Escitalopram
Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant
Escitalopram is a widely prescribed selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat major depressive disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD). As the S-enantiomer of citalopram, escitalopram is considered the most potent SSRI in terms of serotonin transporter selectivity. Therapeutic effects typically develop after 2–4 weeks. It is available under the brand names Cipralex and Lexapro, among others.
Quick Facts: Escitalopram
Key Takeaways
- Escitalopram is the S-enantiomer of citalopram and the most selective SSRI available, prescribed for depression, anxiety disorders, panic disorder, social phobia, and OCD.
- Therapeutic effects typically begin after 2–4 weeks; full benefits are usually reached after 4–8 weeks of continuous treatment. Do not stop taking it early.
- The usual adult dose is 10 mg once daily, with a maximum of 20 mg/day. Elderly patients should start at 5 mg/day and not exceed 10 mg/day.
- Never combine escitalopram with MAO inhibitors — a minimum washout period of 14 days (for irreversible MAOIs) or 7 days after stopping escitalopram is required.
- Do not stop abruptly — tapering over several weeks is recommended to avoid discontinuation symptoms such as dizziness, electric shock sensations, and insomnia.
What Is Escitalopram and What Is It Used For?
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant that increases serotonin levels in the brain. It is prescribed for major depressive disorder, generalized anxiety disorder, panic disorder (with or without agoraphobia), social anxiety disorder, and obsessive-compulsive disorder (OCD).
Escitalopram belongs to a group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). These medications work by blocking the reabsorption (reuptake) of serotonin in the brain, making more of this important neurotransmitter available at nerve cell connections. Serotonin plays a key role in regulating mood, anxiety, sleep, and emotional well-being. By increasing serotonin availability, escitalopram helps restore the chemical balance that is disrupted in conditions such as depression and anxiety disorders.
What makes escitalopram unique among SSRIs is its molecular structure. It is the S-enantiomer — the pharmacologically active mirror-image form — of citalopram. While citalopram contains both the active S-enantiomer and the relatively inactive R-enantiomer, escitalopram delivers only the active form. Research published in Pharmacology & Therapeutics (2014) has shown that the R-enantiomer may actually counteract some of the therapeutic effects of the S-enantiomer, which is why escitalopram can be effective at lower doses and may have a faster onset of action in some patients.
In the landmark Lancet network meta-analysis by Cipriani et al. (2018), which compared 21 antidepressants across 522 clinical trials involving over 116,000 patients, escitalopram was ranked among the most effective and best-tolerated antidepressants. This large-scale analysis provides strong evidence for escitalopram as a first-line treatment option for depression.
Escitalopram is approved for the following conditions:
- Major Depressive Disorder (MDD): The primary indication. Escitalopram helps relieve persistent sadness, loss of interest, fatigue, sleep disturbances, and other symptoms of clinical depression.
- Generalized Anxiety Disorder (GAD): Helps reduce chronic, excessive worry and anxiety that interferes with daily life.
- Panic Disorder: Effective for reducing the frequency and severity of panic attacks, with or without agoraphobia (fear of open or crowded places).
- Social Anxiety Disorder (Social Phobia): Reduces the intense fear and avoidance behavior associated with social situations.
- Obsessive-Compulsive Disorder (OCD): Helps reduce the frequency and intensity of obsessive thoughts and compulsive behaviors.
It may take several weeks before you start to feel better. Continue taking escitalopram even if it takes time to notice improvement. If you do not feel better or if you feel worse, contact your doctor. Do not stop taking the medication without medical guidance.
What Should You Know Before Taking Escitalopram?
Before starting escitalopram, tell your doctor about all medical conditions you have — especially heart problems, epilepsy, diabetes, liver or kidney disease, or bleeding disorders — and all medications you take. Escitalopram must not be combined with MAO inhibitors or certain heart rhythm medications.
Contraindications — Do Not Take Escitalopram If You:
- Are allergic to escitalopram or any of the inactive ingredients in the tablet
- Are taking or have recently taken monoamine oxidase inhibitors (MAOIs), including phenelzine, iproniazid, isocarboxazid, nialamide, or tranylcypromine. You must wait at least 14 days after stopping an irreversible MAOI before starting escitalopram. After stopping escitalopram, you must wait at least 7 days before taking an MAOI.
