<unk> , like other SSRIs, has been shown to affect sexual functions causing side effects such as decreased libido, delayed ejaculation, and anorgasmia. There is also evidence that SSRIs may cause an increase in suicidal ideation. An analysis conducted by the FDA found a statistically insignificant 1.5 to 2.4-fold (depending on the statistical technique used) increase of suicidality among the adults treated with<unk>  for psychiatric indications. The authors of a related study note the general problem with statistical approaches: due to the rarity of suicidal events in clinical trials, it is hard to draw firm conclusions with a sample smaller than two million patients. Citalopram and<unk>  are associated with dose-dependent QT interval prolongation and should not be used in those with congenital long QT syndrome or known pre-existing QT interval prolongation, or in combination with other medicines that prolong the QT interval. ECG measurements should be considered for patients with cardiac disease, and electrolyte disturbances should be corrected before starting treatment. In December 2011, the UK implemented new restrictions on the maximum daily doses at 20 mg for adults and 10 mg for those older than 65 years or with liver impairment. There are concerns of higher rates of QT prolongation and torsades de pointes compared with other SSRIs. The U.S. Food and Drug Administration and Health Canada did not similarly order restrictions on<unk>  dosage, only on its predecessor citalopram. Very common effects Very common effects (>10% incidence) include: * Headache (24%) * Nausea (18%) * Ejaculation disorder (9–14%) * Somnolence (4–13%) * Insomnia (7–12%) Common (1–10% incidence) Common effects (1–10% incidence) include: * Insomnia * Somnolence (sleepiness) * Dizziness * Paraesthesia (abnormal skin sensation) * Tremor * Decreased or increased appetite * Anxiety * Restlessness * Abnormal dreams * Libido decreased * Anorgasmia * Sinusitis (nasal congestion) * Yawning * Diarrhea * Constipation * Vomiting * Dry mouth * Excessive sweating * Arthralgia (joint pain) * Myalgia (muscular aches and pains) * Fatigue * Pyrexia (fever) * Impotence (erectile dysfunction) Psychomotor effects The most common effect is fatigue or somnolence, particularly in older adults, although patients with pre-existing daytime sleepiness and fatigue may experience paradoxical improvement of these symptoms.<unk>  has not been shown to affect serial reaction time, logical reasoning, serial subtraction, multitask, or Mackworth Clock task performance. Discontinuation symptoms<unk>  discontinuation, particularly abruptly, may cause certain withdrawal symptoms such as "electric shock" sensations, colloquially called "brain shivers" or "brain zaps" by sufferers. Frequent symptoms in one study were dizziness (44%), muscle tension (44%), chills (44%), confusion or trouble concentrating (40%), amnesia (28%), and crying (28%). Very slow tapering was recommended. There have been spontaneous reports of discontinuation of Lexapro and other SSRIs and SNRIs, especially when abrupt, leading to dysphoric mood, irritability, agitation, anxiety, headache, lethargy, emotional lability, insomnia, and hypomania. Other symptoms such as panic attacks, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), mania, worsening of depression, and suicidal ideation can emerge when the dose is adjusted down. Sexual dysfunction Some people experience persistent sexual side effects after they stop taking SSRIs. This is known as post-SSRI sexual dysfunction (PSSD). Common symptoms include genital anesthesia, erectile dysfunction, anhedonia, decreased libido, premature ejaculation, vaginal lubrication issues, and nipple insensitivity in women. Rates are unknown, and there is no established treatment. Pregnancy Antidepressant exposure (including<unk>  is associated with shorter duration of pregnancy (by three days), increased risk of preterm delivery (by 55%), lower birth weight (by 75 g), and lower Apgar scores (by <0.4 points). Antidepressant exposure is not associated with an increased risk of spontaneous abortion. There is a tentative association of SSRI use during pregnancy with heart problems in the baby. The advantages of their use during pregnancy may thus outweigh the possible negative effects on the baby. Overdose Excessive doses of<unk>  usually cause relatively minor untoward effects, such as agitation and tachycardia. However, dyskinesia, hypertonia, and clonus may occur in some cases. Therapeutic blood levels of<unk>  are usually in the range of 20–80 μg/L but may reach 80–200 μg/L in the elderly, patients with hepatic dysfunction, those who are poor CYP2C19 metabolizers or following acute overdose. Monitoring of the drug in plasma or serum is generally accomplished using chromatographic methods. Chiral techniques are available to distinguish<unk>  from its racemate, citalopram.
Escitalopram
Citalopram
Atomoxetine
Sertraline
Bupropion
Dapoxetine
Fluoxetine
Duloxetine