Can Lexapro Cause Anxiety Attacks? | What To Expect

Yes, Lexapro can briefly trigger or worsen anxiety attacks in some people, especially in the first weeks or after dose changes.

Starting Lexapro can feel like a big step. Many people begin this medicine hoping for calmer days, then feel alarmed when anxiety attacks seem to flare up instead. That experience can be confusing and scary, and it raises a fair question about what the drug is doing.

This guide walks through how Lexapro works, why anxiety can spike at certain points in treatment, and what you can do if panic or intense fear shows up after you begin the medication. It is general information only and does not replace a one-to-one talk with your own doctor, who knows your health history.

How Lexapro Works For Anxiety

Lexapro is the brand name for escitalopram, a selective serotonin reuptake inhibitor, or SSRI. It is approved in many countries for depression and for conditions such as generalized anxiety disorder, and it is often used when panic attacks are part of the picture. The official Lexapro prescribing information from the U.S. Food and Drug Administration describes how it changes serotonin activity over time to ease mood and anxiety symptoms.

SSRIs change the way nerve cells handle serotonin. Over time, this shift can ease constant worry, low mood, and the physical symptoms that ride along with them. The main point is that this happens “over time.” The full calming effect can take several weeks, and the first stretch on the medicine does not always match the final result.

Why An SSRI Can Feel Strange At First

During the first days and weeks on Lexapro, the brain is adjusting to new serotonin levels. That adjustment can feel bumpy. Guidance from groups such as the National Alliance on Mental Illness notes that feeling nervous, restless, or unable to sleep is common in the early phase of escitalopram treatment, and that these reactions often settle as the body adapts.

Prescribing information and large drug references also mention a cluster of symptoms that can appear in the early phase of treatment or around dose changes. These include increased anxiety, agitation, panic attacks, irritability, and trouble sleeping, along with rare but serious mood changes that call for prompt medical review.

Lexapro’s Track Record With Anxiety Disorders

While the short-term picture can feel rocky, longer term data on escitalopram show that many people with anxiety disorders, including panic disorder, do well on it. In clinical studies, SSRIs as a group reduce the number and intensity of panic attacks for many patients once the dose is stable and enough time has passed.

Lexapro Anxiety Attacks When You Start Or Change Dose

When someone reports new or worse anxiety attacks on Lexapro, timing is one of the main clues doctors review. The pattern around the start date, dose jumps, or missed doses can show whether the medicine likely plays a part or whether something else is driving the change.

Early Activation And Restlessness

Some people feel more wired after their first few doses. They might notice a racing mind, a tight chest, or a sense that they cannot sit still. In a person who already lives with anxiety, that extra buzz can tip over into an attack, especially at night when there are fewer distractions.

Drug information sites and patient leaflets on escitalopram, such as the NHS guidance on escitalopram, explain that side effects such as nervousness, sweating, shaking, or difficulty sleeping often appear first and then fade as the body adapts. In many cases, anxiety attacks ease at the same pace as those sensations settle down, and that arc can take several weeks.

Dose Increases And Missed Doses

Changes in dose can also stir up symptoms. Stepping up too quickly may create the same restless feeling as the start of treatment. On the other side, missing several doses in a row or stopping on your own can bring withdrawal-like symptoms, which might include surges of anxiety, dizziness, or “electric” feelings in the head.

Doctors usually raise the dose in small steps and spread those steps over weeks. That gentle pace makes it easier for the brain and body to catch up. When that schedule is rushed, or when doses are stopped suddenly, the shift can be jarring enough to bring on anxiety attacks even in people who had been feeling steadier.

Scenario With Lexapro	What You Might Feel	Typical Timing
First week on the medicine	Nervous energy, shaky hands, knot in the stomach	Days 1–7
Early weeks at a new dose	Stronger waves of worry, brief anxiety attacks	Weeks 1–3 after a change
Taking doses at different times each day	Feeling “off,” on-and-off anxiety and irritability	Any time routine is uneven
Missing several doses in a row	Brain zaps, dizziness, surges of fear	Within a few days of stopped doses
Stopping without a taper plan	Intense rebound anxiety, mood swings	First week after stopping
Stable dose with good sleep and routine	Gradual calming, fewer anxiety attacks	After 4–6 weeks or more
Stable dose with ongoing daily stress	Anxiety attacks tied to triggers more than to timing of pills	Any point in treatment

Other Triggers That May Be Blamed On Lexapro

Life Stress And Sleep Debt

Lexapro is rarely started in a calm season of life, so higher work stress, family strain, health worries, and broken sleep often sit in the background. Short nights, late scrolling, caffeine late in the day, and irregular work hours can all lower the threshold for panic, and the new medicine can end up taking the blame for attacks driven by that mix.

