Lexamil contains escitalopram, an SSRI antidepressant. It is prescribed for depression and for anxiety conditions including generalised anxiety, panic disorder, social anxiety and obsessive-compulsive disorder. It comes as 5 mg, 10 mg and 20 mg tablets, takes several weeks to work, and should not be started or stopped without medical guidance.
What is Lexamil?
Lexamil is Schedule 5 in South Africa — prescription-only:
| Product | Contains |
|---|---|
| Lexamil 5 mg | Escitalopram 5 mg |
| Lexamil 10 mg | Escitalopram 10 mg |
| Lexamil 20 mg | Escitalopram 20 mg |
Escitalopram is one of the most widely prescribed antidepressants in South Africa, and is available under several other names too.
Escitalopram is a selective serotonin reuptake inhibitor (SSRI). Nerve cells communicate by releasing serotonin into the gap between them and then reabsorbing it; escitalopram blocks that reabsorption, so serotonin remains available for longer.
Escitalopram’s relationship to citalopram is worth understanding. Citalopram is a mixture of two mirror-image forms of the same molecule; only one of them — the S-form — does the useful work. Escitalopram is that active half on its own, which is why it works at roughly half the dose: 10 mg of escitalopram is broadly comparable to 20 mg of citalopram.
But the mechanism does not explain the timing, and the timing is what matters most in practice. Serotonin levels rise within hours, yet benefit takes weeks. The improvement therefore comes from slower adaptive changes in nerve circuits, not simply from more serotonin.
This creates a pattern worth knowing in advance: side effects appear in the first days, benefit arrives weeks later. The early experience is often all cost and no benefit — and that is the single most common reason people stop before the medicine has had a chance to work.
In anxiety conditions, symptoms sometimes feel worse for the first week or two before improving. This is recognised, temporary, and often why a lower starting dose is used.
What is Lexamil commonly used for?
- Depression — including moderate to severe episodes.
- Generalised anxiety disorder, where escitalopram is a common first choice.
- Panic disorder, with or without agoraphobia.
- Social anxiety disorder.
- Obsessive-compulsive disorder, often needing higher doses and longer to respond.
- Post-traumatic stress disorder, in some cases.
- Premenstrual dysphoric disorder.
Expect a realistic timeline. Sleep and appetite often improve within one to two weeks. Mood and anxiety usually improve over four to six weeks, sometimes longer.
Once it works, treatment usually continues for at least six months after recovery, because stopping early markedly increases relapse risk.
Medicine is rarely the whole treatment. Psychological therapy — cognitive behavioural therapy in particular — works at least as well for many anxiety conditions and better in combination.
How Lexamil fits into this medicine category
| Group | Examples | Typical role |
|---|---|---|
| SSRIs | Escitalopram (Lexamil), citalopram, fluoxetine | First-line for depression and anxiety |
| SNRIs | Venlafaxine, duloxetine | Depression, anxiety; duloxetine also nerve pain |
| Tricyclics | Amitriptyline | Older; nerve pain, sleep, depression |
| Benzodiazepines | Diazepam | Short-term anxiety only; dependence risk |
| Gabapentinoids | Pregabalin | Anxiety, nerve pain, add-on epilepsy |
| Antipsychotics | Risperidone | Psychosis, bipolar; sometimes added |
SSRIs are generally first choice because they are effective and much safer in overdose than older antidepressants. See the mental health, nerve and neurological medicines hub.
What to check before using Lexamil
Do not stop it abruptly. Escitalopram has a relatively short duration, so discontinuation symptoms are common if stopped suddenly — dizziness, electric-shock sensations (“brain zaps”), nausea, irritability, vivid dreams and flu-like feelings. These are unpleasant but not dangerous, and are avoided by tapering gradually under medical guidance. They are not withdrawal in the addiction sense, and escitalopram is not addictive.
Do not increase the dose yourself. Like citalopram, escitalopram can affect the heart’s QT interval at higher doses, so maximum doses are capped — with lower limits for people over 65, those with liver impairment, and those on interacting medicines.
