duloxetine or another serotonergic medicine can increase adverse effects and serotonin-syndrome risk. The fact that both were previously prescribed does not make the combination safe.
Switching from an MAO Inhibitor
Current labeling specifies prohibited intervals between Lexapro and an MAOI. These intervals differ depending on direction of the switch and the exact medicine. The prescriber and pharmacist must verify dates.
Switching Because of Side Effects
Sexual dysfunction, emotional blunting, nausea or sleep problems may justify a change, but abrupt cessation can add discontinuation symptoms. Discuss the impact honestly so the clinician can balance symptom control and quality of life.
Managing Common Lexapro Concerns Safely
Feeling More Anxious at First
Some patients experience early nervousness or restlessness. Report severe or rapidly worsening symptoms, especially with suicidal thinking or reduced need for sleep. Do not self-treat with alcohol, cannabis, borrowed benzodiazepines or an extra Lexapro dose.
Feeling Sleepy
Do not drive until the effect is understood. The prescriber may review timing, dose, sleep quantity and other sedating medicines. Persistent daytime sleepiness can also signal sleep apnea or another condition.
Difficulty Sleeping
Record dose timing, caffeine, naps and bedtime. A clinician may change timing or address another cause. Adding diphenhydramine, a benzodiazepine or a prescription sleep medicine without review can create interactions or next-day impairment.
Missed Several Doses
Contact the pharmacist or prescriber rather than restarting at an assumed schedule. The response depends on the number of missed doses, previous dose, symptoms and other treatment changes.
Vomiting or Diarrhea
Repeated vomiting or diarrhea can affect medicine intake and electrolytes, and low sodium can overlap with antidepressant adverse effects. Seek advice when symptoms are persistent, severe or accompanied by confusion, weakness or fainting.
Lexapro Refill and Continuity Planning
Interrupted supply can produce discontinuation symptoms and destabilize recovery. Refill planning should begin before tablets run out, particularly before travel, insurance changes or a prescriber transition.
Before Each Refill
- Confirm the current dose and whether any adjustment was recent.
- Report new medicines, pregnancy or significant medical changes.
- Discuss suicidal thoughts, mania-like symptoms or severe side effects.
- Verify whether the manufacturer or formulation changed.
- Schedule follow-up rather than relying on repeated automatic refills.
If the Usual Pharmacy Has No Stock
Ask the pharmacist and prescriber about an equivalent approved product and how to avoid interruption. Do not buy loose tablets from a marketplace or change to citalopram because the names appear related.
Lexapro Is Not the Same as Citalopram
Escitalopram and citalopram are related medicines but are not interchangeable milligram for milligram. Use only the exact medicine written on the prescription.
When Lexapro Requires Same-Day or Emergency Review
Same-Day Clinical Contact
Contact the treating professional promptly for severe restlessness, new mania-like behavior, rapidly worsening depression, persistent vomiting, unusual bleeding, significant sexual adverse effects or discontinuation symptoms that interfere with function.
Emergency Care
Use emergency services for a suicide attempt or immediate plan, seizure, loss of consciousness, severe allergic reaction, suspected overdose, severe confusion with low-sodium symptoms or a concerning cluster of serotonin-syndrome symptoms.
Information to Provide
Bring or report the container, strength, time of the last dose, estimated amount taken and all other medicines or substances. Accurate information is more important than concern about being judged.
Branded Lexapro, Generic Escitalopram and Authenticity
An FDA-approved generic escitalopram product contains the same active ingredient and must meet applicable standards for quality and bioequivalence. The color, shape, imprint, inactive ingredients and manufacturer may differ from branded Lexapro.
Before Taking a Refill
- Confirm the patient name, medicine, strength and directions.
- Check whether the product is a tablet, solution or another formulation.
- Ask the pharmacist about an unexpected change in appearance.
- Review the manufacturer if there is a known inactive-ingredient allergy.
- Confirm that the seal and packaging are intact.
Do not authenticate a tablet from a website photograph. Counterfeiters can copy colors and imprints, and an authentic generic may look different from the brand.
How to Evaluate an Online Lexapro Pharmacy
A safer online service requires a valid prescription, identifies the prescriber and dispensing pharmacy and provides pharmacist access. Escitalopram is not an appropriate product for checkout without a mental-health and medication review.
Safer-Service Checklist
- The clinician is licensed for the patient’s location.
- The pharmacy is active in the relevant official state licensing database.
- The seller requires a valid prescription and does not guarantee approval.
- A pharmacist is available for interactions, missed doses and side effects.
- The medicine arrives with a patient-specific label and traceable manufacturer.