- Are taking moclobemide (a reversible MAO-A inhibitor used for depression)
- Are taking selegiline (an irreversible MAO-B inhibitor used for Parkinson's disease) without medical supervision, as it increases the risk of side effects
- Are taking linezolid (an antibiotic with MAO-inhibiting properties) unless close medical monitoring is available
- Have been born with or have experienced episodes of abnormal heart rhythm (as seen on an ECG)
- Are taking medications for heart rhythm problems or medications that can affect heart rhythm (see Drug Interactions section)
Warnings and Precautions
Tell your doctor before starting escitalopram if you have any of the following conditions, as dose adjustments or closer monitoring may be necessary:
- Epilepsy or seizure history: Treatment should be discontinued if seizures occur for the first time or if seizure frequency increases.
- Impaired liver or kidney function: Your doctor may need to prescribe a lower dose and monitor you more closely.
- Diabetes: Escitalopram may affect blood sugar levels. Your insulin or oral diabetes medication dose may need adjustment.
- Low sodium levels (hyponatremia): SSRIs can cause or worsen low blood sodium, particularly in elderly patients and those taking diuretics.
- Bleeding tendency: Escitalopram may increase bleeding risk, especially when combined with anticoagulants, NSAIDs, or aspirin.
- Coronary artery disease or recent heart attack: Close cardiac monitoring is recommended.
- Low resting heart rate or electrolyte imbalances: These factors increase the risk of heart rhythm disturbances (QT prolongation).
- Certain types of glaucoma: Escitalopram may increase intraocular pressure in patients with angle-closure glaucoma.
Antidepressants may increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults under 25, especially in the first weeks of treatment or when doses are changed. Patients and caregivers should watch for worsening depression, unusual behavior changes, and suicidal thoughts, particularly during the initial treatment period. Contact a healthcare provider immediately if such symptoms occur. This warning applies to all antidepressants, not specifically escitalopram.
Some patients with bipolar disorder may switch into a manic phase when taking antidepressants. Symptoms of mania include unusually elevated mood, rapidly changing thoughts, reduced need for sleep, and excessive physical activity. Contact your doctor if you experience these symptoms.
Restlessness, agitation, and an inability to sit or stand still (akathisia) may also occur during the first weeks of treatment. Inform your doctor promptly if you experience these symptoms.
Medications such as escitalopram (SSRIs/SNRIs) may cause symptoms of sexual dysfunction, including decreased libido, difficulty achieving orgasm, and erectile dysfunction. In some cases, these symptoms have persisted after discontinuation of treatment.
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, talk to your doctor before using escitalopram. The decision to use this medication during pregnancy requires careful consideration of the benefits of treating depression versus the potential risks to the baby.
If escitalopram is taken during the last three months of pregnancy, the newborn may experience symptoms including breathing difficulties, bluish skin, seizures, difficulty regulating body temperature, feeding difficulties, vomiting, low blood sugar, muscle stiffness or floppiness, overactive reflexes, tremor, jitteriness, irritability, and excessive crying. These symptoms are usually temporary but require medical attention.
Use of SSRIs during pregnancy, particularly during the third trimester, may increase the risk of persistent pulmonary hypertension of the newborn (PPHN), a serious condition where the baby breathes too fast and appears bluish. Symptoms typically appear within 24 hours of birth.
Taking escitalopram near the end of pregnancy may also increase the risk of heavy vaginal bleeding shortly after delivery (postpartum hemorrhage), especially if you have a history of bleeding disorders. Inform your midwife or doctor that you are taking escitalopram.
Escitalopram is expected to be excreted in breast milk. The decision to breastfeed while taking escitalopram should be made in consultation with your doctor, weighing the benefits of breastfeeding against the potential exposure of the infant to the medication.
Driving and Operating Machinery
Escitalopram may impair reaction time in some individuals. Do not drive or operate heavy machinery until you know how this medication affects you. Discuss any concerns about driving with your doctor, especially during the initial treatment period or after dose changes.
How Does Escitalopram Interact with Other Drugs?
