Lexapro vs. Paxil—What Is the Difference and Which One Should I Take?

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For some with anxiety and depression, medication may be the best way to a happier and healthier life—but with all of the medications available, it can be difficult to know which one is best for you. 

Lexapro and Paxil are two options for treating major depressive disorder and generalized anxiety disorder. They’re both selective serotonin reuptake inhibitors (SSRIs) and work similarly to treat certain mental health conditions. However, individuals may react differently to these medications, even though they’re in the same drug class. 

Before starting medication, it is essential to understand the possible benefits and side effects it can have—that’s why we’ve provided the comparison guide below.

If you are experiencing symptoms of depression or anxiety, a certified and licensed medical professional on Klarity can discuss your options with you. Schedule an appointment today and learn which medication, if any, works best for you.

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 800-273-8255.

What Is Lexapro?

Lexapro is a common SSRI medication for treating anxiety and depression. It works like other SSRIs by slowing down the brain’s reabsorption of serotonin. Without consistent serotonin levels, the brain cannot send as many messages, causing symptoms of depression and anxiety. 

By slowing this neurotransmitter, Lexapro allows the brain to pass more messages between nerve cells, increasing a person’s mood and good feelings. 

Lexapro Forms and Doses

Lexapro is most commonly prescribed in tablet form but is also available as an oral solution. Typically, patients take 10 mg of Lexapro a day, but the dosage can come in 5 mg, 10 mg, or 20 mg. A higher dosage can be used to treat more severe symptoms, but also when a person has minimal reaction to a lower dose. 

When you speak to a medical professional about Lexapro, they will determine if this is the best treatment for you and determine the right dosage. The healthcare providers on Klarity are experienced in prescribing Lexapro to treat anxiety and depression.

Conditions Lexapro Treats

Lexapro is labeled and marketed as an antidepressant. It treats various forms of depression, including major depression disorder (MDD). However, it can also extend to treating anxiety. Given that individuals often suffer from forms of both, Lexapro can be a great choice of treatment. Overall, Lexapro can improve energy and feelings of well-being and decrease nervousness. 

Symptoms of Anxiety Lexapro Can Treat

Lexapro can treat persistent nervousness by increasing a patient’s feelings of safety and contentedness. Doing this can also contribute to a relaxed demeanor, fewer panic attacks, and more stability in thinking. 

Symptoms of Depression Lexapro Can Treat

Lexapro can be effective for treating a variety of depression symptoms because it improves the patient’s overall feeling of well-being. Increasing your brain’s serotonin can prevent depression symptoms from returning. Lexapro can stabilize and improve mood. However, it is important to continue taking it unless otherwise instructed by a healthcare provider. 

Off-Label Uses for Lexapro

Lexapro has off-label benefits for other conditions also caused by serotonin deficiency. These include OCD, eating disorders, panic disorder, PTSD, and premenstrual dysphoric disorder (PMDD). However, it is advised to speak with a healthcare provider about Lexapro as a treatment for these conditions. 

Lexapro Costs

Lexapro is the name brand of the generic drug escitalopram and tends to be more expensive. The cost of Lexapro varies depending on which brand you are prescribed and your health insurance status. 

Generic escitalopram can vary in price, from as little as $13 to as much as $129 for thirty 10 mg tablets. Name-brand Lexapro can cost much more than the generic, even as high as $534 for the amount and dosage mentioned above. 

However, the price you would pay for Lexapro will depend on your insurance coverage.

Lexapro Side Effects

Before taking Lexapro, you should be familiar with the possible side effects of the medication. You should speak to your healthcare provider if the side effects persist or worsen over time. However, most side effects of Lexapro are expected to reduce in severity as you continue to take it. The most common side effects include the following:

  • Nausea
  • Excessive sweating
  • Insomnia and tiredness
  • Dry mouth
  • Dizziness
  • Diarrhea

Lexapro Warnings for Use

Supervision from your healthcare provider is always advised when taking Lexapro to avoid developing serious health conditions. However, some possibly dangerous side effects are more unpredictable, so patients and those around them should keep a close eye on the effects of Lexapro. 

