Escitalopram Cardiac Risk: What You Need to Know About Heart Safety

When you take escitalopram, a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety. Also known as Lexapro, it helps balance brain chemicals—but it can also affect your heart in ways most people don’t expect. While it’s generally safe for most, there’s a known, though rare, risk of QT prolongation, a change in the heart’s electrical rhythm that can lead to dangerous arrhythmias. This isn’t something that happens to everyone, but it’s serious enough that doctors check for it, especially if you have other risk factors.

Who’s most at risk? People over 65, those with existing heart conditions like heart failure or prior arrhythmias, and anyone taking other medications that also affect heart rhythm. Combining escitalopram with drugs like certain antibiotics, antifungals, or even some anti-nausea meds can stack the risk. Even low doses can be risky if you’re genetically sensitive—some people have a variation in the CYP2C19 gene that slows how their body clears the drug, causing it to build up. It’s not just about the dose; it’s about your body’s unique response. That’s why blood tests and EKGs aren’t always routine, but they’re smart if you’ve had unexplained dizziness, fainting, or a family history of sudden cardiac events.

Don’t panic—most people take escitalopram without any heart issues. But awareness matters. If you’re on it and start feeling your heart race, skip beats, or feel lightheaded, don’t brush it off. Talk to your doctor. They can check your QT interval with a simple EKG and review all your meds to spot dangerous combinations. You might need a switch to another antidepressant with less cardiac impact, like sertraline or citalopram (which has its own limits). The goal isn’t to avoid treatment, but to make sure it’s safe for your body.

Below, you’ll find real-world insights from people who’ve navigated this risk, studies on how escitalopram compares to other SSRIs, and practical advice on monitoring your heart health while on antidepressants. This isn’t theoretical—it’s about protecting your health while managing your mental well-being.