lexapro causing nocturnal anxiety. how to sleep?

June 14, 2023 4:09 PM

I restarted Lexapro 5 days ago for PMDD symptoms, but it seems to be causing major nocturnal anxiety (I basically haven't been able to sleep for the last 3 days). How do I sleep at night? Will this go away if I stop Lexapro and wait it out, or has the Lexapro triggered some kind of underlying anxiety disorder that I should take different drugs for (like Buspar)?

Two nights after taking Lexapro 5mg/night, I’ve been waking up at night after a few hours of sleep with a racing heartbeat, sweating, a strange warmth in my chest, and anxious thoughts, and haven’t been able to get back to sleep. This has never happened to me before (I tend to be on the side of oversleeping, and I've never experienced anxiety symptoms before this). I really need to figure out how to sleep. I can't fall asleep during the day either.

I think the Lexapro (5mg) is causing the nocturnal anxiety and that I should stop taking it and the anxiety will go away. My doc (general practitioner) disagrees; she thinks the anxiety is caused by stressful life events that I’m going through, and that the Lexapro just triggered something that was already there. She thinks the dose of the Lexapro is so low that it would be strange if it caused such a major side effect.

My doc thinks Buspirone (Buspar) + Hydroxyzine HCL (Atarax) would help with the anxiety, but I’m worried about the side effects and withdrawal effects of taking yet more drugs. Should I quit the Lexapro and wait for the anxiety to pass, or switch the Lexapro to the Buspar? Or should I try a different antihistamine? Or other, non-drug methods?

Asking on MeFi because doc is a general practitioner, not a psychiatrist, so is not 100% sure; I have a psych referral but that’s going to take a few weeks to go through, so I just need a second opinion (YANAD, etc).

posted by icosahedron to Health & Fitness (14 answers total)

You can have increased anxiety for a week or two when starting Lexapro -- but it subsides! It's a common, short-term side effect.

Is there any chance you can take your Lexapro dose during the AM instead and have a brisk walk in place for if and when you get that zoomy wave?

And lots of people take additional meds short-term to help with the anxiety if it feels unmanageable on your own.
posted by Ink-stained wretch at 4:41 PM on June 14, 2023 [9 favorites]

I wonder if there could be an interaction between your antihistamine and Lexapro? Might be worth asking a pharmacist?
posted by esker at 4:52 PM on June 14, 2023

My own experience on a couple of different occasions has been that the first week or so on a new SSRI is always Sleep Disruption Central and then it goes away like magic. Changing the time of day I take the med maybe helps hurry that along. So if I were in your position I'd stick it out another week or so, maybe taking the Lexapro in the morning, before making any final decisions.

It's also pretty common to see a short term anxiety spike with a new med. Something a psychiatrist might well do, that a GP might or might not be willing to do, is to prescribe you a small, low dose, number of rescue meds like a benzo to get you through this temporary spike before you level out.
posted by Stacey at 5:06 PM on June 14, 2023 [2 favorites]

I take my Lexapro in the morning for this reason, so that is the first thing I would try unless there is a specific reason it need to be at night. If you really did just start, it's too early to make any conclusions because drugs like Lexapro are not fully effective for multiple weeks
posted by JZig at 5:11 PM on June 14, 2023

Initially, I was taking Lexapro in the evening as I felt it was making me sleepy during the day. However, things seemed to flip and after weeks of bad sleep, I mentioned this to a friend and they said that their doc advised taking in the morning due to insomnia. I switched and much of the insomnia went away.
posted by amanda at 5:29 PM on June 14, 2023

Response by poster: Thanks all. Should add that I did the doses as follows: 5 mg (night 1), 5 mg (night 2), 2.5 mg (night 3), none (night 4)

Even after the very small night dose and then no dose on night 4, I still had major insomnia that night, so it's hard to believe that switching the dose to the morning would help? Also, I had taken Lexapro 10mg nightly a year ago and experienced none of these side effects...

Also to clarify, I'm not currently on an antihistamine, I meant to add that taking Hydroxyzine HCL (Atarax) (the antihistamine prescribed for sleep) made me feel feverish, so I thought of switching it to something else.
posted by icosahedron at 5:41 PM on June 14, 2023

If you google "Lexapro and insomnia," it's another common side effect in the beginning, and another reason "they" recommend taking it the AM. That would be another reason to take the additional meds until your body adjusts.
posted by Ink-stained wretch at 7:09 PM on June 14, 2023

Most SSRIs are recommended for morning doses for this reason. I think the SNRIs are the same way. The one exception I recall offhand is paroxetine.

