Panic disorder is a chronic mental illness that affects people of almost every age group. It often goes along with various medical and psychiatric conditions, making people more prevalent to suicide. The suicidal ideations and autonomic instability associated with panic disorder increase with comorbid depression. If you are suffering from anxiety and panic disorder, here's a guide to using Escitalopram, a renewed alternative to Etizolam.

Escitalopram: An FDA-Approved Antidepressant

Escitalopram is used to treat panic disorder, generalized anxiety disorder (GAD), and major depressive disorder (MDD) by acting as a selective serotonin reuptake inhibitor (SSRI). It is also very effective in treating psychiatric conditions like obsessive-compulsive disorder (OCC). (1)

You can develop anxiety and depression without any prevalent reason. Illnesses, work-related problems, bereavement, or any life event can trigger depression or anxiety, interfering with day-to-day activities. You can restore your normal routine and ease your symptoms of GAD and MDD with the help of FDA-approved Escitalopram, which works by regulating the levels of serotonin in your brain. (2)

Escitalopram is also used as an off-label medication to treat other medical conditions like menopause-associated vasomotor symptoms, premenstrual dysphoric disorder, post-traumatic stress disorder, and social anxiety disorder.

Mechanism of Action of Escitalopram

Escitalopram binds to the serotonin transporter (SERT), a sodium-dependent protein known as 5-HTT, located in the pre-synaptic neuron. Escitalopram inhibits serotonin reuptake, thereby potentiating serotonin activity in the synaptic cleft (central nervous system). (3)

Human behavioral processes, such as sexuality, aggression, perception, mood, appetite, stress response, fear, and addiction, are modulated by 5-hydroxytryptamine (5-HT) or serotonin. Multiple serotonin receptors present in the hindbrain, midbrain, limbic, and cortical brain regions carry out these behavioral processes. (4, 5)

A very little binding affinity of Escitalopram is shown with other receptors like muscarinic and histamine receptors to improve your energy and well-being. (6)

Administration of Escitalopram

Escitalopram is taken by mouth with or without food. It comes in the form of tablets (5mg, 10mg, and 20mg), as well as oral solutions (1 mg/mL). Your doctor prescribes a starting dose of 10mg. After your symptoms achieve proper control within a week, the dose can be increased.

Here are different dosages of Escitalopram for different disorders:

• Generalized Anxiety Disorder: The lowest dose of Escitalopram (10 mg) is maintained and increased to 20 mg/day after a week. 

• Major Depressive Disorder: For managing MDD, 10mg/day of Escitalopram is recommended and increased to 20mg/day after one week. 

• Insomnia: For depression-related insomnia, 5-20 mg/day of Escitalopram is recommended for eight weeks. For panic disorder-related insomnia, 5-10 mg/day is recommended for eight weeks. (7, 8)

Who Can and Cannot Take Escitalopram

If you’re an adult aged over 18, your doctor can prescribe you Escitalopram. However, if you have the following reasons, take advice from your doctor:

• If you have heart rhythm disorder or any other heart condition.
• If you’re breastfeeding or trying to conceive.
• If you have had allergic reaction to any medications in the past.
• If you have diabetes mellitus.
• If you have had abnormally high moods (mania).
• If you have an eye condition like glaucoma (pressure in the eye).
• If you’re undergoing electroconvulsive therapy (ECT).
• If you have epilepsy.

Can Escitalopram Cause Any Problem?

Escitalopram can cause minor after-effects contained in the table below. If these side effects continue to persist, speak with your pharmacist or doctor.

How to Store Escitalopram?

• Once you have opened the bottle, you can use the oral solution for eight weeks.
• Keep the medicine away from light and heat. Store in a cool, dry place.
• Keep your medicine out of the reach of children. (7)

References:

1. Stahl SM, Gergel I, Li D. Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2003 Nov;64(11):1322–7.
2. Landy K, Rosani A, Estevez R. Escitalopram. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 May 29]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK557734/
3. Kasper S, Sacher J, Klein N, Mossaheb N, Attarbaschi-Steiner T, Lanzenberger R, et al. Differences in the dynamics of serotonin reuptake transporter occupancy may explain superior clinical efficacy of Escitalopram versus citalopram. Int Clin Psychopharmacol. 2009 May;24(3):119–25.
4. Berger M, Gray JA, Roth BL. The Expanded Biology of Serotonin. Annu Rev Med. 2009;60:355–66.
5. Pastoor D, Gobburu J. Clinical pharmacology review of Escitalopram for the treatment of depression. Expert Opin Drug Metab Toxicol. 2014 Jan 1;10(1):121–8.
6. A comparative review of Escitalopram, paroxetine, and sertraline: are they all alike? [Internet]. [cited 2021 May 29]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047306/
7. Lexapro (escitalopram) dosing, indications, interactions, adverse effects, and more [Internet]. [cited 2021 May 29]. Available from: https://reference.medscape.com/drug/lexapro-escitalopram-342961
8. Rao N. The clinical pharmacokinetics of Escitalopram. Clin Pharmacokinet. 2007;46(4):281–90.