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Lexapro vs Effexor

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Comparative Analysis


For patients struggling with major depressive disorder (MDD) or various forms of anxiety, medications that modify levels of neurotransmitters in the brain can provide significant relief. Lexapro and Effexor are two such drugs often prescribed to manage these conditions. Both influence different neurotransmitter pathways but have been shown to effectively alleviate symptoms associated with depression and anxiety. Lexapro, also known as escitalopram, is a selective serotonin reuptake inhibitor (SSRI), primarily impacting serotonin levels in the brain. On the other hand, Effexor, or venlafaxine, is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI). It affects both serotonin and norepinephrine levels providing broader-spectrum modulation of brain chemistry.

Lexapro vs Effexor Side By Side

Brand NameLexaproEffexor
ContraindicationsShould not be taken with or within 5 weeks of using MAO inhibitors.Should not be taken with or within 5 weeks of using MAO inhibitors.
CostBrand-name: Approximately $356 for 30 tablets of 10 mg. Generic: From about $.10/day to $1/day.Brand-name: Approximately $470 for 30 capsules of 75 mg. Generic: From about $.10/day to $2/day at very high doses.
Generic NameEscitalopramVenlafaxine
Most Serious Side EffectIncreased thoughts about suicide or self-harm.Signs of an allergic reaction, easy bruising or bleeding, seizure, changes in mood or behavior, rapid heartbeat, severe nausea/vomiting/diarrhea.
Severe Drug InteractionsMonoamine oxidase (MAO) inhibitors.Monoamine oxidase (MAO) inhibitors.
Typical DoseStarts at 10 mg/day for adults, up to a maximum of 20 mg/day.Starts at 75 mg/day, can increase to 150 mg/day, up to a maximum of 225 mg/day.

What is Lexapro?

Escitalopram (the generic name for Lexapro) is a drug from the SSRI class of antidepressants, which represented a significant advancement over older classes such as tricyclic antidepressants. Escitalopram was first approved by the FDA in 2002. Lexapro increases levels of free serotonin available in the brain by inhibiting its reuptake, effectively making it linger longer than usual. This medication is prescribed to manage various types of depression and anxiety disorders. Lexapro mainly influences serotonin with only minor effects on other neurotransmitters such as dopamine and norepinephrine, resulting in fewer side effects compared to other antidepressants that have stronger impacts on these two neurotransmitters.

On the other hand, Venlafaxine (Effexor) belongs to another class known as SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors). It works by not only increasing serotonin but also boosting norepinephrine levels in your brain. While this dual action can be more effective for some people's depression symptoms, it may potentially lead to more side effects because it affects additional pathways within the brain.

What conditions is Lexapro approved to treat?

Lexapro is approved for the treatment of various forms of depression and anxiety:

  • Major depressive disorder, also known as unipolar or clinical depression
  • Generalized anxiety disorder (GAD), a chronic condition characterized by excessive worry and fear
  • Panic disorder (when used off-label)

On the other hand, Effexor is approved for dealing with:

  • Major depressive disorder
  • Generalized anxiety disorder
  • Social anxiety disorder, or social phobia
  • Panic disorders

How does Lexapro help with these illnesses?

Lexapro, also known as escitalopram, helps manage depression and anxiety by increasing the amount of serotonin available in the synapses of the brain. Similar to Prozac, it does this by inhibiting its reabsorption into the neurons, which allows serotonin levels to remain elevated for longer periods. Serotonin is a vital neurotransmitter that regulates mood, cognition, memory, sleep patterns among other physiological processes.

On the other hand, Effexor (venlafaxine) increases not only serotonin but also norepinephrine in the synaptic clefts. Norepinephrine is another important neurotransmitter involved in regulating attention and response actions including heart rate and blood pressure; hence increased levels can lead to heightened focus and energy.

While both medications are effective against depression and anxiety disorders due to their influence on serotonin levels; Effexor's impact on norepinephrine makes it potentially more energizing. However individual responses vary widely so patient preferences should be considered alongside clinical judgement when choosing between these drugs.

What is Effexor?

Effexor is the brand name for venlafaxine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI). This means it increases levels of serotonin and norepinephrine in the brain by reducing their reabsorption. It also has a weak inhibitory effect on dopamine absorption but doesn't significantly contribute to its therapeutic effects. Venlafaxine was first approved by the FDA in 1993. Unlike Lexapro, an SSRI antidepressant that principally affects serotonin levels, Effexor impacts both serotonin and norepinephrine pathways. Its action on these two neurotransmitters can make it a more suitable choice for patients who do not respond well to "typical" SSRIs like Lexapro. In terms of side-effects, while Effexor may still cause some common SSRI-related side effects such as nausea or mild insomnia, it does not typically lead to weight gain often associated with many other antidepressants.

What conditions is Effexor approved to treat?

Effexor, clinically known as venlafaxine, is approved by the FDA for treating several conditions like:

  • Major depressive disorder (MDD)
  • Generalized anxiety disorder (GAD)
  • Social anxiety disorder (SAD)
  • Panic Disorder Its wide range of application makes it a versatile choice among SSRIs and SNRIs.