(Atarax is OK for short term use, but if it made you feel bad don't take it either!)
posted by cobaltnine at 7:21 PM on June 14, 2023 [1 favorite]

It's so normal for Lexapro (and some other antidepressants) to cause anxiety when you first take them that doctors often prescribe a benzo or another short-term anxiety med just in case. An antihistamine would serve that purpose. If it were me, I'd try that (or just Benadryl to sleep) and see if it helped before thinking about adding Buspar.
posted by lapis at 7:41 PM on June 14, 2023

Your anxiety about anxiety is most likely the primary problem here, and will subside if you take the lexapro long enough for it to ratchet down your anxiety - and go ahead and switch to morning for a few weeks too. Mine gives me a little sleepy hour about 90m after I take it, so now I actually take it at my 3:30-4am pee break, sleep through the drowsies, and my day is pretty cool. Moodwise this doesn't appear to be any issue; I think the standard rec to take at night is because of that drowsy bit, but none of my prescribers have cared what time of day I take it.

You might also try taking 1 hydroxizine in the middle of a non-work day and see if that too is really causing the feverish feeling or if it's the anxiety about the anxiety about the insomnia about the anxiety.

I also had the anxiety-stack, which is why I very much recognize yours. This might be the difference between last time and this time - your anxiety baseline is just higher, and/or maybe more health-focused, than last time. If you really hate the hydroxyzine, you can try otc benadryl/diphenhydramine or my other favorite, doxylamine succinate, starting with a half and see if you need more than that (the cheapest version is usually drugstore-brand "maximum strength sleep aid" but the one that isn't diphenhydramine - if you really like it, I think Costco has the best price in super-bulk).

I got a lot of relief in those first two weeks just reminding myself HELP IS ON THE WAY. I am Taking Action and soon things will even out and I will feel lots better, and just being mindful of that instead of getting really into the possibility I might experience some side effects was really useful. It's worth noting that lexapro takes time to reach therapeutic levels and it also doesn't leave your body instantly. Not taking it one night just introduces a slight inconsistency, and not taking it once after 3 days might not be meaningful at all and you just...had insomnia. If you're dealing with severe PMDD you may also be having cycle-related sleep issues (I did for sure), so it might not even be possible to point a single finger of blame at any one thing here.
posted by Lyn Never at 9:29 AM on June 15, 2023

I haven't dealt with an SSRI's. But I have suffered some terrible insomnia. For myself, the #1 aid for sleep, is marijuana. THC in capsule form. Works longer than if you smoke. If needed, combine with a benzo (it's what I am using currently). To be sure, I'm 66, neuro-atypical, with childhood PTSD. I had to learn to deal with horrendous nightmares.
posted by Goofyy at 11:28 AM on June 15, 2023

I have been on and off lexapro so many times in the last 20 years I've lost count. The insomnia and midnight anxiety, as others have said, is a very common side effect and for me at least, it goes away in one to two weeks. It will also crop up again if you stop, even if you carefully ramp off, but again, it will subside in a week or two. I second Lyn Never's recommendation of an antihistamine: benadryl really helps me stay asleep, but hydroxyzine does absolutely nothing whatsoever, so YMMV. My doctors have always said they're fine with lexapro, no need to worry about any interactions.
posted by mygothlaundry at 12:28 PM on June 15, 2023

Yeah, this was pretty much my experience until I started taking it in the morning. I take 20mg daily along with Lamictal and Klonopin (a benzo), then at night it's Yaz (PMDD) more Lamictal, more Klonopin, Belsomra (sleep disorder med), and Xanax if I'm struggling with some outside anxiety trigger. Been doing it for about... 6-7 years now. I also take non-drowg Benadryl throughout the day during allergy season without issue as well.

I know it sucks. Give it some time, don't go off of it cold turkey, but trust your gut. If this ain't it, there are other options for PMDD. Happy to chat over Memail if you want.
posted by The Adventure Begins at 4:31 AM on June 18, 2023 [1 favorite]

My first 2 weeks on Lexapro were AWFUL. I felt completely insane, wild anxiety, couldn't think straight, couldn't sleep, it was really bad. But 2 weeks in to the day, it was like a switch flipped and everything was... better to an extent that I could scarcely believe.
Stick it out, and hopefully you'll find it as beneficial as I have.
posted by TheCoug at 8:05 AM on June 26, 2023