Does escitalopram lower your heart rate? (+ 3 studies)

In this article, we discuss the impact of escitalopram on heart rate and cardiovascular function, exploring its safety, effects on heart rate variability, dosage considerations, and potential interactions with other medications. 

Does escitalopram lower your heart rate?

Yes, escitalopram is a popular antidepressant that affects serotonin levels and can cause a decrease in heart rate. Although rare, it can indirectly impact heart rate and cardiovascular function. Altering serotonin levels can cause a mild increase or decrease in heart rate due to the interaction between serotonin and the autonomic nervous system.

Is escitalopram safe for people with pre-existing heart conditions?

Patients with pre-existing heart conditions should use escitalopram with caution as it may result in changes in heart rate. Those with cardiovascular issues such as arrhythmias or a history of heart attacks should be carefully monitored while taking this medication.

To evaluate the potential risks and benefits based on the patient’s unique condition, a thorough assessment by a healthcare provider is imperative. 

What do studies suggest?

In an eight-week study, escitalopram caused a noteworthy reduction in heart rate but had no significant impact on blood pressure in 30 participants with hypertension and depression. 

Another study of 3000 participants with pre-existing heart conditions showed that escitalopram caused a minor reduction in heart rate but did not affect blood pressure or ECG values. 

These studies showed that escitalopram is safe for individuals with pre-existing heart conditions but does exhibit the ability to reduce heart rate. Monitoring its use in such patients is crucial to ensure their well-being and safety. (1,2) 

Does escitalopram affect QT prolongation?

To analyze how different medications affect heart rate when taken with escitalopram, we must consider their impact on QTc. QT prolongation can result in a slower heart rhythm due to more extended contraction and relaxation periods.

A study revealed that escitalopram when given at a 30mg dosage, can extend the QT interval by up to 11.8 milliseconds. However, it’s important to note that the maximum approved dosage of escitalopram is 20mg per day. This research highlights the difficulty of predicting QT prolongation (3).

Gender, electrolyte imbalances, cardiac conditions, and drug interactions can prolong QT. Thus, electrocardiogram monitoring is vital in clinical settings, particularly for those taking medications that affect heart rate and QT intervals.

What dosage of escitalopram would cause a lower heart rate?

The dosage of escitalopram plays a pivotal role in influencing heart rate alterations. Lower doses of the medication typically have a lower likelihood of significantly affecting heart rate, whereas higher doses may result in more notable effects.

It is recommended that the maximum dose is 20mg daily, and taking more than this can cause more noticeable adverse reactions.

Balancing the therapeutic benefits for mental health while minimizing cardiovascular side effects is a challenge healthcare providers must navigate. 

What medications interact with escitalopram to lower heart rate?

It’s essential to be careful when combining escitalopram with other medications that can affect heart rate, such as beta-blockers or certain antipsychotics, as this can amplify the effects on heart rate. This combination can increase the risk of heart rhythm disturbances, so it’s necessary to monitor closely and adjust the dosage if needed.

To help you understand better, here are some categories of medications that may interact with escitalopram and cause a decrease in heart rate:

  • Certain antipsychotic medications, such as Pimozide, Flupentixol, and Ziprasidone, can prolong the QTc interval, resulting in a slower heart rate and increasing the risk of arrhythmias. 


  • Some antiarrhythmic drugs, including amiodarone and sotalol, affect the heart rate by prolonging the QTc interval, potentially causing bradycardia.


  • Specific antihistamines like mizolastine, desloratadine, and clemastine may interact with escitalopram, causing QTc prolongation and a slower heart rate. 


  • The use of certain antibiotics like azithromycin and moxifloxacin, antimalarials such as amodiaquine and mefloquine, and antiemetics like ondansetron can cause QTc prolongation and lower heart rate.

Taking escitalopram with some medications can increase the risk of arrhythmias, including Torsade de Pointes (TdP). Healthcare providers should be cautious and consider alternative treatments if necessary, closely monitoring patients. 

How can patients on escitalopram observe & monitor heart rate changes?

For patients on escitalopram, monitoring heart rate is recommended. Baseline assessments, including an ECG and medical history, should be done before starting the medication. Regular follow-up checks should be conducted for any heart rate changes, which typically occur within the first few weeks of treatment.

Healthcare providers should maintain open communication with patients to address any concerns. In most cases, the heart rate returns to normal within a few weeks after stopping escitalopram.

What do you do if Lexapro affects your heart rate?

If you notice any changes in your heart rate while taking Lexapro, contact your healthcare provider immediately. Regular check-ups and tests like ECGs can help identify heart rate changes and guide appropriate management strategies. Your healthcare provider may also offer lifestyle recommendations to promote heart health.

What are safer alternatives to Lexapro? 

There are alternative medications that can be considered instead of Lexapro. These include SSRIs such as Zoloft and Prozac and SNRIs such as Cymbalta and Effexor, which are commonly used for treating depression. Other options like Wellbutrin or Remeron may also be worth considering.

Psychotherapy, stress reduction techniques, exercise, and a balanced diet can also help with mild to moderate depression. Combining medication with psychotherapy may also be beneficial.

Should you consider combination therapy?

If there are significant concerns about the interaction between antidepressants and your heart health, a consultation with a cardiologist can provide specialized insights and guidance. 

The choice of an alternative medication should be based on a thorough evaluation by your healthcare provider, taking into account your specific medical history, current medications, and the severity of your mental health condition. 


In this article, we have explored the complex relationship between escitalopram and developing a lower heart rate, highlighting its potential to cause fluctuations in cardiovascular function. We’ve discussed the effects of escitalopram on serotonin levels and heart rate variability, safety considerations, dosage complications and interaction effects with other medications.

Regular assessments and communication between healthcare providers and patients are crucial during escitalopram therapy. Discuss alternative options with your healthcare provider if you have cardiovascular issues while taking Lexapro.


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Peixoto MF, Cesaretti M, Hood SD, Tavares A. Effects of SSRI medication on heart rate and blood pressure in individuals with hypertension and depression. Clin Exp Hypertens. 2019;41(5):428-433. doi: 10.1080/10641963.2018.1501058. Epub 2018 Jul 26. PMID: 30047786.,individuals%20with%20hypertension%20and%20depression.


Thase ME, Larsen KG, Reines E, Kennedy SH. The cardiovascular safety profile of escitalopram. Eur Neuropsychopharmacol. 2013 Nov;23(11):1391-400. doi: 10.1016/j.euroneuro.2013.05.011. Epub 2013 Aug 6. PMID: 23928296.


Suzuki Y. [Long QT Syndrome Induced by Antidepressants]. Seishin Shinkeigaku Zasshi. 2016;118(3):147-151. Japanese. PMID: 30620510.

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