Prescription

Lexapro vs Prozac: which antidepressant is better?

by

Ros Lederman

Medically reviewed by

Lloyd Sederer, MD

November 24, 2021

Lexapro and Prozac are two of the most commonly prescribed medications for anxiety and depression disorders. Both drugs are selective serotonin reuptake inhibitors (SSRIs), but they are not exactly the same. When considering whether to start Lexapro vs Prozac (or switching from one to the other), it is important to be aware of their uses, dosages, and side effects in order to understand which could be the better option for you.

 

Read on to learn more about Lexapro vs Prozac, including:

  • Lexapro uses vs Prozac uses
  • Lexapro side effects vs Prozac side effects
  • Lexapro vs Prozac dosage information
  • How long it takes for Prozac and Lexapro to work
  • Prozac vs Lexapro for depression
  • Prozac vs Lexapro for anxiety
  • Lexapro vs Prozac for social anxiety
  • Prozac vs Lexapro for OCD

 

Minded Medication Guides, including Zoloft vs Prozac and Wellbutrin vs Lexapro, are intended as educational aids only. They are not intended as medical advice for individual conditions or treatment. They are not a substitute for a medical exam, nor do they replace the need for services provided by medical professionals. Talk to your doctor, nurse, or pharmacist before taking any prescription medication and throughout any treatment.

Lexapro vs Prozac: an overview

Lexapro and Prozac are both selective serotonin reuptake inhibitors (SSRIs). SSRIs are one type of antidepressant medication that can also be used to treat anxiety. Typically, antidepressants are categorized based on how and which neurotransmitters (small molecules in your brain that send messages between nerves) they affect in order to provide symptom relief.

 

As their name implies, SSRIs impact the levels of serotonin in your brain. Serotonin affects emotions such as satisfaction, optimism, and contentment. It also helps balance your mood and impacts your overall sense of wellbeing. SSRIs prevent serotonin from being reabsorbed into and de-activated in the neurons (nerves in your brain), therefore boosting the level of serotonin in your brain.

 

No two SSRIs, however, are exactly the same. Looking more closely Lexapro vs Prozac can help you determine which might be better for your anxiety or depression treatment.

Lexapro vs Prozac: a closer look at Lexapro

Lexapro, the brand name of the generic drug escitalopram, is used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD).

 

Sometimes, Lexapro can also be prescribed for “off-label” uses, which means taking a medication for a condition other than what it has been approved by the FDA to treat. Off-label use is a common and acceptable medical practice. Lexapro (escitalopram) is sometimes prescribed for off-label treatment of:

  • Eating disorders (including binge eating disorder or bulimia nervosa)
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Premenstrual dysphoric disorder (PMDD)

Lexapro dosages

Lexapro (escitalopram) is available in tablet and liquid forms:

Lexapro tablet

  • 5 mg
  • 10 mg
  • 20 mg

Lexapro liquid

  • 1 mg/ml

 

A typical starting dose of Lexapro is 10 mg, taken once daily. If needed, your doctor or prescribing nurse may gradually increase your dosage over several weeks. While the maximum recommended daily dose of Lexapro is 20 mg, some people may need a higher dose to experience relief from their symptoms.

 

Lexapro is a once-daily medication that can be taken with or without food in the morning or in the evening.

 

If you accidentally miss a dose of Lexapro, you should take the missed dose as soon as you remember—or, if it is closer to when you would take your next dose, just take the next dose.

How long does it take for Lexapro to work?

With most SSRIs—including Lexapro—you might notice your appetite, energy, and/or sleep start to improve within the first two weeks of beginning the medication. It can take 6 to 8 weeks or more, however, to improve other symptoms (like decreased interest in activities or depressed mood).

Lexapro side effects

Common side effects of Lexapro include:

  • Anxiousness
  • Appetite loss
  • Constipation
  • Difficulty sleeping
  • Dizziness
  • Dry mouth
  • Infections
  • Nausea
  • Sexual problems (such as decreased sex drive or impaired sexual function)
  • Shaking
  • Sleepiness
  • Sweating
  • Weakness
  • Yawning

 

It is important to always let your doctor, prescribing nurse, or Minded provider know if you experience these (or any other) side effects.

