Escitalopram

Escitalopram is a selective serotonin reuptake inhibitor (ssri) antidepressant medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

Escitalopram is prescribed for:

• Major depressive disorder — persistent low mood, loss of interest, poor sleep and energy
• Generalised anxiety disorder — excessive, hard-to-control worry
• Panic disorder, with or without agoraphobia
• Social anxiety disorder
• Obsessive-compulsive disorder (OCD), as advised by a psychiatrist

Treatment usually continues for at least six months after recovery from a first depressive episode — often longer for repeated episodes or chronic anxiety — to prevent relapse. Medication works best combined with counselling or psychotherapy, regular sleep, physical activity and follow-up visits, so keep your review appointments even when you feel well.

Most side effects appear early and fade within one to two weeks:

• Common: nausea, headache, dry mouth, sweating, sleepiness or insomnia, temporary increase in anxiety or restlessness
• May persist for some users: reduced sexual desire or delayed orgasm, weight change, vivid dreams
• Serious (seek help): new or worsening suicidal thoughts — particularly in people under 25 during the first weeks; unusual bleeding or bruising; severe agitation with fever and muscle twitching (possible serotonin syndrome); fainting or palpitations; confusion and weakness in the elderly (possible low sodium)

Report side effects rather than stopping the medicine — most can be managed with timing or dose changes.

Important precautions with Escitalopram:

• People under 25 need close monitoring during the first weeks, when restlessness or suicidal thoughts can transiently increase — family awareness helps
• Allow 2–4 weeks for benefit; do not abandon treatment early
• Never stop abruptly; always taper under medical guidance
• Tell your doctor about epilepsy, bipolar disorder, heart rhythm problems, bleeding tendency, glaucoma, liver or kidney disease and diabetes
• Combining it with NSAIDs or aspirin increases bleeding risk — mention every painkiller you use
• Avoid alcohol, which worsens depression and side effects
• Be careful driving early in treatment until you know how it affects you

Tell your doctor about all medicines before starting Escitalopram:

• MAO inhibitors — absolutely contraindicated together or within 14 days; risk of fatal serotonin syndrome
• Other serotonergic drugs — tramadol, triptans, other antidepressants, lithium, St John's Wort — raise the risk of serotonin syndrome and seizures
• NSAIDs, aspirin, warfarin and clopidogrel — increased bleeding tendency; protective measures may be needed
• Omeprazole and cimetidine — can raise escitalopram levels; dose limits may apply
• QT-prolonging medicines (certain antibiotics, antipsychotics, antiarrhythmics) — additive heart-rhythm risk

Avoid alcohol, and never add herbal mood remedies without asking your doctor.

Escitalopram must not be taken if any of the following applies:

• Use of a MAO-inhibitor antidepressant currently or within the past 14 days
• Known congenital long QT syndrome or a significant uncorrected heart-rhythm disorder
• Concurrent use of other strongly QT-prolonging medicines, unless a specialist accepts and monitors the combination
• Known allergy to escitalopram or citalopram

It should be used only with specialist guidance in bipolar disorder (used alone it can trigger a manic switch), severe liver disease, poorly controlled epilepsy, and in anyone under 18, where treatment decisions belong to a psychiatrist.

Pregnancy: Decisions are individual. Untreated depression and anxiety carry real risks for both mother and baby, and abrupt discontinuation often causes relapse, so Escitalopram is used in pregnancy when a doctor judges the benefit outweighs the risk. Babies exposed late in pregnancy occasionally show temporary adaptation symptoms (jitteriness, feeding or breathing difficulty) after birth, so the delivery team should know about the medicine.

Breastfeeding: Small amounts pass into breast milk. Many mothers breastfeed successfully during treatment under medical supervision while watching the baby for unusual sleepiness, irritability or poor feeding. Always plan pregnancy and feeding choices together with your psychiatrist.

Store Escitalopram in its original pack below 30°C, protected from light, heat and moisture, and away from bathrooms or kitchen humidity. Keep it out of the reach and sight of children and stored discreetly away from anyone who might take it without a prescription. Take stock before long trips so daily dosing is never interrupted, because missed days can bring discontinuation symptoms. Do not use tablets past their expiry date or ones that look damaged, and dispose of leftover medicine safely rather than passing it to relatives with similar symptoms.