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Anxiety

26 min read

Lexapro vs Prozac for depression and anxiety

Written by Klarity Editorial Team

Published: Mar 5, 2024

Medically Reviewed by Dr. Zoe Russell

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Table of contents

Lexapro and Prozac are among the most commonly-prescribed selective serotonin reuptake inhibitors (SSRIs) for anxiety and depression. They have a lot of similarities, but there are important differences that may make one better for you. In this post, we explore the major differences between Lexapro vs Prozac to help you learn more about their differences, including:

  • What each medication is and how it works
  • What forms and doses each comes in
  • The conditions each medication treats
  • What each medication costs
  • Side effects, drug warnings, and potential interactions for each medication
  • What are the answers to frequently asked questions about Lexapro vs Prozac

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LexaproProzac
Drug ClassSelective serotonin reuptake inhibitor (SSRI)Selective serotonin reuptake inhibitor (SSRI)
Brand / Generic StatusBrand name for escitalopramBrand name fluoxetine
Form(s) of the Drug• Immediate-release tablets
• Clear, peppermint-flavored liquid suspension
• Clear, peppermint-flavored liquid suspension
• Half-green, half-white capsules
Standard DosageLiquid suspension:
• 10mg per dose

Immediate-release tablets:
• 10mg per dose
• 20mg per dose
Liquid suspension:
• 10mg per dose

Capsules:
• 10mg per dose
• 20mg per dose
Conditions TreatedFDA-approved uses:
• Major depressive disorder
• Generalized anxiety disorder

Off-label uses:
• Obsessive-compulsive disorder (OCD)
• Binge-eating disorder
• Bulimia nervosa
• Post Traumatic Stress (PTSD)
• Premenstrual dysphoric disorder
• Panic disorder
• Insomnia
FDA-approved uses:
• Anxiety and stress
• Major depression
• Bulimia nervosa
• Premenstrual dysphoric disorder (PMDD)
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Postpartum depression
• Schizoaffective disorder

Off-label uses:
• Anorexia nervosa
• Premature ejaculation
• Various anxiety disorders
CostGeneric form (escitalopram):
• $15.00 and $120.00 for a 30-day supply*

Brand-name:
• $250.22 for a 30-day supply*

*Without insurance
Generic form (fluoxetine):
• $3 to $4 for 30-days’ worth of capsules*
• $12 for 30 days’ worth of liquid suspension

*May cost up to $100 for high dosages

Brand-name:
• $460 to $1000 for 30 days’ worth of capsules
Side-EffectsCommon side effects:
• Dizziness and drowsiness
• Weakness, shakiness, or sweating
• Insomnia
• Loss of appetite or nausea
• Dry mouth
• Constipation
• Unexplained weight changes
• Decreased sex drive or impotence
• Difficulty having an orgasm

Serious side effects:
• Abdominal pain or bleeding
• Allergic reaction
• Blurred or tunnel vision
• Abnormal dreams or decreased focus
• Chest pain or irregular heartbeat
• Eye pain, swelling, or halos around lights
• Euphoria, depression, or unusual behavior
• Headache, confusion, or slurred speech
• Heartburn or vomiting
• Hot flashes
• Severe weakness or dizziness
• Feeling unsteady or uncoordinated
• Sweating and tremors
• Rigid muscles
Common side effects:
• Nausea
• Diarrhea or constipation
• Changes in appetite
• Headache and fatigue
• Increased sweating
• Trouble sleeping
• Impotence/sexual dysfunction

Serious side effects include:
• Fever
• High blood pressure
• Rigid muscles
• Seizures
• Kidney or respiratory failure
• Disorientation or delirium
• Serotonin syndrome
Warnings For UseContraindicated conditions:
• Liver or kidney problems
• Heart problems
• Seizures or convulsions
• Bipolar disorder
• Low sodium levels in the blood
• High blood pressure
• History of stroke
• Bleeding problems

Drug interactions:
• MAOIs
• NSAIDs
• Aspirin
• St. John’s Wort
• Tryptophan
• Opioid-based painkillers
• Anti-psychotics
• Alcohol
Contraindicated conditions:
• Diabetes
• Liver disease
• Alcohol use disorder
• History of bipolar disorder
• History of suicide attempts
• Low blood sodium or dehydration
• Seizures
• Gastrointestinal ulcers
• Glaucoma

Drug Interactions:
• Monoamine oxidase inhibitors (MAOIs)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Aspirin and other blood thinners
• Antihistamines
• Opioid pain relievers
• St. John’s wort
• Cannabis and MDMA

What is Lexapro?

