Can You Overdose on Lexapro? Risks and Treatment

Escitalopram (Lexapro) is one of the most commonly prescribed selective serotonin reuptake inhibitors (SSRIs) for depression and anxiety. It’s generally safe and well-tolerated, particularly compared to older antidepressants, but it’s not without risks.

Can you overdose on Lexapro or SSRIs in general? Yes, it’s possible to overdose on Lexapro and other SSRIs if you take too much. Find out what happens during an escitalopram overdose and when to seek help.

What Is Lexapro?

Lexapro is a prescription medication that belongs to the SSRI class of drugs. It’s used to treat depression and anxiety disorders like social anxiety disorder, major depressive disorder, and generalized anxiety disorder. In some cases, Lexapro is used to treat other conditions, such as post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).

Like other SSRIs, Lexapro works by increasing the levels of serotonin in the brain, a neurotransmitter that plays a crucial role in mood regulation.[1] SSRIs block the reabsorption, or reuptake, of serotonin in the nerve cells that release it, making more serotonin available in the space between nerve cells (synapse). This allows serotonin to bind to receptors on the receiving nerve cell for longer periods to improve symptoms of depression and anxiety.

Typical Lexapro Dosage

Dosage is based on the condition Lexapro is used to treat and an individual’s health factors. However, the usual adult dosage for generalized anxiety disorder or depression is:[2]

• Initial dose: 10 mg orally once daily with a possible increase after at least 1 week of treatment to 20 mg once daily.
• Maintenance dose: 10 to 20 mg orally daily
• Maximum daily dose: 20 mg

The usual dose for elderly patients with depression is:[3]

• 10 mg orally daily

The usual pediatric dose for depression in children 12 years and older is:[4]

• Initial dose: 10 mg orally daily with an increase to 20 mg after at least 3 weeks of treatment
• Maintenance dose: 10 to 2- mg orally daily
• Maximum daily dose: 20 mg

Can You Overdose on Lexapro?

Yes, you can overdose on Lexapro, though it’s usually not fatal compared to older antidepressants like tricyclics or MAO inhibitors. Because Lexapro increases the available serotonin in the brain, high doses can overstimulate serotonin receptors and cause serotonin syndrome, a potentially life-threatening condition with symptoms like agitation, confusion, rapid heart rate, muscle twitching, and fever, as well as possible seizures, kidney failure, and death without treatment.[5]

In addition, serotonin affects other bodily processes like thermoregulation, muscle function, and cardiovascular activity, so high levels can lead to other serious symptoms.

Mild overdose symptoms are often reported at doses above 30 to 50 mg, but severe toxicity is more likely to occur above 300 to 400 mg or with drug interactions.[6] Some case studies show that people have ingested up to 560 mg without fatal outcomes, but they do require intensive hospital monitoring.[7]

How Does Lexapro Overdose Happen?

An overdose can happen in a few different ways. Sometimes, people forget that they took their usual dose in the morning and take it again later, leading to an overdose. People may take Lexapro in high doses deliberately as a self-harm attempt.

Drug interactions can lead to accidental overdose as well.[8] Combining Lexapro with other serotonergic agents like monoamine oxidase inhibitors (MAOIs), certain migraine medications, or MDMA (ecstasy)  can cause an overdose, even at regular doses.

Can You Overdose on SSRIs in General?

SSRIs like Lexapro, fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa) are generally considered safer than older antidepressants, but they’re not without risks.[9]

Mild to moderate overdoses are relatively common with these drugs, but the symptoms are often manageable, such as nausea, dizziness, tremor, and drowsiness. Severe overdoses can occur, however, especially when SSRIs are combined with other medications that increase serotonin.

In large doses, SSRIs can cause severe symptoms like seizures, cardiac arrhythmias, and serotonin syndrome.

Though SSRI overdoses tend to have low mortality rates, the risk increases significantly if they’re combined with other psychoactive drugs, benzodiazepines, or alcohol.

What Happens If I Accidentally Take 2 Lexapro?

It’s not uncommon to accidentally double your dose, which is often how accidental Lexapro overdoses occur. For example, you may have a 10 mg daily dose, and you accidentally take another 10 mg later in the day.

In most healthy adults, a single double dose is unlikely to cause severe toxicity. However, you may notice some mild symptoms like nausea, sleepiness, lightheadedness, and feeling jittery.

If this happens, don’t panic. Experiencing serious harm from a one-time double dose isn’t common. Contact your doctor. They may recommend monitoring at home or direct you to the nearest emergency department. However, if you have a heart condition, take other serotonergic drugs, or experience severe symptoms, seek immediate medical attention.

Signs of Lexapro Toxicity

Recognizing Lexapro toxicity early is crucial. The symptoms can range from mild discomfort to dangerous complications. The milder signs of Lexapro toxicity include nausea, vomiting, dizziness, lightheadedness, drowsiness, tremors, sweating, and agitation or restlessness.

In severe cases, you may experience serotonin syndrome or more dangerous and distressing symptoms like confusion, hallucinations, severe muscle twitches or rigidity, very high fever, rapid or irregular heartbeat, seizures, or loss of consciousness.

If you experience any severe symptoms, treat them as a medical emergency and seek help.

Treatment for Lexapro Toxicity

Lexapro toxicity can be mild at lower doses in healthy people, but some cases may require emergency interventions. Depending on the symptoms, dosage, and your general health, you may need assessment of your heart function, intravenous fluids to support blood pressure and hydration, and continuous cardiac monitoring.

Activated charcoal is sometimes used to limit absorption of the drug, but that’s only if the overdose was within the last hour. In some cases, benzodiazepines are used to control seizure activity or agitation. Lexapro overdoses can have profound effects for a period after the dose, so that you may be hospitalized for continuous monitoring for at least 24 hours, depending on the severity.

Tips to Prevent Lexapro Overdose

Lexapro overdoses can happen, but there are some practical steps you can take to reduce the risks:

• Discuss any unusual or concerning symptoms you experience while taking Lexapro with your doctor.
• Ask questions about the drug and what you should expect.
• Discuss the other drugs you use – prescription, over the counter, and illicit – to understand potential interactions.
• Don’t take Lexapro with illicit drugs or drugs of abuse.
• Take your dose at the same time daily to avoid confusion.
• Educate family members about your prescription to avoid accidental overdosing.
• Set notifications for your usual dosage on your phone.
• If you miss a dose, don’t take another or double your dose. Wait and take your next dose at the usual time.

Be Careful with Medication Dosing

Lexapro is an effective and generally safe antidepressant when taken as prescribed. But like all medications, it can be dangerous in high doses. If you accidentally double your dose or are concerned about the potential drug interactions, understanding the signs of escitalopram overdose and taking precautions can help you avoid serious health consequences.

Frequently Asked Questions About Lexapro Overdose