 

Some Lexapro side effects may improve during the first few weeks as your body adjusts to the medication. However, other Lexapro side effects—including its sexual side effects—might not improve as time goes on. 

 

Rare or serious side effects of Lexapro include:

  • Angle-closure glaucoma (symptoms include: pain in your eye, vision changes, or swelling or redness in or around your eye)
  • Low sodium levels in your blood (symptoms include: headaches, feeling weak, or having a hard time concentrating or remembering things)
  • Seizures
  • Serotonin Syndrome (symptoms include: shivering, diarrhea, confusion, severe tightness in your muscles, fever, or seizures. Serotonin Syndrome can be fatal if not diagnosed early and properly treated.)
  • Teeth grinding

 

Because it is an SSRI, Lexapro or escitalopram also can put you potentially at higher risk for life-threatening bleeding, especially in your gums, intestines, nose, or stomach. This risk may be even higher if you are also taking certain other medications, including:

  • Anticoagulants (such as Eliquis or Warfarin)
  • Aspirin
  • Nonsteroidal anti-inflammatories (NSAIDs—like ibuprofen or naproxen)

 

If you experience any of these (or other) serious side effects, seek immediate medical attention.

 

You should also always tell your doctor, prescribing nurse, or Minded provider about any and all other medications and/or supplements you are taking to determine if Lexapro may have any negative interactions with them.

Warnings

Some antidepressants—including Lexapro—come with an FDA “Black Box” warning, meaning that the FDA has identified certain potentially serious safety risks that could result from taking the medication. While Black Box warnings should be taken seriously, their actual safety risk may be low.

 

The Black Box Warning for Lexapro (escitalopram) states:

  • Antidepressants might increase the risk of suicidal behaviors or thoughts in children, adolescents, and young adults
  • Lexapro is not approved for use in children under 12 years old

Lexapro and pregnancy

If you are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed, it is important to discuss your treatment plan with your doctor, prescribing nurse, or Minded provider. Lexapro and other SSRI medications can harm your baby during pregnancy. They can also be passed to your baby through your breast milk.

 

Lexapro and alcohol

Drinking alcohol is not recommended if you are taking Lexapro (or other antidepressant medications).

 

While alcohol may appear to improve your mood in the short term, it can actually worsen depression and anxiety symptoms in the long term. Additionally, alcohol can increase the negative effects of antidepressant medications (such as sedation), while also decreasing their benefits. There is, as well, a risk of unintentionally overdosing on Lexapro if you take it with alcohol.

 

Symptoms of a Lexapro overdose may include:

  • Convulsions
  • Coma
  • Dizziness
  • Drowsiness/sleepiness
  • Hypotension (low blood pressure), including fainting
  • Insomnia
  • Irregular heartbeat
  • Nausea and/or vomiting

 

Lexapro—and SSRI medications generally—must be taken regularly to be effective. Taking them regularly also helps avoid withdrawal symptoms. You should not skip any doses of Lexapro in order to drink alcohol.

Lexapro withdrawal symptoms

If you need to stop taking Lexapro (escitalopram) for any reason, work with your doctor, prescribing nurse, or Minded provider to come up with a plan to carefully and gradually taper down your dose. This is important to avoid withdrawal symptoms. For some people, symptoms of antidepressant medication withdrawal are mild and only last a week or so. But for other people, these symptoms are more prominent and may last weeks or even months.

 

Lexapro withdrawal symptoms may include:

  • Dizziness
  • Headache
  • Irritability
  • Nausea
  • Nightmares
  • Paresthesias (a prickling and/or tingling sensation on your skin)
  • Vomiting

Lexapro vs Prozac: A closer look at Prozac

Prozac—the brand name of the generic drug fluoxetine—is used to treat bulimia nervosa, major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), and premenstrual dysphoric disorder (PMDD).

