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Drug vs. Drug

Cymbalta vs. Lexapro: Differences, similarities, and which is better for you

Kristi Torres writer headshot By | Updated on June 18, 2020

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Cymbalta and Lexapro are two prescription drugs most commonly used to treat both major depressive disorder (MDD) and generalized anxiety disorder (GAD). Major depressive disorder is estimated to affect approximately 16 million adults in the United States. It is characterized by a low mood for at least a two-week period. Patients may also exhibit a loss of interest in activities they normally enjoy or low energy. Some patients experience pain without any known cause.

Generalized anxiety disorder is estimated to affect 6.8 million adults in the United States. It is characterized by excessive worry about a variety of issues including money, family, health, and work. It is diagnosed once patients display this worry on more days than not for at least six months.

While Cymbalta and Lexapro are both used to treat these conditions and many others, there are some significant differences between the two medications.

What are the main differences between Cymbalta and Lexapro?

Cymbalta (duloxetine) is a prescription medication indicated in the treatment of both MDD and GAD. Cymbalta belongs to a group of antidepressants known as selective serotonin-norepinephrine reuptake inhibitors (SNRIs). In the neuron synapse, Cymbalta blocks the reuptake of both norepinephrine and serotonin. This leaves the neurotransmitters more readily available to play a positive role on mood and affect. Other SNRIs you may be familiar with are Effexor (venlafaxine) and Pristiq (desvenlafaxine).

Cymbalta is available as a 20 mg, 30 mg, and 60 mg oral capsule.

Lexapro (escitalopram) is also a prescription medication indicated in the treatment of both MDD and GAD. Lexapro belongs to the group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Lexapro works by blocking the reuptake of serotonin at the neuronal membrane transport pump. This action effectively leaves more free serotonin in the neuron synapse. Other SSRIs you may be familiar with include Prozac, Zoloft, Celexa, or Paxil.

Lexapro is available as an oral tablet in strengths of 5 mg, 10 mg, and 20 mg. It is also available as an oral solution in a 5 mg/5 ml concentration.

Main differences between Cymbalta and Lexapro
Lexapro Lexapro
Drug class Selective serotonin-norepinephrine reuptake inhibitor Selective serotonin reuptake inhibitor
Brand/generic status Brand and generic available Brand and generic available
What is the generic name? Duloxetine Escitalopram
What form(s) does the drug come in? Oral capsule Oral tablet and oral solution
What is the standard dosage? 60 mg once per day 10 mg once per day
How long is the typical treatment? Long-term (months to years) Long-term (months to years)
Who typically uses the medication? Adolescents and adults Adolescents and adults

Conditions treated by Cymbalta and Lexapro

As previously mentioned, Cymbalta and Lexapro are both indicated to treat both major depressive disorder and generalized anxiety disorder. Cymbalta is approved for some unique indications related to neuropathic and musculoskeletal pain. These indications set Cymbalta apart from other antidepressant medications as it is the only one approved in pain-related diagnoses. Lexapro is sometimes used off-label for conditions such as obsessive compulsive disorder, bulimia nervosa, and binge eating.

The following chart provides a list of conditions treated by Cymbalta and Lexapro. It may not include all potential uses, and you should always consult with your healthcare professional to see if one of these drugs is right for you.

Condition Cymbalta Lexapro
Major depressive disorder Yes Yes
Generalized anxiety disorder Yes Yes
Fibromyalgia Yes No
Chronic musculoskeletal pain Yes No
Neuropathic pain associated with diabetes mellitus Yes No
Chemotherapy-induced peripheral neuropathy Off-label No
Stress urinary incontinence (men) Off-label No
Binge eating disorder No Off-label
Bulimia nervosa No Off-label
Obsessive compulsive disorder No Off-label
Panic disorder No Off-label
Posttraumatic stress disorder No Off-label
Premenstrual dysphoric disorder No Off-label
Premature ejaculation No Off-label

Is Cymbalta or Lexapro more effective?

A meta-analysis reviewed studies comparing duloxetine to escitalopram and other common SSRIs. The study found that in terms of the treatment of major depression, duloxetine fails to show a significant advantage in terms of treatment success over SSRIs. However, according to this review, patients are more likely to discontinue duloxetine due to adverse events. A second meta-analysis echoed these findings. It may not be possible to say if Cymbalta or Lexapro are better than the other in terms of treating depression. The increased rate of side effects with Cymbalta would be an important factor to consider when choosing a therapy.

Coverage and cost comparison of Cymbalta vs. Lexapro

Cymbalta is a prescription medication that is typically covered by both commercial and Medicare drug plans. The out-of-pocket price for Cymbalta 60 mg can be more than $300, but with a coupon from SingleCare, you could get the generic for as low as $15 at participating pharmacies.