Escitalopram has clinically significant interactions with MAO inhibitors, serotonergic drugs (risk of serotonin syndrome), drugs that affect heart rhythm (QT prolongation risk), and medications that increase bleeding risk. Always tell your doctor about all medications, supplements, and herbal remedies you take.
Drug interactions with escitalopram can be serious and sometimes life-threatening. It is essential that your doctor and pharmacist are aware of all medications you are currently taking, have recently taken, or plan to take — including over-the-counter medications, herbal supplements, and vitamins.
Major Interactions — Avoid Combination
| Drug / Drug Class | Risk | Action Required |
|---|---|---|
| Irreversible MAOIs (phenelzine, tranylcypromine, isocarboxazid) | Life-threatening serotonin syndrome | 14-day washout before escitalopram; 7 days after stopping escitalopram |
| Moclobemide (reversible MAO-A inhibitor) | Serotonin syndrome | Do not combine |
| Linezolid (antibiotic) | Serotonin syndrome (MAO-inhibiting antibiotic) | Do not combine unless closely monitored |
| Pimozide (antipsychotic) | QT prolongation, cardiac arrhythmias | Contraindicated |
| Class IA/III antiarrhythmics (quinidine, amiodarone, sotalol) | QT prolongation, torsades de pointes | Do not combine |
| Certain antipsychotics (haloperidol, thioridazin, phenothiazines) | QT prolongation | Do not combine without ECG monitoring |
Moderate Interactions — Use with Caution
| Drug / Drug Class | Risk | Action Required |
|---|---|---|
| Lithium, tryptophan | Increased serotonergic effects | Caution; monitor for serotonin syndrome signs |
| Triptans (sumatriptan and similar) | Serotonin syndrome risk | Use with caution; monitor symptoms |
| Tramadol and other opioids | Serotonin syndrome; lowered seizure threshold | Use with caution |
| St. John’s Wort (Hypericum perforatum) | Increased serotonergic effects and side effects | Avoid combination |
| Warfarin, anticoagulants | Increased bleeding risk; altered INR | Monitor coagulation at start and end of treatment |
| NSAIDs, aspirin | Increased gastrointestinal bleeding risk | Use with caution; consider gastroprotection |
| Omeprazole, cimetidine, fluconazole, fluvoxamine, ticlopidine | Increased escitalopram blood levels (CYP2C19 inhibition) | Doctor may reduce escitalopram dose |
| Metoprolol, flecainide, propafenone | Escitalopram may increase levels of these drugs (CYP2D6) | Dose adjustment may be needed |
| Imipramine, desipramine, clomipramine, nortriptyline | Increased tricyclic antidepressant levels | Monitor and adjust dose |
| Mefloquine, bupropion | Lowered seizure threshold | Use with caution in patients with epilepsy risk |
| Selegiline (irreversible MAO-B inhibitor) | Increased risk of serotonergic side effects | Use with caution only under close supervision |
While escitalopram is not expected to interact pharmacologically with alcohol, combining them is not recommended. Alcohol is a depressant that can worsen depression and anxiety symptoms and may increase sedation. Avoid or limit alcohol during treatment.
What Is the Correct Dosage of Escitalopram?
The standard adult dose of escitalopram is 10 mg once daily for most conditions, which may be increased to a maximum of 20 mg/day. Elderly patients (over 65) should start at 5 mg/day with a maximum of 10 mg/day. Take escitalopram at the same time each day, with or without food.
Always take escitalopram exactly as prescribed by your doctor. Swallow the tablet whole with water — do not chew it as the taste is bitter. Escitalopram can be taken with or without food. Tablets of 10 mg, 15 mg, and 20 mg strength can be split into two equal halves if needed.
Adults
Depression
The usual recommended dose is 10 mg once daily. Your doctor may increase the dose to a maximum of 20 mg per day depending on your response to treatment.
Panic Disorder
The starting dose is 5 mg once daily for the first week, then increased to 10 mg per day. Your doctor may increase the dose to a maximum of 20 mg per day.
Social Anxiety Disorder
The usual recommended dose is 10 mg once daily. Your doctor may either reduce the dose to 5 mg per day or increase it to a maximum of 20 mg per day, depending on your response.