 

Like Lexapro, Prozac also has some common off-label uses, including:

  • Binge eating disorder
  • Body dysmorphic disorder
  • Dysthymia
  • Generalized anxiety disorder (GAD)
  • Post-traumatic stress disorder (PTSD)
  • Social anxiety disorder  

Prozac dosages

Prozac (fluoxetine) is available in multiple forms and doses:

Prozac capsules

  • 10 mg
  • 20 mg
  • 40 mg

Prozac Weekly Capsules

  • 90 mg

Fluoxetine liquid

  • 20 mg/5ml

Fluoxetine tablets

  • 10 mg
  • 20 mg
  • 60 mg

 

A typical starting dose of Prozac is 20 mg. As with Lexapro, your doctor or prescribing nurse may gradually increase the dosage over several weeks, if needed. While the maximum recommended daily dose is 80 mg, some people need a higher dose for symptom relief.

 

When you and your doctor or prescribing nurse have found the right dose for your symptom relief, you may want to discuss switching to the longer-acting, weekly dose.

 

Unless you are on the weekly dose, Prozac (fluoxetine) is typically taken once a day—usually in the morning—with or without food. 

 

As with Lexapro, if you miss your daily dose of Prozac, either take the missed dose as soon as you remember or, if it is closer to when you would take the next dose, just take the next dose.

 

If you miss your dose of the once-weekly Prozac, take it as soon as you remember and then return to your usual medication schedule.

How long does it take for Prozac to work?

Similar to Lexapro and other SSRIs, you may begin noticing improvements in your energy, appetite, and/or sleep in the first week or two of starting Prozac. But, like other SSRIs, it can take 6 to 8 weeks (or longer) for other symptoms—like lack of interest or low mood—to improve.

Prozac side effects

Common side effects of Prozac include:

  • Anxiousness
  • Appetite loss
  • Change in sleep habits
  • Dry mouth
  • Fatigue
  • Flu-like symptoms
  • Hot flashes
  • Indigestion/diarrhea
  • Nausea/vomiting
  • Nightmares or unusual dreams
  • Rash
  • Sexual problems
  • Sore throat/sinus infection
  • Sweating
  • Tremor/shaking
  • Weakness
  • Yawning

 

Like Lexapro, some side effects of Prozac (fluoxetine) tend to improve in the first few weeks after you begin taking the medication. Others—such as decreased sex drive or impaired sexual function—may not go away while you are on Prozac.  

 

Talk to your doctor, prescribing nurse, or Minded provider if you experience any of these or other side effects.

 

Rare or serious side effects of Prozac include:

  • Angle-closure glaucoma (symptoms include: pain in your eye, vision changes, or swelling or redness in or around your eye)
  • Arrhythmias (irregular heartbeat—symptoms include: shortness of breath, dizziness, or fainting)
  • Low sodium levels in your blood (symptoms include: headaches, feeling weak, or having a hard time concentrating or remembering things)
  • Seizures
  • Serotonin Syndrome (symptoms include: shivering, diarrhea, confusion, severe tightness in your muscles, fever, or seizures. Serotonin Syndrome is serious and can be fatal if not diagnosed early and treated properly.)
  • Teeth grinding

 

Prozac also can increase your risk for potentially life-threatening bleeding in your gums, intestines, nose, stomach, or other areas of your body. This risk can be even higher if you are also taking certain other medications, such as:

  • Anticoagulants (such as Eliquis or Warfarin)
  • Aspirin
  • Nonsteroidal anti-inflammatories (NSAIDs—like ibuprofen or naproxen)

 

You should seek medical attention immediately if you experience this or any other serious side effect(s).

 

And always let your doctor, prescribing nurse, or Minded professional know about any and all other medications and/or supplements you are taking so that they can determine if adding Prozac (fluoxetine) has the potential for negative interactions.