How does Effexor help with these illnesses?

Norepinephrine is a neurotransmitter that also acts as a hormone, playing crucial roles in various bodily processes such as alertness, memory recall, focus and attention. It's also heavily involved in the "fight or flight" response to prime the body for action under stress. Like serotonin, low levels of norepinephrine have been associated with depression. Effexor works by increasing both serotonin and norepinephrine levels available in the brain thus alleviating some symptoms of depression. Its dual action on these two key neurotransmitters sets it apart from Lexapro which primarily increases serotonin levels only. This makes Effexor a potential treatment option when patients do not respond well to typical SSRI antidepressants like Lexapro or can be used in combination with them.

How effective are both Lexapro and Effexor?

Both escitalopram (Lexapro) and venlafaxine (Effexor) have proven efficacy in treating patients with depression, and they were approved by the FDA within a few years of each other. They function on different neurotransmitters which can influence when they are prescribed. The effectiveness of escitalopram and venlafaxine in alleviating depressive symptoms was directly compared in numerous clinical trials; both medications showed comparable efficacy as well as safety profiles. In these studies, there were no significant differences between the two drugs regarding their ability to treat depressive symptoms.

A review from 2004 highlighted that Escitalopram is effective from the first week of treatment, has a favorable side effect profile compared to many other antidepressants, and is well-tolerated even among elderly populations. This same study reported that escitalopram rapidly became one of the most frequently prescribed antidepressant drugs globally due to its effectiveness at doses starting at 10mg/day for adults.

A more recent 2016 meta-analysis suggested that venlafaxine could be slightly more effective than SSRI's including escitalopram but it often serves as a second-line treatment option when SSRIs fail or produce intolerable side effects. While substantial research supports venlafaxine's use alongside an SSRI, data confirming its standalone efficacy is less robust than for escitalopram. Nonetheless, because of its unique pharmacology impacting both serotonin and norepinephrine reuptake inhibitors (SNRIs), Venlafaxine may be beneficial for patients who did not respond well to SSRIs or need to avoid common side effects such as weight gain or sexual dysfunction commonly associated with SSRIs.

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At what dose is Lexapro typically prescribed?

Oral dosages of Lexapro typically start at 10 mg/day for adults, which is effective in treating generalized anxiety disorder and depression for many individuals. If necessary, the dose can be increased to a maximum of 20 mg/day. Adolescents between ages 12-17 may also begin with a dosage of 10 mg/day, but it's important not to exceed this amount as higher doses haven't been studied in this age group. For older adults or patients with liver impairment, the recommended starting dose is lower — at about 5 mg per day — due to slower metabolism of the drug. The adjustment or increase in dosage should always be done under medical supervision following several weeks if there is no response.

At what dose is Effexor typically prescribed?

Effexor treatment typically begins at a dosage of 75 mg/day, which can then be increased to 150 mg/day, divided into two doses taken in the morning and evening. If needed and under the guidance of a healthcare professional, the dose may further increase to a maximum of 225 mg/day, divided into three doses ideally spaced eight hours apart. This escalated regimen might be explored if there's an insufficient response to treatment at lower dosages after several weeks. Always remember that medication adjustments should only occur under your doctor's supervision.

What are the most common side effects for Lexapro?

Common side effects of Lexapro and Effexor can include:

  • Anxiety or nervousness
  • Sleep disturbances such as insomnia
  • Somnolence (sleepiness/drowsiness)
  • Asthenia (general weakness and fatigue)
  • Tremors or unintentional trembling
  • Decreased appetite
  • Nausea, upset stomach, diarrhea, constipation
  • Dry mouth
  • Sweating -Negative impact on sexual drive and performance including decreased libido, abnormal ejaculation and impotence. -Rash or skin reactions -In some cases may cause unusual dreams

In addition to these common side effects, both medications may also contribute to the experience of flu-like symptoms. If any of these side effects persist or worsen it is important to seek immediate medical attention.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Lexapro?

Effexor, much like Lexapro, is generally tolerated well by patients. However, in some rare cases the following severe side effects can occur:

  • Increased thoughts about suicide or self-harm.
  • Allergic reaction signs such as hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
  • Changes in vision: blurred sight or eye pain/swelling/redness
  • Elevated blood pressure leading to symptoms such as nosebleeds, shortness of breath and severe headache followed by a feeling like you might pass out.
  • Low sodium levels - symptoms may include a headache with confusion and memory problems accompanied by weakness and unsteadiness on feet.
  • Serotonin syndrome - recognisable through agitation, hallucinations (seeing things that are not there), fever or sweating excessively along with fast heart rate and muscle stiffness. Other signs to look for include twitching muscles which can lead to loss of coordination resulting in nausea and vomiting or diarrhea.

Should any of these occur while taking Effexor it’s important that medical help is sought immediately.

What are the most common side effects for Effexor?