Generalized Anxiety Disorder
The usual recommended dose is 10 mg once daily. The dose may be increased to a maximum of 20 mg per day.
Obsessive-Compulsive Disorder (OCD)
The usual recommended dose is 10 mg once daily. The dose may be increased to a maximum of 20 mg per day.
Elderly Patients (Over 65 Years)
Elderly Dosing
The recommended starting dose is 5 mg once daily. Your doctor may increase the dose to a maximum of 10 mg per day. Lower maximum doses are recommended for elderly patients due to changes in drug metabolism and increased sensitivity to side effects.
Children and Adolescents (Under 18)
Escitalopram is not generally recommended for children and adolescents under 18 years of age. The risk of side effects including suicidal thoughts, self-harm behaviors, and hostility (aggression, defiance, and anger) is higher in this age group when taking antidepressants. Despite this, a physician may prescribe escitalopram to patients under 18 if they determine the benefits outweigh the risks. The long-term effects on growth, maturation, and cognitive and behavioral development have not yet been established in this age group.
Duration of Treatment
It may take several weeks before you start to feel better. Continue taking escitalopram even if improvement is not immediate. Do not change your dose without talking to your doctor first. It is recommended to continue treatment for at least 6 months after you feel well again to prevent relapse. The total duration of treatment depends on the individual and the condition being treated — your doctor will advise you on when and how to stop.
Missed Dose
Do not take a double dose to make up for a missed dose. If you remember before going to bed, take the dose right away. If you remember during the night or the following day, skip the missed dose and take your next dose at the usual time.
Overdose
If you take too much escitalopram, or if someone else (such as a child) accidentally ingests the medication, contact a doctor or emergency services immediately — even if no symptoms are present. Signs of overdose may include dizziness, tremor, agitation, seizures, loss of consciousness, nausea, vomiting, irregular heart rhythm, decreased blood pressure, and changes in fluid and electrolyte balance. Bring the medication packaging when seeking medical help.
What Are the Side Effects of Escitalopram?
Like all medications, escitalopram can cause side effects, though not everyone experiences them. The most common side effects include nausea and headache. Most side effects tend to diminish after the first few weeks of treatment. Contact your doctor immediately if you experience signs of serotonin syndrome, severe allergic reactions, or irregular heartbeat.
Side effects usually improve after the first few weeks of treatment. Be aware that some symptoms listed below may also be part of your underlying condition and will improve as the medication takes effect.
Severe allergic reactions (swelling of face, tongue, lips, or throat; skin rash; difficulty breathing or swallowing), signs of serotonin syndrome (high fever, agitation, confusion, tremor, sudden muscle contractions), rapid or irregular heartbeat, fainting, or thoughts of self-harm.
Very Common
- Nausea
- Headache
Common
- Nasal congestion or runny nose (sinusitis)
- Decreased or increased appetite
- Anxiety, restlessness, unusual dreams, difficulty falling asleep, drowsiness
- Dizziness, yawning, tremor, tingling sensations
- Diarrhea, constipation, vomiting, dry mouth
- Increased sweating
- Muscle and joint pain (arthralgia and myalgia)
- Sexual dysfunction (delayed ejaculation, erectile problems in men; decreased libido and difficulty achieving orgasm in women)
- Fatigue, fever
- Weight gain
Uncommon
- Hives (urticaria), skin rash, itching
- Teeth grinding (bruxism), agitation, nervousness, panic attacks, confusion
- Sleep disturbances, taste changes, fainting (syncope)
- Dilated pupils (mydriasis), visual disturbances, ringing in the ears (tinnitus)
- Hair loss
- Heavy menstrual bleeding, irregular menstruation
- Weight loss
- Palpitations, swollen arms and legs, nosebleeds
- Unusual bleeding including gastrointestinal bleeding
Rare
- Severe allergic reaction (anaphylaxis) with swelling of skin, tongue, lips, or face
- Serotonin syndrome (high fever, agitation, confusion, tremor, sudden muscle contractions)
- Aggression, personality changes, hallucinations
- Slow heart rate (bradycardia)
Frequency Not Known
- Decreased sodium levels (hyponatremia) — symptoms include nausea, malaise, muscle weakness, or confusion
- Dizziness upon standing (orthostatic hypotension)
- Abnormal liver function tests (elevated liver enzymes)
- Yellowing of skin and eyes (hepatitis)
- Movement disorders (involuntary muscle movements)
- Painful erections (priapism)
- Signs of abnormal bleeding (ecchymoses), low platelet count (thrombocytopenia)
- Increased secretion of ADH hormone leading to water retention
- Elevated prolactin levels
- Breast milk production in men and women who are not breastfeeding
- Mania
- Increased risk of bone fractures
- Changes in heart rhythm (QT prolongation), torsades de pointes
- Difficulty urinating
- Seizures
- Heavy vaginal bleeding after delivery (postpartum hemorrhage)
- Angioedema (sudden swelling of skin or mucous membranes)
- Suicidal thoughts or behavior
- Motor restlessness (akathisia)
- Loss of appetite
An increased risk of bone fractures has been observed in patients taking SSRIs. If you experience any side effects not listed here, or if any side effects become severe, contact your doctor or pharmacist.