Lexapro is a selective serotonin reuptake inhibitor (SSRI) often prescribed to treat anxiety and depression symptoms. Like other SSRIs, Lexapro alters how the brain uses the neurotransmitter serotonin, a chemical central to mood regulation. 

By increasing the amount of serotonin in the brain and slowing down its reabsorption, Lexapro balances your mood and restores a sense of calm. Without a consistent level of serotonin in the brain, you can experience various symptoms of depression and anxiety.

Lexapro forms and doses

Lexapro is available as a oral tablet in 5 milligrams, 10 milligrams, and 20 milligrams dosages. The typical daily dose is 10 milligrams, and higher quantities are often prescribed to individuals with severe symptoms or minimal reaction to the lower doses. 

When you speak with a healthcare provider on Klarity, they help determine which form and dosage are best for treating your specific symptoms.

Conditions Lexapro treats

Lexapro is primarily prescribed to treat depression. Because low serotonin levels impact several mental health conditions, some SSRIs can also treat other conditions like anxiety. If you experience both anxiety and depression, Lexapro could be an ideal choice for you.

Like many medications, there are also off-label uses for Lexapro. Any off-label treatment should only be done with the guidance of a healthcare professional.

Symptoms of anxiety Lexapro can treat

Lexapro effectively treats many anxiety symptoms. By stabilizing your serotonin levels, this medication helps you feel at ease in the present, greatly reducing apprehension toward current and future events. This process can affect other symptoms, reducing the severity of panic attacks and irregular thought patterns and helping people relax in their daily life.

Symptoms of depression Lexapro can treat

Lexapro treats a host of depression symptoms. By boosting your serotonin, this SSRI can reduce feelings of nervousness and increase your overall sense of well-being and general contentment. 

Off-label uses for Lexapro

There are several off-label uses for Lexapro (escitalopram), including:

  • Generalized anxiety disorder (GAD): While Lexapro is FDA-approved for the treatment of major depressive disorder and generalized anxiety disorder, it may be prescribed off-label for the treatment of GAD.
  • Social anxiety disorder (SAD): Lexapro effectively reduces symptoms of SAD, characterized by intense fear or anxiety in social situations.
  • Post-traumatic stress disorder (PTSD): Lexapro is sometimes prescribed off-label for the treatment of PTSD, which is a mental health condition that can occur after a traumatic event.
  • Obsessive-compulsive disorder (OCD): Lexapro is effective in reducing the symptoms of OCD, although it is not specifically FDA-approved for this use.
  • Premenstrual dysphoric disorder (PMDD): Lexapro is sometimes used off-label for treating PMDD, a severe form of premenstrual syndrome that affects some women.

Lexapro costs

The cost of Lexapro can vary based on whether you’re prescribed the name brand or its generic form, escitalopram. For 30 tablets of the 10 milligrams dose, generic escitalopram can cost $19 per drugs.com.

Name brand Lexapro is much more expensive. For 100 tablets of the 10 milligrams dose, it can cost $1,552 per drugs.com. If you can get your prescription covered by insurance, it can be much more affordable, whether you get the name-brand or generic form.

Lexapro side effects

Like other antidepressant medications, Lexapro has side effects you should know before taking it. Some of these side effects can become less severe as you acclimate to the drug, but if they persist or worsen over time, notify your provider immediately.

The most common side effects include:

  • Insomnia
  • Tiredness
  • Nausea
  • Dry mouth
  • Dizziness
  • Sweating
  • Diarrhea

Lexapro warnings for use

When taking Lexapro, there is a chance you may experience serious health issues. Most of these can be prevented with careful guidance from your healthcare provider, while others can be more unpredictable. The medical professionals on Klarity can review your health history to determine if Lexapro is right for you.

Warning signs include:

  • Serotonin syndrome: 

This is a rare but potentially life-threatening condition where the brain has too much serotonin. If you’re taking multiple serotonin-boosting medications, side effects can include sweating, rapid heart rate, muscle spasms or stiffness, fever, and confusion.