Some of the most serious issues are described below:

  • Suicidal thoughts and behavior can occur, especially at the beginning of taking Lexapro, and it can feel like the depression is worsening. If this happens, you should immediately speak with your healthcare provider and call the Suicide and Crisis Lifeline by dialing 988.  
  • Serotonin syndrome is a rare condition that can be life-threatening. It occurs when the brain contains too much serotonin causing increased heart rate, sweating, fever, muscle stiffness and spasms, and confusion. The most common cause is taking two antidepressants at one time, and medical care should be sought immediately if any symptoms occur.
  • When symptoms of depression and anxiety decrease, it can seem like the medication is no longer necessary. However, stopping Lexapro suddenly can cause withdrawal symptoms like nausea, anxiety, difficulty sleeping, and flu-like symptoms. Always speak to your medical provider if you would like to stop taking Lexapro. 

Lexapro Drug Interactions

It is important to understand the ways that other drugs can interact with Lexapro while you are taking it. Taking certain medications alongside Lexapro can cause health issues as well as reduce the effectiveness of Lexapro and the additional medication. 

If you are already taking a medication that does not interact well with Lexapro, your healthcare provider may prescribe a different antidepressant or suggest switching your other medications. 

Below is a list of common medications that do not interact well with Lexapro. However, you should have a comprehensive discussion of your medicines with a healthcare provider before taking Lexapro. 

  • Bepridil
  • Cisapride
  • Fluconazole
  • Methylene Blue
  • Pimozide
  • Rasagiline
  • Selegiline
  • Thioridazine
  • Ziprasidone

Licensed providers on Klarity provide personalized treatment. Find a provider that matches your needs and preferences.

What Is Paxil?

Paxil is the name brand for the generic drug Paroxetine and is a fairly new medication used for treating depression, anxiety, and other serotonin-related conditions. Like Lexapro, Paxil is a selective serotonin reuptake inhibitor or SSRI, so it works very much in the same way. By regulating the brain’s reabsorption of serotonin, Paxil improves overall mood and feelings of well-being. 

Paxil Forms and Doses

The dosage of Paxil depends on the condition being treated, and it comes in 10 mg, 20 mg, or 40 mg tablets. It is also available in an oral liquid form. For depression, healthcare providers often prescribe 20 mg per day to start, and they adjust as needed to a possible maximum dosage of 50 mg per day. 

For conditions such as OCD, panic disorder, and anxiety disorders, the initial dosage is the same, at 20 mg per day, but it can be increased to up to 60 mg per day, depending on the condition and the patient. 

Conditions Paxil Treats

Paxil is most commonly used as an antidepressant, but it can also be used to treat a range of other mental health conditions. 

In some patients, Paxil can also effectively treat anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder. By improving the brain’s ability to utilize serotonin, Paxil improves sleep, appetite, energy levels, interests, and overall mood. It can also help decrease fear, anxiety, unwanted thoughts, and panic attacks.

Symptoms of Anxiety Paxil Can Treat

Like other SSRIs, Paxil effectively increases a patient’s mood and serotonin use. By reducing anxiety symptoms, such as nervousness and fear, Paxil can improve a patient’s daily life. Over time it can re-adjust the way the brain uses serotonin. However, some SSRIs are not always the most effective option for treating anxiety, and underlying causes of anxiety disorders may go untreated by only addressing serotonin. 

Symptoms of Depression Paxil Can Treat

Paxil can be effective for the treatment of depression by adjusting the way the brain absorbs serotonin. A lack of serotonin, commonly referred to as the “happy chemical,” can leave people with low mood and motivation. Paxil can restore your brain’s ability to use serotonin, improving your mood and overall interest in life. 

Off-Label Uses for Paxil

Off-label use is when your healthcare provider prescribes a medication to treat a particular condition it’s not FDA-approved to treat. 

For example, Paxil is FDA-approved to treat depression and anxiety, but it can also be beneficial for OCD, even though it’s not FDA-approved to treat it. FDA approval requires testing and resources, but an unapproved medication doesn’t necessarily make it unsafe. 

