Can Lexapro Cause Heart Palpitations?

In this article, we will take a close look at Lexapro, an important medication used in the treatment of depression, a disease that, according to the WHO, affects nearly 4% of the global population [1]. We will explore its potential side effects, particularly its impact on heart health, and discuss whether it can cause heart palpitations.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

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Can Lexapro cause heart palpitations?

Lexapro, also known as escitalopram, like most drugs, may cause mild to serious side effects. The specific side effect of heart palpitations is not explicitly mentioned in the common side effects of Lexapro [2]. However, in the event of an overdose, Lexapro can lead to heart problems such as abnormal heart rhythm [2].

Nevertheless, it can cause irregular rhythms, especially in individuals with pre-existing heart conditions [3]. However, this situation is rare, and often patients take many medications, which could provoke these conditions; thus, this cannot be linked entirely to escitalopram. For instance, a patient can experience sinus bradycardia (a slower than 60 BPM heart rate) after taking escitalopram [4].

On the other hand, in a study on animals, Lexapro was associated with a slight increase in the risk of tachycardia (a faster heartbeat than 100 BPM) [5]. A fast heart rate, without exercise or stress, is abnormal and can potentially lead to palpitations. An exact translation of the results of this experiment to humans is not certain, but possible.

What is Lexapro?

Lexapro, also known as escitalopram, is part of the selective serotonin reuptake inhibitors (SSRIs) class. It works by increasing the amount of the chemical serotonin in the brain. Lexapro is sold on prescription and is available as an oral tablet and liquid solution [6].

When is Lexapro prescribed?

Lexapro is typically prescribed for the treatment of depression or generalized anxiety disorder. It's approved for use in adults and children 12 years of age and older. The usual daily dosage is 10 to 20 milligrams [6, 7].

How does Lexapro work exactly?

The primary mechanism of action of Lexapro involves increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that is responsible for mood regulation. The increase in its amount is achieved by inhibition of the reuptake. The increased chemical availability of serotonin in the brain reduces symptoms of depression and anxiety [6, 8].

More precisely, Lexapro works by enhancing serotonergic neurotransmission. It decreases the functional activity of the 5-HT1A and 5-HT1B autoreceptors, which normally, when activated, inhibit neuron firing. This process of increased serotonin neurotransmission is not immediate. That creates a delay between the initiation of treatment and the anti-depressive effect [9].

What is the impact of Lexapro on the heart?

Lexapro has been found to have several effects on the heart. Most of them are harmless to a healthy individual. However, in patients with preexisting heart conditions, they may be of concern.

The primary cardiovascular effect escitalopram can have is arrhythmia (irregular rhythm). This risk is highest in patients with diseases like heart failure [3].

Lexapro causes an imbalance in the autonomic nervous system. This system can automatically either excite (the sympathetic system) or calm down (the parasympathetic system) certain actions of the body, like the heart rate. Escitalopram favors the parasympathetic effect. It was found to cause an increase in mean arterial pressure and a decrease in heart rate [10].

However, Lexapro is an SSRI-class drug that appears to have fewer cardiovascular side effects than other antidepressant types. This statement is drawn from the fact that SSRIs have a similar mechanism of action and, thus, have similar effects. When another SSRI, fluoxetine, was compared with a tricyclic antidepressant (nortriptyline), the cardiovascular effect was better. The SSRI patients had a better ejection fraction and a lower heart rate, with a slight increase in blood pressure. Additionally, less than 5% of them had adverse cardiovascular effects [11].

In conclusion, even though Lexapro can affect the heart to some extent, these effects are often less than those of other antidepressant classes. However, patients with pre-existing heart disease are at higher risk of experiencing cardiovascular side effects.

Is Lexapro safe to use in heart disease?

There are some safety concerns in individuals with heart disease. That is why this is a topic of interest to the medical society.

Lexapro can cause an irregular heart rhythm. The risk of this side effect is higher in individuals with pre-existing heart conditions, such as heart failure [3]. However, the decision to treat depression or anxiety with Lexapro in patients with heart disease should be made on a case-by-case basis. Both the type and severity of the disease should be considered [12].

Generally, studies suggest that SSRIs, including Lexapro, have a relatively benign cardiovascular profile in patients with pre-existing cardiac disease [12, 13]. When followed throughout one year, escitalopram treatment was found to be safe and well-tolerated in patients with recent acute coronary syndrome [14].

However, the studies suggesting safety were performed on small groups of patients. The small number of participants makes it difficult to generalize. Thus, the results do not definitively conclude that SSRIs are entirely safe for all patients with heart disease [15].

Lexapro can be used in patients with heart disease, although only under careful medical supervision. Patients with suspected heart disease have to clarify their status before treatment.

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Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.