Warnings

Prozac also comes with an FDA Black Box warning. The Black Box Warning for Prozac says:

  • Antidepressants might increase the risk of suicidal behaviors or thoughts in children, adolescents, and young adults under 25 years old
  • Prozac is not approved for use in children under 7 years old

Prozac and pregnancy

Like Lexapro and other SSRIs, Prozac passes to your baby during pregnancy and can be passed to your baby through your breast milk, causing harm to your baby. This is why it is important to discuss your treatment plan with your doctor or prescribing nurse if you are planning to become pregnant or breastfeed.

Prozac and alcohol

Drinking alcohol is not recommended while taking Prozac. Not only can alcohol increase the negative side effects of antidepressant medications (including Prozac), it can also decrease their benefits. And there also is a risk of unintentionally overdosing on antidepressant medications if taken with alcohol.

 

Symptoms of a Prozac overdose may include:

  • Heart problems, such as irregular heartbeat, high blood pressure, or cardiac arrest (when your heart suddenly stops beating)
  • Seizures
  • Serotonin Syndrome (described above)

 

SSRI medications (including Prozac) must be taken regularly in order to effectively provide symptom relief and to help avoid withdrawal symptoms. You should not skip doses of Prozac to drink alcohol.

Prozac withdrawal symptoms

As with Lexapro, if you have to stop taking Prozac, work with your doctor, prescribing nurse, or Minded provider to develop a plan to do so carefully and gradually in order to avoid withdrawal symptoms. Some people experience mild antidepressant medication withdrawal symptoms, while others have more severe symptoms that last weeks or even months. Following a plan developed with your care provider can help avoid these symptoms.

 

Prozac withdrawal symptoms may include:

  • Dizziness
  • Headache
  • Irritability
  • Nausea
  • Nightmares
  • Paresthesias (a prickling and/or tingling sensation on your skin)
  • Vomiting

What is the difference between Lexapro and Prozac?

Prozac vs Lexapro for depression

When considering Prozac vs Lexapro, both medications are approved to treat major depressive disorder (MDD). A 2014 study found that Lexapro was more effective than Prozac in treating severe periods of depression. However, that same study also noted that there was no difference in effectiveness between the medications during the early stages of depression treatment (i.e., the first two weeks). In other words, either medication may be helpful to you.

Lexapro vs Prozac for anxiety

Lexapro is approved to treat generalized anxiety disorder (GAD). Prozac can be prescribed off-label to treat GAD as well. However, when comparing Lexapro vs Prozac for anxiety, while few studies have looked at how effective Prozac is in treating anxiety, many studies have found Lexapro to be an effective treatment for anxiety.

Prozac vs Lexapro for social anxiety

While both medications are sometimes prescribed to treat social anxiety disorder, there are few head-to-head comparisons of the effectiveness of Prozac vs Lexapro available. A 2012 article in Neuropsychiatric Disease and Treatment that looked at several available studies did note, however, that while both medications may be effective in treating social anxiety disorder, Lexapro rated slightly more effective than Prozac.

Lexapro or Prozac for OCD

Prozac is approved to treat obsessive-compulsive disorder (OCD), and Lexapro can be prescribed off-label to treat OCD. According to a 2012 article in the International Journal of Neuropsychopharmacology that examined multiple studies of the different medications used to treat OCD, both Prozac and Lexapro have been found to be effective treatments for OCD.

Which is better for sleep—Prozac or Lexapro?

Neither Prozac nor Lexapro typically is used to help treat sleep difficulties or insomnia. In fact, difficulty falling asleep and insomnia are uncommon but potential side effects for both medications. However, based on data from clinical trials, insomnia may be a more common side effect with Prozac than with Lexapro.

Prozac vs Lexapro doses

When looking at Prozac vs Lexapro dosage information, both are available in once-daily doses that can be taken with or without food. However, there are a few differences to keep in mind:

  • Prozac is typically taken in the morning. Lexapro can be taken in the mornings or evening.
  • Prozac is also available in a once-weekly dose.

Prozac vs Lexapro side effects

While Prozac and Zoloft have some potential side effects in common, each has its own more common side effects for you to know, and bring to your doctor’s attention.

The list above of potential side-effects of this medication is long because it represents side-effects seen in groups of people who, for example, were part of clinical trials, not individual patients.