Paxil can be used to treat various off-label issues, including OCD, PTSD, premenstrual dysphoric disorder, and panic disorders. Under a different brand name, Paxil has also been known to reduce symptoms of menopause, such as hot flashes. Any use of Paxil to treat off-label conditions should be discussed with your healthcare provider. 

Paxil Costs

Like most medications, the cost of Paxil depends on the brand being prescribed as well as whether it is covered by insurance. For thirty 20 mg tablets of Paxil, the cost can range from $89 to $265. For the same amount of generic Paroxetine, patients would pay around $24. 

Paxil Side Effects

Paxil can cause a few side effects, most often just minor discomfort. As your body gets acclimated to the medication, these possible symptoms should subside. However, if the side effects get worse over time or do not go away, contact your healthcare provider immediately. 

Common side effects of Paxil include but are not limited to the following: 

  • Headache
  • Sweating
  • Rash
  • Nausea
  • Dry mouth, change in taste
  • Weakness, lack of energy
  • Insomnia
  • Changes in urination
  • Confusion

Paxil Warnings for Use

In rare cases, individuals who take Paxil can experience severe health conditions. Paxil should always be taken under the supervision of a medical professional, and if symptoms of these issues occur, seek medical attention immediately. If the healthcare providers on Klarity determine that Paxil is the best treatment for your depression or anxiety, they will discuss these warnings with you before writing a prescription. 

Common health concerns that are possible while taking Paxil include:

  • At the beginning of treatment with Paxil, patients can experience an increase in depression symptoms, including suicidal thoughts or behavior. If you have any suicidal thoughts while taking Paxil, immediately contact the Suicide and Crisis Lifeline at 988. It is important to always notify your healthcare provider about these feelings. 
  • Serotonin syndrome can occur when the brain has too much active serotonin. It is a rare but life-threatening condition that causes muscle stiffness and spasms, increased heart rate, confusion, sweating, and fever. Serotonin syndrome is commonly caused by taking more than one antidepressant at a time, and you should seek medical attention if you are experiencing any of these symptoms.
  • Withdrawal symptoms can occur if you suddenly stop taking Paxil, and you should not change your dosage or stop altogether unless instructed by your healthcare provider. Paxil should be taken under the supervision of a healthcare professional.

Paxil Drug Interactions

Like other antidepressants, it is important to understand what drugs could have a negative reaction with Paxil if taken at the same time. When taken at the same time, some medications and Paxil can make each other less effective or cause a reaction. Before taking Paxil, your medical professional will discuss any additional medications you are already taking. 

Here are some medications that are not recommended in conjunction with Paxil, but it is not a complete list. 

  • Other SSRIs
  • Dapoxetine
  • Pimozide
  • Thioridazine
  • Sibutramine
  • Dexfenfluramine
  • Fenfluramine

Which Is Better for Anxiety and Depression? Paxil or Lexapro?

It is important to understand that medical professionals choose certain medications for each patient based on their specific needs and restrictions. When it comes to Paxil and Lexapro for treating anxiety, both medications work in a similar way to improve the brain’s use of serotonin.

Individuals can react differently to the same medications, so what works best for one person may not be best for you. The effectiveness of Paxil in comparison to Lexapro and vice versa will be determined by a healthcare provider who will take into account your symptoms, any health issues, other medications you are already on, and what may have worked in the past.

Klarity connects you with healthcare professionals who will take several factors into consideration before prescribing any medication. 

Frequently Asked Questions About Paxil and Lexapro

Does Lexapro Have More Side Effects Than Paxil?

Lexapro and Paxil have similar possible side effects. However, Lexapro is more likely to cause fever, blurred vision, frequent urination, indigestion, sexual difficulties, agitation and restlessness, changes in taste, weight change, and tremors. Paxil has an increased likelihood of causing anxiety, constipation, and general weakness. 

Each medication is also more likely to cause certain withdrawal symptoms if they are stopped suddenly. Symptoms of withdrawal from Lexapro include dizziness, tingling, vivid dreams, tiredness, irritability, and low mood. 