What Happens When You Stop Taking Escitalopram?
Do not stop escitalopram suddenly. Your doctor will typically recommend gradually reducing the dose over several weeks to minimize discontinuation symptoms. Abrupt cessation can cause dizziness, electric shock sensations, sleep disturbances, nausea, anxiety, and irritability.
When you stop taking escitalopram — especially if the cessation is abrupt — you may experience discontinuation symptoms. These are common when SSRI treatment is ended and are more likely if the medication has been taken for a long time, at higher doses, or if the dose is reduced too quickly.
For most people, discontinuation symptoms are mild and resolve within one to two weeks. However, for some individuals, symptoms can be more intense and last for two to three months or longer. If you experience severe symptoms after stopping, your doctor may recommend restarting the medication at a lower dose and then tapering more gradually.
Common discontinuation symptoms include:
- Dizziness (feeling unsteady or having balance problems)
- Sensory disturbances: tingling, burning sensations, and “brain zaps” (electric shock-like sensations, including in the head)
- Sleep disturbances: vivid dreams, nightmares, inability to sleep
- Anxiety, headache, nausea
- Sweating (including night sweats)
- Restlessness or agitation, tremor
- Confusion or disorientation, emotional instability or irritability
- Diarrhea, visual disturbances, palpitations
How Should You Store Escitalopram?
Store escitalopram at room temperature, out of the sight and reach of children. No special storage conditions are required. Do not use after the expiration date printed on the packaging.
Keep this medication out of the sight and reach of children. Do not use escitalopram after the expiration date stated on the label or carton — the expiration date refers to the last day of that month. This medication does not require any special storage conditions.
Do not dispose of medications via wastewater or household waste. Ask your pharmacist how to dispose of medications that are no longer needed. These measures help protect the environment.
What Does Escitalopram Contain?
Each tablet contains escitalopram (as oxalate) as the active ingredient, along with inactive ingredients including microcrystalline cellulose, talc, croscarmellose sodium, magnesium stearate, and a film coating.
The active substance is escitalopram. Each tablet contains 5 mg, 10 mg, 15 mg, or 20 mg of escitalopram (as the oxalate salt).
The other (inactive) ingredients are:
- Tablet core: Silicified microcrystalline cellulose, talc, croscarmellose sodium, magnesium stearate
- Film coating: Hypromellose, macrogol 400, titanium dioxide (E 171)
This medication contains less than 1 mmol (23 mg) sodium per tablet, meaning it is essentially sodium-free.
Escitalopram tablets are white, film-coated, and available as round (5 mg) or oval (10 mg, 15 mg, 20 mg) tablets. Tablets of 10 mg, 15 mg, and 20 mg strength have a score line and can be split into two equal halves.
Frequently Asked Questions
Escitalopram typically takes 2 to 4 weeks before you notice an improvement in symptoms. Some effects, such as improved sleep or reduced anxiety, may come sooner. Full therapeutic benefits are usually felt after 4 to 8 weeks of continuous treatment. It is important not to stop taking the medication early, even if you don’t feel immediate improvement. The drug needs time to reach steady-state levels in the brain and produce its full antidepressant and anxiolytic effects.