Lexapro is also a prescription medication that is typically covered by both commercial and Medicare drug plans. The out-of-pocket price for a 30 day supply of Lexapro 10 mg can be as much as $400. SingleCare offers a coupon for generic Lexapro, which can lower the price to $10 or less.

Cymbalta Lexapro
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage 30, 60 mg capsules 30, 10 mg tablets
Typical Medicare copay Less than $10 Less than $10
SingleCare cost $15+ $10+

Common side effects of Cymbalta vs. Lexapro

Cymbalta and Lexapro have the potential to cause similar side effects, though some are more likely with one or the other agent. Nausea, for example, was only reported in 5% of patients taking Lexapro in clinical trials versus 23% of patients taking Cymbalta. While the nausea is not always a long-lasting side effect, it can impact a person’s quality of life. It is more likely to happen in the first few weeks of therapy, and given that these drugs generally take anywhere from two to six weeks to show an impact on depression or anxiety symptoms, nausea could be a reason for early discontinuation before the true benefit of the drug is known.

Perspiration, or sweating, occurs at a similar rate between the two drugs. This side effect may also impact a person’s daily life and self-esteem, and it could be a reason patients choose to discontinue the drug.

The following list is not intended to be a complete list of adverse events. Please consult a pharmacist, doctor, or another medical professional for a complete list of possible side effects.

Cymbalta Lexapro
Side effect Applicable? Frequency Applicable? Frequency
Nausea Yes 23% Yes 5%
Dry mouth Yes 13% Yes 5%
Sweating Yes 6% Yes 5%
Diarrhea Yes 9% Yes 8%
Constipation Yes 9% Yes 3%
Dyspepsia No n/a Yes 3%
Dizziness Yes 9% No n/a
Somnolence Yes 10% Yes 6%
Headache Yes 14% No n/a
Increased blood pressure Yes 2% No n/a
Decreased appetite Yes 7% Yes 3%
Decreased libido No n/a Yes 2%

Source: Cymbalta (DailyMed) Lexapro (DailyMed)

Drug interactions of Cymbalta vs. Lexapro

Cymbalta and Lexapro are each metabolized by the cytochrome enzyme system in the liver. Cymbalta is a major substrate for CYP1A2, and a moderate inhibitor of CYP2D6. It is important to note that some patients may suffer from attention disorders in addition to depression and anxiety disorders. Many patients with attention disorders are treated with amphetamines. Cymbalta can increase the serum concentration of amphetamines through its inhibition of CYP2D6. Patients taking this combination should be monitored closely.

Lexapro is a major substrate of CYP2C19 and CYP3A4, and a weak inhibitor of CYP2D6.

The use of Lexapro with tricyclic antidepressants, such as amitriptyline, may increase the risk of QT prolongation and serotonin syndrome. In general, this combination should be avoided.

The following list is not intended to be a complete list of drug interactions. It is best to consult your provider or pharmacist for a complete list.

Drug Drug class Cymbalta Lexapro
Acalabrutinib
Dabrafenib
Erdafitinib
Gilteritinib
Ibrutinib
Antineoplastics Yes Yes
Almotriptan
Eletriptan
Oxitriptan
5HT Agonist/Triptans (antimigraine agents) Yes Yes
Amphetamine salts
Dexmethylphenidate
Methylphenidate
Amphetamines Yes Yes
Alosetron
Ondansetron
Ramosetron
5HT3 Antagonists
(anti-nausea agents)
No Yes
Apixaban
Edoxaban
Antiplatelets Yes Yes
Aripiprazole Antipsychotic Yes Yes
Aspirin
Ibuprofen
Naproxen
Diclofenac
Nonsteroidal anti-inflammatory drugs (NSAIDs) Yes Yes
Bemiparin
Enoxaparin
Heparin
Anticoagulants No Yes
Bupropion Dopamine/norepinephrine reuptake inhibitor No Yes
Buspirone Antianxiety Yes Yes
Carbamazepine Anticonvulsant No Yes
Enzalutamide Chemotherapy
agent
No Yes
Esomeprazole
Omeprazole
Proton pump inhibitor No Yes
Fluconazole Antifungal No Yes
Fluoxetine
Duloxetine
Paroxetine
Sertraline
SSRIs Yes Yes
Hydroxychloroquine Aminoquinolone/Antimalarial No Yes
Linezolid Antibiotic Yes Yes
Metaxalone Muscle relaxers Yes Yes
Pimozide Antipsychotic No Yes
Selegiline
Phenelzine
Rasagiline
Monoamine oxidase inhibitor (MAOI) Yes Yes
St. John’s Wort Herbal supplement Yes Yes
Hydrochlorothiazide
Chlorthalidone
Metolazone
Thiazide diuretics No Yes
Tramadol Opiate pain reliever Yes Yes
Amitriptyline
Clomipramine
Doxepin
Nortriptyline
Tricyclic antidepressants Yes Yes
Venlafaxine Selective norepinephrin/serotonin reuptake inhibitor (SNRIs) Yes Yes