  • Suicidal thoughts and behavior: In individuals 24 years or younger, Lexapro can cause new or worsening depression and suicidal thoughts or behaviors, primarily during the first few months of treatment. If you experience suicidal ideation or thoughts of self-harm, seek help immediately and notify your healthcare provider.
  • Withdrawal: SSRIs have a low risk of dependency, but it’s still possible to experience withdrawal if you suddenly stop taking them. Symptoms can include anxiety, agitation, nausea, trouble sleeping, and flu-like symptoms, beginning within three days of stopping Lexapro. Speak with your healthcare provider to safely avoid withdrawal.

Lexapro drug interactions

Lexapro can have adverse interactions with other medications or supplements, potentially causing health issues or making one or both substances ineffective. Your healthcare provider may choose not to prescribe you Lexapro because of its possible drug interactions or suggest an alternative medication.

It’s vital to avoid certain medications, supplements, and substances that can interact with Lexapro (escitalopram) and cause potentially serious side effects. Here are some examples:

  • Monoamine oxidase inhibitors (MAOIs): Lexapro should not be taken with MAOIs or within 14 days of stopping MAOIs. Taking MAOIs with Lexapro can lead to a potentially deadly condition known as serotonin syndrome, which causes symptoms such as confusion, fever, muscle rigidity, and seizures.
  • Other antidepressants: When you combine Lexapro with other antidepressants, like other SSRIs, or tricyclic antidepressants, you can increase the risk of developing serotonin syndrome.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are drugs like ibuprofen and aspirin. Taking Lexapro with NSAIDs can increase the risk of bleeding.
  • Blood thinners: People who take blood thinners and Lexapro also experience an increased risk of bleeding.
  • St. John’s wort: St. John’s wort is sometimes used to treat symptoms of major depressive disorder, but taking it with Lexapro or other antidepressants increases the risk of serotonin syndrome.
  • Alcohol: Drinking alcohol while on Lexapro increases the risk of drowsiness, dizziness, and impaired judgment.

What is Prozac?

Prozac is another selective serotonin reuptake inhibitor that treats symptoms of major depressive disorder. Similar to Lexapro, Prozac increases serotonin levels in the brain to create a chemical balance that regulates your mood and emotions. 

Prozac forms and doses

Prozac is available in capsule form in 10 milligrams, 20 milligrams, and 40 milligrams doses.

The exact dosing for Prozac depends on your age and specific health concerns. That said, the usual dosage ranges from 10 milligrams to 60 milligrams by mouth once daily.

Conditions Prozac treats

Though primarily prescribed to treat depression and anxiety symptoms, Prozac also has off-label uses. If your Klarity healthcare provider believes your specific condition can be treated using Prozac, they may recommend it even if you don’t explicitly have anxiety or depression.

Symptoms of anxiety Prozac can treat

Prozac treats key anxiety symptoms, including constant nervousness that can interfere with daily activities. As your treatment progresses, these symptoms will likely decrease, allowing you to experience greater calm and positive thought patterns.

Symptoms of depression Prozac can treat

Prozac is often prescribed to treat major depressive disorder, which has many symptoms, including hopelessness and general emotional instability. Compared to other medications, Prozac is especially effective at contributing to greater energy levels, making it useful for individuals who struggle with low energy as a symptom of depression.

Off-label uses for Prozac

Prozac (fluoxetine) has several off-label uses, including:

  • Obsessive-compulsive disorder (OCD): Although the FDA does not specifically approve Prozac for the treatment of OCD, it is effective in reducing the symptoms of this disorder.
  • Panic disorder: Prozac is sometimes prescribed off-label for treating panic disorder, which is a condition characterized by sudden and recurrent panic attacks.
  • Bulimia nervosa: Prozac is sometimes used off-label to treat bulimia nervosa, an eating disorder characterized by binge eating followed by purging.
  • Premenstrual dysphoric disorder (PMDD): Prozac is effective in reducing the symptoms of PMDD.
  • Post-traumatic stress disorder (PTSD): Prozac is sometimes prescribed off-label for treating PTSD.

If your provider prescribes you Prozac off-label, only take it exactly as instructed.

Prozac costs

Prozac is more affordable in its generic form of fluoxetine. For 30 capsules of the 20 milligrams dose, fluoxetine can cost as little as $47 per drugs.com. Name-brand Prozac is much more costly, as much as $471 for the same amount and dosage of medication per drugs.com.