- Emergency and follow-up instructions are clear.
Red Flags
- “No prescription” or “free prescription” sales claims.
- Promises of immediate happiness or guaranteed anxiety relief.
- No screening for bipolar disorder or suicidal thoughts.
- No named dispensing pharmacy or verifiable U.S. address.
- Loose tablets, altered packaging or unclear strength.
- Advice to stop another antidepressant immediately to place an order.
Storage, Travel and Disposal
Store the exact Lexapro or escitalopram product according to its label, protected from inappropriate heat, moisture and access by children. Keep tablets and liquid in the pharmacy-labeled container.
Oral Solution
Use the supplied or pharmacist-recommended measuring device. Household teaspoons are not reliable measuring tools. Follow the exact product’s storage instructions and discard it according to pharmacy guidance when expired.
Travel
Carry enough medicine in its labeled container and plan refills in advance. Abrupt interruption during travel can cause discontinuation symptoms. International rules and available formulations can differ.
Disposal
Use an authorized medicine take-back option when available or follow current FDA and pharmacist guidance. Do not give leftover escitalopram to another person with similar symptoms.
Frequently Asked Questions About Lexapro
What is Lexapro?
Lexapro is the brand name for escitalopram, a prescription SSRI antidepressant.
What is Lexapro approved to treat?
Current U.S. labeling includes major depressive disorder in adults and patients 12 years and older and generalized anxiety disorder in adults and patients 7 years and older.
Is Lexapro available without a prescription?
No. Escitalopram requires a prescription and appropriate medical follow-up.
Is Lexapro a controlled substance?
No, but it still has serious warnings, interactions and discontinuation risks that require clinical oversight.
Does Lexapro work immediately?
No. Benefit often develops gradually over several weeks, although some symptoms may change earlier.
Can Lexapro be taken only when anxiety occurs?
It is generally prescribed on a consistent daily schedule, not as an immediate rescue medicine. Follow the patient-specific directions.
Why does Lexapro have a boxed warning?
Antidepressants can increase suicidal thoughts and behaviors in pediatric and young adult patients, particularly early in treatment and after dose changes.
What is serotonin syndrome?
It is a potentially life-threatening excess of serotonergic activity that can cause agitation, fever, sweating, muscle rigidity, tremor, changing blood pressure and digestive symptoms.
Can Lexapro cause sexual side effects?
Yes. Reduced libido, delayed orgasm, erectile problems and ejaculation changes can occur and should be discussed with the prescriber.
Can Lexapro cause weight change?
Some patients experience appetite or weight changes. Meaningful or persistent change should be reviewed rather than managed with unverified supplements.
Can I drink alcohol while taking Lexapro?
Current patient guidance advises avoiding alcohol. It can worsen judgment, mood or side effects; discuss individual risk with the prescriber.
Can I take ibuprofen with Lexapro?
SSRIs and nonsteroidal anti-inflammatory drugs can increase bleeding risk. Ask the prescriber or pharmacist before combining them regularly.
Can Lexapro trigger mania?
Yes, particularly in a person with bipolar disorder. Reduced need for sleep, racing thoughts, grandiosity or risky behavior needs urgent review.
Can Lexapro be stopped suddenly?
It should usually be reduced gradually under medical guidance because abrupt stopping can cause discontinuation symptoms.
What should I do after a missed dose?
Follow the pharmacist or prescriber instructions and do not double the next dose.
Is generic escitalopram weaker than Lexapro?
An FDA-approved generic must meet applicable quality and bioequivalence standards. Appearance may differ without indicating lower effectiveness.
Can Lexapro be used during pregnancy?
Pregnancy requires an individualized benefit-risk discussion. Do not stop abruptly; contact the prescriber promptly.
Which symptoms require emergency care?
Immediate self-harm risk, seizure, severe allergic reaction, suspected overdose, severe serotonin-syndrome symptoms or loss of consciousness requires emergency help.
How can I verify an online Lexapro pharmacy?
Check the pharmacy through the relevant official state licensing database and avoid sellers that do not require a valid prescription.
What should I do if Lexapro does not help?
Contact the prescriber for reassessment of duration, adherence, diagnosis, dose, side effects, interactions and other treatment options. Do not add another antidepressant yourself.
Medical Disclaimer and Authoritative Sources
This information is educational and does not replace diagnosis, prescribing, monitoring or emergency care from a qualified healthcare professional. Lexapro is prescription-only. Call emergency services for immediate self-harm danger, seizure, loss of consciousness, severe allergic reaction, suspected overdose or severe serotonin-syndrome symptoms.