Escitalopram is the S-enantiomer (active mirror-image molecule) of citalopram. While citalopram is a racemic mixture containing both the active S-enantiomer and the relatively inactive R-enantiomer, escitalopram delivers only the therapeutically active form. This means 10 mg of escitalopram is roughly equivalent to 20 mg of citalopram. Clinical studies suggest that escitalopram may have a slightly faster onset of action and may be better tolerated by some patients. Both are effective SSRIs used for similar conditions.
While escitalopram is not expected to interact pharmacologically with alcohol in a clinically significant way, drinking alcohol during treatment is generally not recommended. Alcohol is a central nervous system depressant that can worsen symptoms of depression and anxiety, counteracting the therapeutic benefits of escitalopram. Alcohol may also increase sedative effects, impairing your ability to drive or perform tasks requiring alertness. If you choose to drink, discuss safe limits with your doctor.
Weight gain is listed as a common side effect of escitalopram (affecting up to 1 in 10 patients), while weight loss is classified as uncommon. The effect on weight varies between individuals and over the course of treatment. Some patients may experience reduced appetite in the early weeks, while others may notice gradual weight gain over time. Compared to antidepressants such as mirtazapine or paroxetine, escitalopram generally has a moderate effect on weight. If weight changes concern you, discuss dietary and exercise strategies with your healthcare provider.
The decision to use escitalopram during pregnancy should be made carefully with your doctor, weighing the risks of untreated depression against potential effects on the baby. SSRIs used during the third trimester may cause transient symptoms in the newborn, including breathing difficulties, tremor, irritability, and feeding difficulties. There is also a small increased risk of persistent pulmonary hypertension of the newborn (PPHN). Escitalopram use near delivery may increase the risk of postpartum hemorrhage. Abrupt discontinuation during pregnancy is not recommended. Your doctor can help determine the safest approach for both you and your baby.
The maximum recommended dose of escitalopram is 20 mg per day for adults under 65 years of age. For patients aged 65 and over, the maximum recommended dose is 10 mg per day due to altered drug metabolism and increased sensitivity. Patients with liver impairment may also require lower doses. Exceeding the maximum recommended dose increases the risk of side effects, particularly QT prolongation (a heart rhythm abnormality). Always follow your doctor’s dosing instructions.
References
- Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet. 2018;391(10128):1357-1366. doi:10.1016/S0140-6736(17)32802-7
- Sanchez C, Reines EH, Montgomery SA. A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike? Int Clin Psychopharmacol. 2014;29(4):185-196. doi:10.1097/YIC.0000000000000023
- European Medicines Agency (EMA). Summary of Product Characteristics — Cipralex (Escitalopram). EMA/EPAR. Last updated 2024.
- National Institute for Health and Care Excellence (NICE). Depression in adults: recognition and management. Clinical guideline CG90. Updated 2022.
- American Psychiatric Association (APA). Practice Guidelines for the Treatment of Major Depressive Disorder. 3rd edition. 2023.
- World Health Organization (WHO). WHO Model List of Essential Medicines. 23rd list. 2023.
- British National Formulary (BNF). Escitalopram. NICE Evidence Services. Accessed January 2026.
- U.S. Food and Drug Administration (FDA). Lexapro (escitalopram oxalate) — Prescribing Information. Revised 2023.
- Sanchez C, Reines EH, Montgomery SA. Escitalopram versus citalopram: the surprising role of the R-enantiomer. Pharmacol Ther. 2014;142(2):177-186. doi:10.1016/j.pharmthera.2013.12.009
Editorial Team
This article was written and medically reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians in clinical pharmacology, psychiatry, and psychopharmacology. All medical claims in this article are evidence-based, supported by systematic reviews, international guidelines (WHO, EMA, FDA, NICE, APA), and peer-reviewed research. Our editorial process follows the GRADE evidence framework to ensure the highest quality of medical information.
All content is reviewed by board-certified physicians with expertise in clinical pharmacology and psychiatry. Evidence Level 1A.
Following WHO, EMA, FDA, NICE, and APA guidelines. No commercial funding or pharmaceutical company sponsorship.
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