How does Lexapro make you feel the first week?
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
November 18, 2023

Are you considering taking Lexapro for depression or anxiety?

If so, how does Lexapro make you feel the first week?

Read on to learn more about what to expect during your first week of therapy with Lexapro and how to manage any possible adverse effects.

Key Takeaways

  • Individuals may experience immediate side effects during the first week when starting Lexapro, such as nausea, headache, dizziness, and changes in appetite.
  • Lexapro can have a positive impact on mood and overall well-being, reducing anxiety and depressive symptoms.
  • The body takes time to adjust to Lexapro, and it may take several weeks for the full therapeutic effects to be felt.
  • Factors such as overall health, age, genetics, dosage, and underlying medical conditions can influence the effects of Lexapro, and individual experiences may vary.

Understanding escitalopram and its uses

Lexapro, also known as escitalopram, is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs).

Other common examples of SSRIs are Paxil and Zoloft.

The SSRI drug class is the first-line, evidence-based treatment for people diagnosed with anxiety and depression.

It targets serotonin, a neurotransmitter regulating mood, sleep, appetite, and other brain functions.

I have written a comprehensive article on depression here. I highly recommend you read it.

When starting Lexapro, side effects such as nausea, headache, dizziness, drowsiness, insomnia, increased sweating, or changes in appetite are common.

During the first few days of taking Lexapro, your body adjusts to the medication, and you may experience short-term side effects.

By the fourth day, the stabilizing effects of Lexapro are apparent.

It’s important to take the medication as prescribed and be patient as the body adapts.

Factors like overall health, age, genetics, and dosage can influence the effects of Lexapro.

What to expect when you start to take Lexapro

When beginning Lexapro, it’s common to experience immediate side effects and emotional/physical changes.

The first two weeks of treatment are the most pivotal since this is when you will experience these side effects.

Some of these effects may be so strong that you may be tempted to stop taking your medication.

Many of these side effects can be minimized by responsible and careful prescribing and dispensing by your doctor and pharmacist.

Many medication side effects are dose-dependent.

What do I mean by this?

It means that you may experience less severe or debilitating side effects if you are started on the lowest dose of Lexapro.

The dose can then be slowly increased depending on how you tolerate the medication.

In my clinical practice, we follow the mantra, “Start Low, Go Slow, But Go All The Way.”

With my physician colleagues, I recommend starting patients at 5 mg daily, maintaining this dose for a few weeks, monitoring for side effects, increasing to 10 mg daily as tolerated, and repeating until the target dose of 20 mg daily is reached.

This is where individual patient response comes into play.

Some people’s anxiety or depression is resolved at a maintenance dose of 10 mg daily, while others may require a dose of 20 mg daily to find relief.

It really depends, and this is why I always recommend you communicate your response to your medication clearly with your doctor, Nurse Practitioner, or Physician Assistant.

What does Lexapro make you feel the first week?

You may experience the following beneficial responses and side effects during the first week of starting Lexapro:

Common and immediate side effects of Lexapro

Managing common side effects of Lexapro can help reduce discomfort in the first week.

Selective serotonin reuptake inhibitors, such as Lexapro, are used to treat major depressive disorder and generalized anxiety disorder.

Common side effects may include:

  • Nausea
  • Vomiting
  • Headache
  • Dizziness
  • Insomnia
  • Drowsiness
  • Increased sweating
  • Changes in appetite
  • Sexual side effects, such as decreased libido, and erectile dysfunction are also possible.

Be patient as the body adjusts to the medication and its effects are felt.

These side effects tend to be mild and will get better or resolve as you get used to the medication.

Positive physical and emotional effects

You may experience some positive effects from taking Lexapro during the first week of treatment.

A reduction in anxiety or depressive symptoms may be seen.

However, it is important to note that you may not experience the full therapeutic effects of Lexapro until many weeks (12 weeks or more) have passed.

Daily progression of Lexapro side effects in the first week

Here is what you can expect during the first week of treatment (Keep in mind that these effects vary in people):

Days 1 to 3: Your body adjusts

You may experience some of the immediate side effects I mentioned earlier (nausea, headache, sleep disturbances, etc).

Don’t stop taking your medication unless the side effects become unbearable or start affecting your quality of life, and only after consulting your doctor.

Days 4 to 7: You begin to stabilize

By day 4, you may start seeing some improvement in your anxiety level, mood, appetite, or sleep.

Very important: Don’t fret if you don’t see these positive effects yet.

As I mentioned, everyone responds to these medications differently. 

You may need to wait a little longer before you begin reaping some benefits from taking Lexapro.

In the insightful video below, the content creator describes her own experience of being on Lexapro from the first week and beyond:

Factors influencing Lexapro side effects

The following factors may influence how you respond to your medication:

  • Age
  • Genetic predisposition
  • Starting dose
  • Your overall health or functional reserve (read my article on the Geriatric Syndromes)
  • Your current health conditions
  • Other medications you are taking (Lexapro may interact with blood thinners, NSAIDs, other antidepressants, and MAOIs, polypharmacy)

How to manage Lexapro side effects during the first week

There are steps you can take if you start experiencing side effects during the first week of starting Lexapro.

Easy and practical tips for managing side effects:

  • Get plenty of rest and sleep
  • Maintain a healthy diet and balanced nutrition
  • Stay hydrated, but don’t overdo it, especially if you are on fluid restriction for heart failure, etc
  • Don’t take any new medication, OTC drug, or supplement without consulting your doctor first!
  • Avoid alcohol!

When to see your doctor or go to the ER (serious side effects)

  • If you experience shortness of breath, hives/rash, itching, etc (this can be a life-threatening emergency!)
  • If you see blood in your stools or vomit blood
  • If you start having suicidal thoughts 
  • If your anxiety or depression worsens
  • Unexpected changes in behavior or mood


Starting Lexapro has the potential to improve your overall well-being.

However, it’s important to know that it can cause some initial side effects.

Everyone’s reaction to Lexapro will be different.

Take note of any changes you experience while taking it and inform your doctor.

If you have any concerns or experience side effects while taking Lexapro, talk to your doctor.

They can help you manage these side effects and ensure you benefit most from the medication.

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