Prozac vs Lexapro sexual side effects

Both Prozac and Lexapro—and SSRIs generally—can cause sexual dysfunction side effects in both men and women:

Men

  • Decreased libido
  • Difficulty with ejaculation
  • Erectile dysfunction

Women

  • Decreased libido
  • Difficulty with/inability to orgasm

 

If you experience these side effects, they may or may not go away while you are on either Prozac or Lexapro. If these or other side effects become difficult to tolerate, your doctor or prescribing nurse can work with you to adjust your dose or, if necessary, switch you to another medication.

Lexapro vs Prozac weight gain

You may have heard that taking antidepressant medications could lead to weight gain. There is some truth to this statement—but it is not necessarily the direct reason behind all the weight gained in people taking antidepressants.

 

For example, sometimes people lose weight when they are depressed and before they have started treatment. Then, as their appetite returns in response to effective treatment, they might begin to gain back that weight. In those cases, the weight gain is not necessarily from the medication, but rather from the easing of the depression.

 

While few head-to-head comparisons of Prozac vs Lexapro weight gain are available, studies indicate that both medications can cause weight gain.

 

According to a 2011 study in the Journal of Obesity, people who took Lexapro over an 8-month (i.e. short-term) period gained around 4 pounds, on average. A 2016 study in the Journal of Clinical Medicine, on the other hand, found that people who took Prozac over a 2-year (i.e. long-term) period gained 4.6 pounds, on average.

 

That being said, a 2015 study in General Hospital Psychiatry that looked at antidepressant use that ranged from 6 months to 3 years, found that many antidepressant medications—including Lexapro—led to significant weight gain—with the exception of Prozac.

Can you take Lexapro and Prozac together?

Because they are both SSRIs, Prozac and Lexapro should not be taken together. Taking these medications together could lead to dangerously high levels of serotonin collecting in your body, which can cause Serotonin Syndrome. As noted above, if not properly diagnosed and treated, Serotonin Syndrome can be fatal.

Switching from Prozac to Lexapro (or switching from Lexapro to Prozac)

There are several reasons why you might consider switching your antidepressant medication. For instance, you may want to switch medications if:

  • You are experiencing side effects that are difficult to tolerate
  • You have been on Prozac or Lexapro at the right dose (determined by you and your doctor or prescribing nurse) for at least 6-8 weeks without seeing noticeable improvement in your symptoms of depression or anxiety
  • You have been on Lexapro or Prozac for a while but no longer feel that your antidepressant medication is as effective as it was initially

 

Switching to another medication could be what is needed to return you to improved symptoms and functioning.

 

However, remember that because Lexapro and Prozac both can cause withdrawal symptoms if you suddenly stop taking them, working with your doctor, prescribing nurse, or Minded provider is essential. Together, you can develop a plan to stop or switch medications carefully and gradually. This can mean slowly lowering (or tapering) the dose of the medication you are on currently and then starting the new medication.

Final thoughts on Lexapro vs Prozac: which is better?

When looking at Lexapro vs Prozac, both are medications worth considering in your depression or anxiety treatment plan. Although they have many similarities, they also have some key differences that give each medication its own pros and cons.

 

Prozac is approved to treat bulimia nervosa, major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), and premenstrual dysphoric disorder (PMDD). It is used off-label for other conditions. Lexapro is approved to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). It is also used to off-label for other conditions.

 

While both medications have been found to be effective in treating the early stages of depression, Lexapro may be more effective for the treatment of severe depression.

 

Lexapro also may appear to be more effective in treating anxiety—because there are not enough studies measuring how effective Prozac is in treating anxiety.

 

Both Lexapro and Prozac have been found to be effective in treating social anxiety and obsessive-compulsive disorder (OCD). 

 

And both medications come with a list of potential side effects to look out for—including weight gain, sexual side effects, and insomnia—although insomnia, in particular, may be more common with Prozac.

 

Your doctor, prescribing nurse, or a Minded professional can help you determine which medication is the better choice for your treatment plan.


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