What Is the Best Time to Take Lexapro for Anxiety?

Does It Matter if I Take It in the Morning or at Night?

Not according to the clinical evidence. Across multiple randomized controlled trials and meta-analyses, escitalopram was dosed once daily (typically 10 to 20 mg) without any requirement for a specific time of day. None of these studies found time-of-day effects on how well the medication worked.

So the best time to take Lexapro is whichever time helps you remember to take it every day. If the medication makes you feel alert or slightly wired, morning may work better. If it makes you drowsy, nighttime could be the move. That decision is best made with your prescriber based on how you personally respond.

How Long Before It Actually Starts Working?

This is where patience becomes important. SSRIs like escitalopram show some early benefit within the first one to two weeks, but clinically meaningful improvement for anxiety typically takes about four to six weeks. Several large trials ran for 8 to 12 weeks to capture the full treatment effect.

One study in adolescents with generalized anxiety disorder found that early changes in brain connectivity (specifically in the amygdala, the brain's threat-detection center) after a single dose of escitalopram predicted who would improve by week eight. So the medication may be doing something under the hood before you consciously feel different.

In patients with coronary heart disease and anxiety, 12 weeks of escitalopram reduced anxiety more than both exercise and placebo, and those benefits held up six months after treatment ended. The takeaway: give it time, and the improvements may last well beyond the treatment window.

What Dose Does the Research Support?

Most adults with anxiety are treated in the 10 to 20 mg per day range. A large meta-analysis confirmed a dose-response relationship for SSRIs in anxiety disorders: higher doses within the therapeutic range were linked to greater symptom improvement but also more side-effect-related dropouts. In other words, more isn't always better. The right dose balances relief with tolerability.

Could Your Genetics Affect How Lexapro Works?

Yes, and this is an area of growing clinical importance. Your body breaks down escitalopram primarily through a liver enzyme called CYP2C19. People who are "poor metabolizers" of this enzyme (a trait determined by your genes) can end up with significantly higher levels of the drug in their system.

One study in elderly patients found that CYP2C19 poor metabolizers had 1.6 to 2.1 times higher escitalopram exposure than normal metabolizers. Clinical pharmacogenetics guidelines recommend that poor metabolizers may need roughly 50% lower starting doses and slower dose increases.

This doesn't mean everyone needs genetic testing before starting Lexapro. But if you experience unusually strong side effects at standard doses, or if you've had trouble with SSRIs in the past, pharmacogenetic testing is something worth discussing with your doctor.

Is Lexapro a Good Choice for Anxiety Compared to Other Options?

The research is encouraging. In large comparative analyses, escitalopram ranks among the more effective and better-tolerated antidepressants. One trial found it was better tolerated than venlafaxine XR for generalized anxiety disorder. Another showed it outperformed paroxetine at the 10 mg dose.

An interesting finding from a 2022 randomized trial: mindfulness-based stress reduction (an 8-week meditation and awareness program) was "noninferior" to escitalopram for treating anxiety disorders in adults. That means it worked about as well. This doesn't mean you should choose one over the other, but it does suggest that for some people, non-medication approaches can be equally effective.

What Can You Do With This Information?

Here's what the research supports as practical guidance:

1. Pick a consistent time and stick with it. Morning or evening doesn't matter for efficacy. Let your side-effect experience guide the choice.
2. Expect to start at 10 mg/day and give it at least four to six weeks before judging whether it's working.
3. Plan for a minimum 8-to-12-week treatment course. Studies that ran longer (up to 24 weeks) showed continued improvement, so don't rush to stop.
4. If 10 mg isn't enough after four weeks, talk to your prescriber about increasing to 20 mg, but know that the jump in benefit may be modest while side effects can increase.
5. If you have strong side effects at standard doses, ask about pharmacogenetic testing for CYP2C19. You may metabolize the drug differently than average.

A few important caveats: the studies reviewed here focused on adults (with limited data in adolescents and older adults). People with coronary heart disease, pregnant individuals, and those on other medications may need different considerations. And co-existing anxiety with depression can complicate the picture; one study in older adults found that higher anxiety levels during treatment predicted slower and lower rates of depression remission.

As always, these findings should inform a conversation with your prescriber, not replace one.