Warnings of Cymbalta and Lexapro

Cymbalta and Lexapro will not produce an immediate remission of symptoms of either depression disorder or anxiety disorder. It will take a minimum of two weeks to notice any change in most post patients, and up to four to six weeks to realize the full effect of the medication. It is important patients understand this so they do not prematurely discontinue their medication with the belief that it is not working.

Patients with MDD may experience a worsening of depression or suicidal thoughts whether or not they are taking antidepressant medications. These conditions may worsen until remission is achieved. Cymbalta and Lexapro therapy may increase suicidal ideation and thoughts among teens and young adults, especially in the early stages of treatment before any type of remission is achieved. These patients must be monitored closely if this treatment is deemed medically necessary. A therapy change may be necessary if symptoms suddenly arise or get worse.

There have been reports of liver failure, sometimes fatal, with Cymbalta. These cases may present with abdominal pain and elevated liver enzymes with or without jaundice. The consumption of alcohol may increase this risk, and therefore this combination should be avoided.

Serotonin syndrome has been reported with all SSRIs and SNRIs, including Cymbalta and  Lexapro. This is a condition related to abnormally high levels of serotonin and can result in the patient feeling agitated, dizzy, and having an increased heart rate. This can be brought on by the use of two serotonergic drugs together. It is important to refer to the manufacturer’s information on drug interactions when prescribing these drugs.

Frequently asked questions about Cymbalta vs. Lexapro

What is Cymbalta?

Cymbalta is a prescription antidepressant medication used in the treatment of major depression, generalized anxiety disorder, and various neuropathic and musculoskeletal pain disorders. Cymbalta is available as an oral capsule in 20 mg, 30 mg, and 60 mg strengths.

What is Lexapro?

Lexapro is a prescription antidepressant medication used in the treatment of major depression and generalized anxiety disorder.  Lexapro is available as an oral tablet in 5 mg, 10 mg, and 20 mg strengths. It is also available as an oral solution.

Are Cymbalta and Lexapro the same?

While both Cymbalta and Lexapro treat depression and anxiety, they are not the same. Cymbalta blocks the reuptake of both serotonin and norepinephrine in the neuronal synapse, while Lexapro blocks serotonin reuptake only. Cymbalta carries additional indications for pain disorders.

Is Cymbalta or Lexapro better?

Cymbalta and Lexapro appear to be similarly effective in treating depression. Large meta-analyses of multiple studies indicate that the higher rate of adverse events with Cymbalta may be a reason to try Lexapro first in most patients.

Can I use Cymbalta or Lexapro while pregnant?

The Food and Drug Administration (FDA) considers both Cymbalta and Lexapro pregnancy category C, meaning there have not been adequate human studies to determine safety. With Cymbalta, non-teratogenic effects have been observed in newborns following the administration of Cymbalta while pregnant. These include respiratory distress, feeding difficulty, and tremors. With Lexapro use, animal studies have shown teratogenic effects to the fetus, including cardiovascular effects, and it has been determined that it crosses the human placenta. For these reasons, the use of Cymbalta or Lexapro in pregnancy must be weighed against potential harm to the fetus.

Can I use Cymbalta or Lexapro with alcohol?

Alcohol can increase the toxic effects of both Cymbalta and Lexapro. Drinking alcohol while taking these drugs can cause significant psychomotor impairment, and for this reason, patients are advised to avoid alcohol if taking Cymbalta or Lexapro. As previously discussed, alcohol consumption while on Cymbalta increases the likelihood of hepatic failure.

Does Cymbalta help with anxiety?

Cymbalta is approved in the treatment of generalized anxiety disorder. Patients should be educated that the drug will not provide immediate remission of anxiety symptoms, and some patients may need additional medication for acute anxiety episodes.

Does Cymbalta make you happy?

Cymbalta works by increasing available norepinephrine and serotonin. These neurotransmitters play a significant role in mood or affect. Patients who take Cymbalta may report feeling “happier” or less depressed, especially after four to six weeks of treatment.

Does Cymbalta change your personality?

Cymbalta will affect mood by increasing available norepinephrine and serotonin. For most patients, this induces a positive change in their mental health. If you notice a negative change in yourself or someone you care for while taking Cymbalta, including suicidal thoughts or ideations, seek help immediately.