Effexor, also known as Venlafaxine, has a number of side effects that patients should be aware of:

  • Dry mouth and sore throat
  • Blurred vision or other changes in vision
  • Nausea, vomiting, stomach upset or pain
  • Loss of appetite, constipation
  • Sleep problems (insomnia)
  • Sweating excessively or feeling anxious/nervous
  • Fast heartbeat
  • Confusion or agitation
  • Unexplained rash
  • Weight loss and decreased libido
    -Necessity to urinate more frequently than usual
    -Possibility for headache and dizziness
    -Unusual muscle stiffness

Are there any potential serious side effects for Effexor?

While Effexor is generally well-tolerated, it can sometimes cause severe side effects. If you experience any of the following symptoms while taking Effexor, seek medical attention immediately:

  • Signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat
  • Easy bruising or bleeding (nosebleeds, bleeding gums), blood in your urine or stools
  • Blurred vision, eye pain or swelling, or seeing halos around lights
  • A seizure (convulsions)
  • Changes in behavior or mood swings including feelings of agitation, hostility and increased depression
  • Rapid heartbeat that feels uncomfortable
  • Severe nausea/vomiting/diarrhea that doesn't stop quickly

Also please note that sudden discontinuation from Effexor might lead to withdrawal symptoms such as anxiety and irritability. It's important to follow doctor’s instructions on how to taper off this medication if needed.

Contraindications for Lexapro and Effexor?

Both Lexapro and Effexor, like many other antidepressants, may potentially increase symptoms of depression in some individuals. If you observe a worsening of your depressive symptoms or an escalation in suicidal thoughts or behaviours, it is crucial to seek immediate medical assistance.

Neither Lexapro nor Effexor should be taken if you are currently on or have recently stopped using monoamine oxidase (MAO) inhibitors. It's important to always inform your doctor about any medications you're taking; MAO inhibitors necessitate a clearance period of approximately 5 weeks from the body to avoid hazardous interactions with both Lexapro and Effexor.

How much do Lexapro and Effexor cost?

When it comes to the brand-name versions of these drugs:

  • The price of 30 tablets of Lexapro (10 mg) averages around $356, which works out to approximately $12/day.
  • In comparison, the cost for 30 capsules of Effexor XR (75 mg) typically averages is about $470, working out to roughly $15.67/day.

Consequently, if you are taking a typical dosage range for either drug, it appears that brand-name Lexapro is less expensive on a per-day treatment basis than Effexor. However, remember that cost should not be your primary consideration in determining which medication is right for you.

Regarding the generic versions of these drugs (Escitalopram and Venlafaxine), costs are significantly more affordable:

  • Escitalopram can come in packs ranging from 5 up to 500 tablets with strengths varying from 5mg up to 20mg. Costs can start as low as about $.10/day if buying larger packs upfront but won't usually exceed around $1/day even at higher dosages.
  • Generic Venlafaxine starts at similar prices ($.10 - .50 /day when buying larger quantities upfront) but due to its wider dosage range could potentially reach upwards of $2 or so per day at very high doses.

Popularity of Lexapro and Effexor

Escitalopram, in generic form as well as under the brand name Lexapro, was estimated to have been prescribed to about 13.5 million people in the US in 2020. Escitalopram accounted for just over 26% of SSRI antidepressant prescriptions and around 15% of overall antidepressant prescriptions in the United States. The prevalence of escitalopram has steadily increased since it was approved by the FDA back in 2002.

Venlafaxine, including brand versions such as Effexor, was prescribed to approximately 8 million individuals within the USA during that same year. In terms of SNRI (Serotonin-Norepinephrine Reuptake Inhibitor) prescriptions within America, venlafaxine accounts for a significant portion at roughly just under half at about 47%, and makes up around nine percent when considering all types of antidepressants together. Since its approval by the FDA back in 1993, usage rates for venlafaxine have remained relatively steady throughout this period.


Both Lexapro (escitalopram) and Effexor (venlafaxine) have well-established roles in the management of depression, with a wealth of clinical studies supporting their efficacy over placebo treatments. In certain situations, these drugs may be used together but this should only be under careful medical supervision as there can also be contraindications between them. They work differently: Lexapro is a selective serotonin reuptake inhibitor (SSRI), primarily acting on the serotonin system, while Effexor acts on both the serotonin and norepinephrine systems.

Lexapro is often seen as a first-line treatment for depression due to its proven effectiveness and relatively mild side-effect profile. Meanwhile, Effexor might typically be suggested when an SSRI like Lexapro has not provided adequate relief or if there's specific need to target both serotonin and norepinephrine for symptom control.

Both medications are available in generic form providing significant cost savings, particularly important for those paying out-of-pocket. There may also be an adjustment period where effects aren't immediately apparent; patience during this time is crucial.

The side effect profiles of both drugs share similarities though each medication carries unique risks too - sexual dysfunction being more common with SSRIs like Lexapro while increased blood pressure could occur with SNRIs like Effexor. It's essential that patients closely watch their moods especially when starting therapy; any worsening depressive symptoms or emergence of suicidal thoughts warrant immediate medical attention.