Gözde ÇOLAK, Ali Saffet GÖNÜL
Psychiatry and Clinical Psychopharmacology - 2026;36(4):451-461
Escitalopram, the S-enantiomer of racemic citalopram, is one of the most widely prescribed selective serotonin reuptake inhibitors (SSRIs) for the treatment of depressive and anxiety disorders. Owing to its high selectivity for the serotonin transporter (SERT) and its unique allosteric binding properties, escitalopram demonstrates pharmacological characteristics that distinguish it from other SSRIs. This narrative review provides an up-to-date evaluation of escitalopram, focusing on its mechanism of action, pharmacokinetic profile, clinical efficacy, tolerability, and safety. Evidence from randomized controlled trials and meta-analyses indicates that escitalopram produces significant antidepressant and anxiolytic effects, with symptom improvement often observed within the first one to two weeks of treatment. Neuroimaging studies further support its therapeutic activity by demonstrating dose-dependent SERT occupancy and normalization of fronto-limbic network dysfunction associated with mood regulation. In comparative studies, escitalopram yields favorable response and remission rates and exhibits better acceptability and tolerability relative to other antidepressant agents. Its pharmacokinetic properties-including predictable absorption, linear dose-concentration relationships, and limited cytochrome P450 interactions-contribute to its suitability for long-term use and polypharmacy. Escitalopram is generally well tolerated, with most adverse effects being mild and transient. Although sexual dysfunction, QT interval prolongation, and serotonin syndrome remain clinical considerations, its overall safety profile compares favorably with that of other SSRIs. In conclusion, current evidence supports escitalopram as a first-line pharmacological treatment for major depressive disorder and anxiety disorders. Its pharmacological specificity, consistent clinical efficacy, and favorable tolerability profile reinforce its central role in contemporary psychiatric treatment strategies.