Prozac side effects

Prozac has similar side effects to other antidepressants, many of which can lessen in severity as your body adjusts to the medication. If these side effects aren’t going away or worsening, contact your healthcare provider immediately.

The most common side effects of Prozac include:

  • Insomnia
  • Drowsiness
  • Headache
  • Anxiety
  • Nervousness
  • Nausea
  • Diarrhea
  • Anorexia
  • Dry mouth
  • Tremor
  • Throat pain

Prozac warnings for use

When taking Prozac, there are warnings for use that may result in serious health complications. To prevent issues from occurring, only take Prozac as instructed by your healthcare provider, and notify them immediately if you experience any dramatic changes to your health.

The most common warnings for use include:

  • Suicidal thoughts and behaviors: If you’re 24 or younger, there’s a chance that Prozac may worsen depression symptoms and increase the risk of suicidal thoughts or behaviors within the first few months of treatment or if your dosage changes. It’s essential to monitor your own mental health and thought patterns during this time.
  • Serotonin syndrome: This is a rare but potentially life-threatening syndrome where you have too much serotonin in your system. If you take more than one serotonin-boosting drug at once, you’re at a greater risk of developing symptoms, including sweating, fever, increased heart rate, confusion, and muscle stiffness or spasms.
  • Withdrawal: Although SSRIs aren’t typically flagged for dependency, withdrawal symptoms can occur if you suddenly stop taking Prozac. These symptoms can include nausea, trouble sleeping, and dizziness. If you want to stop taking Prozac, speak to your healthcare provider to figure out a safe method of tapering off your medication.

Prozac drug interactions

Like Lexapro, Prozac may interact with other prescription drugs and over-the-counter supplements, causing one or all medications to become less effective. Notify your healthcare provider of all medicines and supplements you’re taking before receiving a prescription for Prozac, as they may recommend an alternative medication to prevent any adverse interactions.

Notable drug interactions for Prozac:

  • Monoamine oxidase inhibitors (MAOIs): Prozac should not be taken with MAOIs or within 14 days of stopping MAOIs. This combination can lead to a potentially life-threatening condition known as serotonin syndrome, which can cause symptoms such as confusion, fever, muscle rigidity, and seizures.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and aspirin, can increase the risk of bleeding when taken with Prozac.
  • Blood thinners: Prozac can also increase the risk of bleeding when taken with blood thinners, such as warfarin.
  • Other antidepressants: Combining Prozac with other antidepressants, such as other SSRIs or tricyclic antidepressants, can increase the risk of serotonin syndrome.
  • St. John’s wort: St. John’s wort is an herbal supplement that is sometimes used to treat depression, but it can interact with Prozac and other antidepressants and increase the risk of serotonin syndrome.
  • Alcohol: Drinking alcohol while taking Prozac can increase the risk of side effects such as drowsiness, dizziness, and impaired judgment.

Tell your provider about all other medications, supplements, and substances you are taking, including over-the-counter and herbal supplements, to avoid potential interactions and adverse effects.

Lexapro vs Prozac final thoughts

Lexapro and Prozac are prescription antidepressant medications that should only be taken under the guidance of a qualified provider. They can take several weeks to reach their full effect, and the dosage may need to be adjusted over time based on the patient’s response to treatment.

The choice between Lexapro and Prozac will depend on various factors, including the patient’s medical history, the severity of their symptoms, current mental health conditions, and their response to previous antidepressants.

It is important to work closely with a provider, like the providers on Klarity, to determine the most appropriate medication and dosage for you.

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

How Klarity helps you find the right anxiety and depression medication

Still deciding on Lexapro vs Prozac? Speak with a provider on Klarity about your symptoms and treatment goals, and get online anxiety and depression medication.

Klarity makes finding online anxiety and depression treatment fast and easy. Here’s how—

  1. We connect you with board-certified mental health professionals who can diagnose and prescribe medication online.
  2. Meet with your provider virtually from the comfort of your home. Appointments are always available in 48 hours or less.
  3. We’ll send your prescription to your local pharmacy for you to pick up at your convenience.

Schedule an appointment to get started with Klarity today.

Frequently asked questions about Prozac and Lexapro

Do SSRIs make you gain weight?