Paxil can cause anxiety, nausea, nervousness, and insomnia if you stop taking it suddenly. It is important to always speak to your healthcare provider before stopping any medication. 

What Causes More Weight Gain Paxil or Lexapro?

Both Lexapro and Paxil have a low risk of causing weight gain. Anywhere from 1% to 10% of users experience any weight-related symptoms. The likelihood of weight gain from taking Paxil or Lexapro will depend on your specific body and its reaction to either medication.

Which Has Worse Sexual Side Effects? Lexapro or Paxil?

All SSRI medications are more likely than other kinds of antidepressants to cause sexual side effects. Both Lexapro and Paxil can cause a decrease in sex drive, erectile dysfunction, and issues with ejaculation. 

Whether one medication will cause more side effects for you depends on your specific reaction to it, and it is difficult for medical professionals to predict which one is more likely to cause these issues. 

Which Is Better for Sleep? Lexapro or Paxil?

Lexapro and Paxil can both cause sleep-related side effects like insomnia, disruptive sleep, and drowsiness. 

A little over five percent of people who take Lexapro experience insomnia, in comparison to nearly 25% of people taking Paxil reporting that they experienced insomnia. Whether either medication causes insomnia or sleep-related issues will be different for everyone, but Paxil is reportedly more likely to cause insomnia.

Can I Drive On Lexapro? On Paxil?

Before driving on Lexapro or Paxil, it is important to learn about any potential side effects it is causing you. It is not recommended to drive or operate heavy machinery during at least the first few weeks of taking any SSRIs or until you understand how it affects your attention, ability to stay awake, and vision. If you’re unsure about the safety of driving, talk to your provider.. 

Can I Drink Alcohol On Paxil? On Lexapro?

Drinking alcohol while taking Paxil or Lexapro is not recommended, as it can have a negative impact on the antidepressant’s effectiveness and increase the effect of the alcohol. 

Alcohol is a depressant, and it can increase your symptoms of depression as well as worsen your side effects from the medication. Drinking while on Lexapro or Paxil can cause an increase in drowsiness and dizziness as well as worsen your coordination and alertness. 

What Is Better For Anxiety? Paxil or Lexapro?

Lexapro and Paxil can both be used to treat anxiety. However, Lexapro is more commonly prescribed for this mental health condition. It is important to note that just because a medication works for many people does not mean it is the best one for you.

What Is Better For Depression? Paxil or Lexapro?

Given they are both SSRI’s and treat depression in a similar way, it is difficult to determine which is better than the other for treating depression. 

A 2014 study by the University of London found that in a comparison between Lexapro, Paxil, and another antidepressant called sertraline, Lexapro had more advantages when it came to efficacy and tolerability for treating depression. 

Does Paxil Affect Pregnancy? Does Lexapro?

Pregnancy can also trigger symptoms of depression, and it is important to discuss the possible risks of taking Lexapro or Paxil while pregnant. 

Possible risks to the fetus include spontaneous abortions, low birth weight and prematurity, neonatal serotonin syndrome, neonatal behavior syndrome (withdrawal), respiratory issues, and persistent pulmonary hypertension of the newborn. 

If you are pregnant or trying to get pregnant and want to take Lexapro or Paxil, it is important to discuss the possible risks with your healthcare provider. 

How Klarity Helps You Discover the Right Medication

At Klarity, you don’t have to figure out whether Lexapro or Paxil is right for you. You’ll have access to unlimited appointments with a licensed healthcare provider who can evaluate, diagnose, and recommend the best medication if applicable. 

Your mental health shouldn’t be an afterthought. No more long waitlists, no more inconvenient commutes. Find a provider and meet with them from the comfort of your home in just 48 hours. 

Medically Reviewed By Dr. Zoe Russell

Dr. Zoe Russell received a dual bachelor’s degree in biology and psychology from the University of Michigan-Dearborn, pursued a master’s degree in public health from Michigan State University, and received her doctorate in osteopathic medicine from Michigan State’s College of Osteopathic Medicine in 2021. Currently, Dr. Russell is completing her residency training in family medicine and hopes to specialize in female reproductive and mental health.

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