Tell your doctor or pharmacist if you:
- Have any heart condition, a rhythm disorder, a slow heart rate, or a family history of sudden cardiac death.
- Have low potassium or magnesium.
- Have bipolar disorder, or have ever had a manic episode — an antidepressant alone can trigger mania.
- Have epilepsy.
- Have liver or kidney disease.
- Have glaucoma, or a bleeding disorder.
- Have diabetes, as blood sugar control may shift.
- Are over 65, where a lower maximum dose applies.
- Are pregnant, planning pregnancy or breastfeeding. Untreated depression in pregnancy also carries risks — this is a balance to discuss, not an automatic reason to stop.
- Are under 25, where closer monitoring is advised early in treatment.
- Take medicines affecting heart rhythm — some antibiotics, antifungals, antipsychotics and antiarrhythmics.
- Take tramadol, triptans for migraine, linezolid, St John’s wort, or another antidepressant — all raise serotonin.
- Take an MAOI antidepressant. This must be avoided, with a gap when switching.
- Take warfarin, aspirin or an anti-inflammatory such as ibuprofen — SSRIs increase bleeding risk.
- Take omeprazole or cimetidine, which raise escitalopram levels.
Possible cautions and when to ask a pharmacist or doctor
Common effects, mostly early and often settling within two weeks, are nausea, dry mouth, sweating, drowsiness or insomnia, headache, tremor, diarrhoea, reduced appetite and yawning.
Sexual side effects are common and often under-discussed — reduced desire, difficulty reaching orgasm, or erectile difficulty. They affect a substantial minority and do not always settle. Raise it if it happens; a dose adjustment or different antidepressant often helps, and this is a frequent reason people quietly stop medicine that is otherwise working.
Seek medical attention urgently if you or those around you notice:
- New or worsening thoughts of suicide or self-harm, or marked agitation — especially in the first weeks or after a dose change. This needs same-day attention.
- Agitation, confusion, fever, sweating, shivering, muscle twitching, a racing heart or diarrhoea — possible serotonin syndrome, particularly with another serotonergic medicine.
- Palpitations, fainting, or an irregular heartbeat.
- A seizure.
- Unusual bruising or bleeding, vomiting blood, or black stools.
- Elevated mood, racing thoughts, reduced need for sleep or unusually impulsive behaviour — possible switch into mania.
- Confusion, marked drowsiness, headache or nausea — possible low sodium, more likely in older people.
- A rash, or swelling of the face or lips.
Tell your doctor if there is no improvement after four to six weeks, if side effects are limiting, or if your circumstances change. Many people need a dose adjustment or a different antidepressant before finding the right one — needing a second try is common and is not a failure.
Related medicine guides
- Browse Mental Health, Nerve & Neurological Medicines guides
- Read: Trepiline used for
- Read: Nurika used for
Frequently asked questions
What is Lexamil used for? Depression and anxiety conditions including generalised anxiety, panic disorder, social anxiety and obsessive-compulsive disorder. It contains escitalopram.
What is Lexamil 10 mg used for? The most common starting and maintenance strength for depression and anxiety.
What is Lexamil 20 mg used for? The higher strength, used where 10 mg is not enough, and often in OCD. Doses are capped because of a heart rhythm effect.
How long does it take to work? Sleep and appetite may improve in one to two weeks; mood and anxiety usually improve over four to six weeks. Side effects often appear first and then settle.
Is Lexamil addictive? No. SSRIs do not cause craving or dose escalation. Stopping abruptly can cause discontinuation symptoms, which is different from addiction.
Can I stop when I feel better? Not on your own. Treatment usually continues at least six months after recovery, and stopping should be tapered gradually.
Is it the same as citalopram? Escitalopram is the active half of citalopram, so it works at roughly half the dose. They are related but not identical.
Can I drink alcohol on it? Alcohol can worsen depression and anxiety and add to drowsiness. Discuss it with your doctor.