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In elderly patients, bilateral peripheral edema is an important health problem. When a patient presents with bilateral peripheral edema; first, clinicians should consider systemic diseases such as cardiac, endocrine, renal and metabolic problems. Routine blood tests and urinalysis should be studied. Patient’s medication history should be evaluated. Here we report a case of bilateral peripheral edema due to use of escitalopram. A 71-year-old woman was presented with a three months history of lack of energy, loss of interest, hypersomnia, malaise and anxiety. We diagnosed major depression to the patient according to the DSM-IV criteria and we started escitalopram 10 mg/day as an antidepressant medication. She was admitted to dermatology policlinics with bilateral lower extremity edema of 7 days duration after escitalopram started. On dermatological examination, there was swelling knee high in both legs. Cellulite was not considered. There was no change of skin redness, ulceration and color. Results of renal function tests, thyroid function tests and liver function tests were within the normal limits. Blood electrolyte levels were normal. Echocardiogram and ECG findings were normal. There was no reason that could be found for edema. Escitalopram was reduced and stopped. After discontinuation of escitalopram, edema decreased. After 12 days, patient’s legs were back to normal. In literature, there were two patients developing edema with escitalopram monotherapy. One of them was associating with escitalopram monotherapy (30 mg/day) with bilateral ankle edema in a 69-year-old depressed woman and the other was a 71-year-old woman presented with bilateral pedal edema associating with escitalopram 10 mg/day. In our patient edema developed progressively (after a week) and knee high and a lower dose as a 71-year-old woman patient. In psychiatric patients, edema was reported with antidepressant drugs such as mirtazapine and trazodone and antipsychotic drugs such as risperidone, olanzapine and quetiapine. Peripheral edema, a rare side effect due to escitalopram is reversible and may be the strong serotonergic effect of this drug. The normal results of laboratory tests excluded renal impairment and sodium overload. The possible etiology of edema due to escitalopram is increase in vascular permeability. Clinicians should be careful when investigating the etiology of edema; especially if patients are using SSRIs.