You just started your first dose of escitalopram, and suddenly the room feels like it’s tilted at a weird angle. It’s unsettling. You’re trying to treat your anxiety or depression, but now you’re clutching the kitchen counter just to keep your balance.
If you’re wondering does lexapro cause dizziness, the short answer is a resounding yes. It’s actually one of the most frequently reported side effects.
But "dizziness" is a vague word. For some people, it feels like a lightheaded "whoosh" when they stand up. For others, it’s a legitimate sense of vertigo where the world is spinning. Most of the time, this happens because your brain is trying to recalibrate to a major shift in its chemical environment. Lexapro (escitalopram) is a Selective Serotonin Reuptake Inhibitor (SSRI). It works by keeping more serotonin available in the spaces between your neurons. While that’s great for your mood eventually, serotonin is also a busybody in the rest of your body—including your inner ear and the parts of your brain that regulate balance.
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It’s annoying. It’s common. And honestly, it’s usually temporary.
Why Lexapro makes you feel like you’re on a boat
The biology here is pretty fascinating, if you can look past the nausea. Serotonin isn't just a "happy chemical." It’s a neurotransmitter that helps regulate everything from your gut motility to your sleep-wake cycles and your vestibular system. When you start Lexapro, you’re essentially flooding the system with more serotonin than it’s used to. Your vestibular system—that complex network in your inner ear and brain that tells you which way is up—has serotonin receptors.
When those receptors get hit with a sudden increase, they can misfire.
Think of it like a soundboard where someone just cranked the volume on one specific channel. The other channels are still trying to play the music, but everything sounds distorted until the sound engineer (your brain) adjusts the sliders. According to clinical data from the FDA, dizziness was reported in about 8% of patients taking Lexapro in controlled trials, compared to only 2% of those taking a placebo. That’s a significant gap.
Sometimes the dizziness isn’t about the ears at all. Lexapro can occasionally cause a slight drop in blood pressure when you stand up too fast, a condition known as orthostatic hypotension. If you’re feeling a "blackout" sensation for a split second after getting out of bed, that’s likely the culprit.
The timeline: How long does this last?
Most people want to know if they're going to feel like this forever.
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Usually, the peak of the dizziness happens in the first one to two weeks. This is the "adjustment phase." Your body is highly adaptive. Eventually, it realizes the higher serotonin level is the new normal and it downregulates its receptors to compensate. By week three or four, most users find that the dizzy spells have faded into the background or vanished entirely.
However, "most" isn't "all."
I’ve talked to people who experienced persistent lightheadedness for months. In those cases, it’s often because they started at a dose that was a bit too high for their specific metabolism. Lexapro is potent. While 10mg is the standard starting dose, many doctors are now starting patients at 5mg—or even 2.5mg—to let the body slowly acclimate. If you’re two months in and still feeling like you’re walking on a trampoline, it’s time for a serious chat with your psychiatrist about your dosage.
Does Lexapro cause dizziness when you stop taking it?
This is the part people often forget to mention. The dizziness you feel when starting the medication is one thing, but the dizziness you feel when stopping it is a whole different beast. This is often referred to as "discontinuation syndrome."
If you miss a dose or try to quit cold turkey, you might experience what patients describe as "brain zaps." It feels like a tiny electric shock in your head, often accompanied by a fleeting, intense burst of dizziness. It’s not dangerous, but it is deeply uncomfortable. This happens because your brain has become accustomed to the Lexapro and suddenly the "supply" is cut off.
Always taper. Never, ever just stop.
Real-world factors that make the spinning worse
It’s rarely just the pill. Other factors in your daily life can act as force multipliers for Lexapro-induced dizziness.
- Dehydration: Lexapro can make some people sweat more or change their salt balance. If you aren't drinking enough water, your blood pressure drops, and the dizziness intensifies.
- Caffeine: You might be used to three cups of coffee, but Lexapro can change how you process caffeine. The jitters can easily turn into a feeling of lightheadedness.
- Alcohol: Mixing an SSRI with a glass of wine can make the sedative and dizzying effects of both much stronger.
- Sodium levels: In rare cases, especially in older adults, Lexapro can cause a drop in blood sodium (hyponatremia). This leads to confusion, headache, and—you guessed it—dizziness.
What should you actually do about it?
If you're currently staring at your bottle of Lexapro wondering if it's worth it, don't panic. There are practical ways to manage this side effect while you wait for your brain to catch up.
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First, slow down. Literally. When you get out of bed, sit on the edge of the mattress for thirty seconds before standing up. This gives your blood pressure time to stabilize. It sounds like advice for an 80-year-old, but it works for a 25-year-old on Lexapro just as well.
Second, check your timing. Some people find that taking Lexapro at night before bed allows them to "sleep through" the peak plasma levels of the drug, meaning the worst of the dizziness happens while they’re horizontal and unconscious. Others find the opposite—that taking it in the morning with a heavy breakfast helps ground them. It’s worth experimenting with the timing (after checking with your doctor).
Third, stay hydrated. Not "I had a soda" hydrated, but "I'm carrying a water bottle everywhere" hydrated. Electrolytes help too.
When to actually worry
While most dizziness is harmless, there are red flags. If your dizziness is accompanied by a racing heart, a high fever, or extreme muscle stiffness, that’s not "normal adjustment." That could be a sign of Serotonin Syndrome, which is a rare but serious medical emergency. Also, if the dizziness leads to actual fainting (syncope), you need to get your heart rhythm checked. Lexapro can, in very rare instances, affect the "QT interval" of your heart rate, which can lead to fainting spells.
But for the vast majority? It's just a bumpy start to a journey toward feeling better mentally.
Actionable steps for managing Lexapro dizziness
- Request a "Micro-Taper" start: If you haven't started yet or just began, ask your doctor if you can stay on a half-dose (5mg) for the first 14 days to let your nervous system adjust gradually.
- The "Seated Transition" rule: Never move from lying down to standing in one motion. Use the "stop-over" method: Lie to sit, sit for 30 seconds, then stand.
- Log your triggers: Keep a simple note on your phone. Does the dizziness happen an hour after taking the pill? After your morning coffee? When you haven't eaten? Finding the pattern takes the mystery (and some of the anxiety) out of it.
- Hydration with intention: Aim for at least 2 liters of water a day, and consider adding an electrolyte powder if you’re also experiencing dry mouth, another common Lexapro side effect.
- Consult a Pharmacist: Pharmacists often know more about the "kinetics" of the drug than the prescribing doctor. Ask them when the drug hits its peak concentration in your bloodstream so you can plan your day accordingly.
- Rule out the "Inner Ear": If the dizziness feels like the room is literally spinning (vertigo) rather than just lightheadedness, ask your doctor about the Epley maneuver or Vestibular Rehabilitation Therapy. Sometimes the medication just highlights a pre-existing inner ear issue.
The goal is to get through the first month. Most people find that the trade-off—a few weeks of feeling a bit wobbly in exchange for a significant lift in mood and a reduction in soul-crushing anxiety—is ultimately a deal they’re willing to make. Just take it slow. Your brain is doing a lot of heavy lifting right now.