Most weight gain caused by SSRIs results from improving anxiety and depression symptoms, as these conditions commonly cause people to have a lower appetite and fewer cravings. As serotonin levels in the brain become regulated, some individuals may notice they are hungrier or eat more because they’re adjusting to a more regular appetite.

Should you take Lexapro and Prozac together?

Lexapro and Prozac should not be taken together because they are both SSRIs, and taking both simultaneously could result in serotonin syndrome. This condition is rare, but it’s marked by dangerously high serotonin levels in the brain, which can lead to life-threatening symptoms.

Which has sexual side effects? Lexapro or Prozac?

Lexapro is more likely to have sexual side effects, including ejaculation issues, decreased sexual drive, and problems with orgasm. Prozac can cause a general decrease in sexual desire, but its sexual side effects are not as widespread as Lexapro’s.

Which is better for sleep? Lexapro or Prozac?

Many antidepressants can cause sleep problems, such as insomnia or drowsiness, and both Lexapro and Prozac have these side effects. While they are relatively uncommon, in some studies, insomnia is a more common side effect when taking Prozac.

Can I drive on Lexapro? On Prozac?

When taking any SSRI medication, it’s important to understand how it affects your body before driving or operating heavy machinery. Lexapro and Prozac can cause drowsiness. You should wait until your body acclimates to the medication before driving. 

If feelings of drowsiness persist or worsen as you take these medications, speak with your healthcare provider before getting behind the wheel.

Can I drink alcohol on Lexapro or Prozac?

Drinking alcohol is not recommended while taking Lexapro or Prozac, as it can impact the effectiveness of the medications and worsen drowsiness and coordination. Let your healthcare provider know if you regularly drink alcohol so they can suggest alternative forms of medicine.

What is better for anxiety? Lexapro or Prozac?

While Prozac and Lexapro are both effective at treating anxiety, many studies have found that Lexapro is better at reducing symptoms and providing individuals with a greater sense of calm. 

What is better for depression? Lexapro or Prozac?

Prozac and Lexapro are both SSRIs that treat depression symptoms in similar ways. However, compared to Prozac, Lexapro has shown to be slightly more effective at reducing how much depression affects a person’s ability to move through daily life.

Sources

Melisa Puckey, BPharm, “Lexapro,” Drugs.com, https://www.drugs.com/lexapro.html

Sophia Entringer. “Prozac,” Drugs.com, https://www.drugs.com/prozac.html

Drugs@FDA: FDA-Approved Drugs, https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Daniel K. Hall-Flavin “Antidepressants and weight gain: What causes it?” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-weight-gain/faq-20058127

“Serotonin Syndrome,” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758

“Lexapro,” GoodRx, https://www.goodrx.com/lexapro

“Prozac,” GoodRx, https://www.goodrx.com/prozac

“Fluoxetine Interactions,” Drugs.com, https://www.drugs.com/drug-interactions/fluoxetine,prozac.html

“Lexapro Interactions,” Drugs.com, https://www.drugs.com/drug-interactions/escitalopram,lexapro.html

“Escitalopram (Lexapro),” NAMI, https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Escitalopram-(Lexapro)

“Fluoxetine (Prozac),” NAMI, https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Fluoxetine-(Prozac)

“Fluoxetine,” MedlinePlus, https://medlineplus.gov/druginfo/meds/a689006.html

Nicole Washington. “What Side Effects Can Lexapro Cause?” MedicalNewsToday, https://www.medicalnewstoday.com/articles/lexapro-side-effects#warning

Sarah Lobello Pearson. “Do Antidepressants Cause Weight Gain?” GoodRx Health, https://www.goodrx.com/classes/ssris/antidepressants-weight-gain

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All professional services are provided by independent private practices via the Klarity technology platform. Klarity Health, Inc. does not provide any medical services.
If you’re having an emergency or in emotional distress, here are some resources for immediate help: Emergency: Call 911. National Suicide Prevention Hotline: Call 988. Crisis Text Line: Text Home to 741-741
Fax:
(855) 975-3008

PO Box 5098 Redwood City, CA 94063

100 Broadway Street, Redwood City CA, 94063

If you’re having an emergency or in emotional distress, here are some resources for immediate help: Emergency: Call 911. National Suicide Prevention Hotline: Call 988. Crisis Text Line: Text Home to 741-741
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