Caffeine, Alcohol, And Other Medicines

Caffeine can speed up the heartbeat and bring on shaky feelings that resemble an anxiety attack, and large coffees, energy drinks, or strong tea can blur the line between medicine effects and stimulant effects. Alcohol, sedating drugs, and some prescribed or over-the-counter medicines can also interact with SSRIs, so it helps to give your doctor and pharmacist a full list of everything you take.

Medical Conditions That Mimic Anxiety Attacks

Thyroid problems, low blood sugar, heart rhythm issues, and some lung or heart conditions can cause symptoms that feel almost the same as an anxiety attack. If episodes on Lexapro appear out of nowhere, last longer, or come with chest pain, fainting, or severe shortness of breath, that pattern deserves medical review to rule out another medical cause.

Practical Steps When Anxiety Spikes On Lexapro

Track Patterns Around Each Anxiety Attack

A simple log can reveal patterns that are easy to miss in the moment. For each anxiety attack, note the date, time, what you were doing, when you last took Lexapro, how much caffeine you had that day, and how much sleep you got the night before, then bring that record to your next visit so your prescriber can see whether episodes cluster around dose changes, missed pills, or certain triggers.

Simple Grounding Ideas During An Anxiety Attack

While you work on the medicine plan, it helps to have tools you can use in the middle of an anxiety attack. These do not cure the problem, yet they can soften the peak and shorten the episode.

Steady Breathing

Slow breathing sends a message of safety through the nervous system. One common pattern is to breathe in through the nose for a count of four, pause for one or two beats, then breathe out through the mouth for a count of six. Many people repeat this for a few minutes until the rush starts to ease.

Grounding Through The Senses

The classic “five-four-three-two-one” exercise involves naming five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. This simple routine draws attention outward and away from racing thoughts about what might happen next.

How To Talk With Your Prescriber

When you meet with your prescriber, describe the anxiety attacks in clear, concrete terms, including how often they occur, how long they last, what sets them off, and how they compare with panic episodes you had before starting Lexapro. Your clinician can then weigh options with you, such as holding the dose steady for longer, lowering it, switching to a different SSRI, or adding a short-term medicine for anxiety while the SSRI continues to build effect.

Topic To Raise	Example Question	What It Can Clarify
Timing of doses	“Would morning or evening dosing suit my symptoms better?”	Links anxiety attacks to when the pill is taken
Dose size	“Is my current dose higher or lower than average for my condition?”	Shows whether a smaller or slower titration might help
Side effect window	“How long do you usually see early side effects last on this drug?”	Sets expectations around how long anxiety attacks may flare
Other medicines	“Could anything else I take be making anxiety worse?”	Checks for interactions that raise nervousness
Therapy options	“Would talking therapy alongside Lexapro make sense for me?”	Combines skill-building with medicine
Safety planning	“What should I do if I have a severe anxiety attack between visits?”	Gives a clear plan for crisis moments

When To Seek Urgent Help

Most early side effects of Lexapro are mild. Some are not. Drug information for escitalopram and other antidepressants, such as the MedlinePlus monograph for escitalopram, points out warning signs that need prompt care, not a wait-and-see approach.

Call emergency services or go to the nearest emergency department right away if an anxiety attack on Lexapro comes with chest pain, trouble breathing, a sudden pounding or irregular heartbeat, seizures, or thoughts of harming yourself or someone else. Sudden swelling of the face, lips, tongue, or throat can signal an allergic reaction and also needs rapid treatment.

There is also a small but real increase in suicidal thoughts in children, teens, and young adults in the early months on SSRIs. Family members and close friends can help by watching for sharp mood shifts, talk about death or self-harm, or sudden risky behavior, and by seeking immediate help if those signs appear.

Living With Lexapro And Anxiety Attacks Long Term

For many people, the early waves of nervousness and anxiety attacks on Lexapro ease off as the weeks pass, panic becomes less frequent, daily baseline anxiety softens, and it becomes easier to function at work, at school, and at home. Others find that Lexapro helps only partway, or that side effects such as sexual problems, sweating, or weight change feel too hard to live with, and in those cases doctors may suggest a different SSRI, another class of antidepressant, or non-drug approaches as the main focus.

The main goal is not to push through endless anxiety attacks for the sake of staying on one specific medicine. The goal is a plan that brings fewer attacks, better day-to-day functioning, and a sense that life is opening up again. Lexapro can be a helpful part of that picture for many people, yet it is only one tool among many.