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

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

If you experience depression, anxiety, or other psychological conditions that affect your mental health, you are not alone. More than 17 million American adults have major depressive disorder, and almost 7 million adults have a generalized anxiety disorder. Even dealing with the stress of coronavirus (COVID-19) is a big source of anxiety for many people.

Lexapro (escitalopram) and Prozac (fluoxetine) are two medications used for depression and other psychological disorders. Both antidepressant medications are approved by the U.S. Food and Drug Administration (FDA). They are part of a group of medications called SSRIs (selective serotonin reuptake inhibitors). SSRIs work by increasing serotonin levels in the brain, which thereby helps improve symptoms of depression. Although both medications are SSRI antidepressants, they have some differences, which we discuss below.

What are the main differences between Lexapro and Prozac?

Lexapro (escitalopram) is an SSRI (selective serotonin reuptake inhibitor). It is available in brand and generic form and as a tablet or an oral solution. The typical dose is 10 mg or 20 mg once a day.

Prozac (fluoxetine) is an SSRI and is available in brand and generic. Prozac is available in tablet and capsule form as well as an oral solution. The dose varies, but a common dose is 20 mg once a day.

Conditions treated by Lexapro and Prozac

Lexapro is indicated to treat MDD, or major depressive disorder (in adults and adolescents ages 12-17 years). Lexapro is also indicated for the treatment of generalized anxiety disorder in adults.

Prozac is indicated for major depressive disorder and obsessive compulsive disorder in children, adolescents, and adults. Prozac is not approved for use in children under 7 years old. Prozac is also used to treat bulimia nervosa, premenstrual dysphoric disorder, and panic disorder. Symbyax (which is a combination drug containing the ingredient in Prozac, fluoxetine, along with another drug called olanzapine) is used to treat depressive episodes associated with bipolar I disorder and is also used for treatment-resistant depression.

Is Lexapro or Prozac more effective?

One study looked at Lexapro in combination with many other antidepressants. When comparing Lexapro to Prozac, the authors found both drugs to be similarly effective.

Another study, which was a review of many studies, compared antidepressants and initially found Lexapro to possibly be more effective and better tolerated than other antidepressants. However, when the authors looked at head-to-head studies and considered all of the data, they found few differences between antidepressants.

Antidepressants take a few weeks to reach their full effect, so when taking an antidepressant, it is important to give it some time to work. The most effective drug for you can only be determined by your healthcare provider, who can look at your medical history and condition(s), as well as any other medications you take that could potentially interact with Lexapro or Prozac. Sometimes it takes a bit of trial and error to find the drug that works best for you.

Coverage and cost comparison of Lexapro vs. Prozac

Lexapro is generally covered by insurance and Medicare Part D. The generic version usually has a much lower copay, whereas the brand-name version usually has a much higher copay or may not be covered at all. Lexapro costs about $379 for 30, 10 mg brand-name tablets or $70 for 30, 10 mg generic tablets. You can get generic Lexapro for as little as $15 with a SingleCare card at participating pharmacies.

Prozac is also generally covered by insurance and Medicare Part D; choosing generic will save a great deal of money. The brand generally has a much higher copay or may not be covered. Prozac costs about $600 for 30, 20 mg brand name capsules, or over $30 for 30, 20 mg generic capsules. You can buy generic Prozac starting at $4 at certain pharmacies that accept SingleCare coupons.

Common side effects of Lexapro vs. Prozac

The most common side effects of Lexapro are headaches, nausea, sexual problems, drowsiness, and insomnia.

The most common side effects of Prozac are headaches, nausea, drowsiness, insomnia, loss of appetite, and nervousness/anxiety.

With each new or refilled prescription of Lexapro or Prozac, you will receive a medication guide that discusses side effects, warnings, and other important information.

This is not a full list of side effects. Other adverse effects may occur. Consult your healthcare provider for a full list of side effects.

Source: DailyMed (Lexapro), DailyMed (Prozac)

Drug interactions of Lexapro vs. Prozac

Because both drugs are in the same category, they have similar drug interactions.

MAOIs (monoamine oxidase inhibitors) should not be used within 14 days of Lexapro or Prozac. The combination may increase the risk of serotonin syndrome, a life-threatening medical emergency due to a buildup of serotonin. Triptans used to treat migraines, such as Imitrex (sumatriptan), as well as other antidepressants, such as Elavil or Cymbalta, should not be used in combination with Lexapro or Prozac due to the risk of serotonin syndrome. Also, the cough suppressant dextromethorphan—which is found in Robitussin-DM as well as a number of other cough and cold products—should be avoided as it can also cause serotonin syndrome when combined with Lexapro or Prozac.

Other drugs that may interact with Lexapro or Prozac include macrolide antibiotics such as Zithromax, NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, or painkillers such as Ultram (tramadol). Alcohol should be avoided when taking Lexapro or Prozac.

This is not a full list of drug interactions. Consult your healthcare provider for a full list of drug interactions.

Warnings of Lexapro and Prozac

All SSRIs, including Lexapro and Prozac, have a boxed warning of suicidality. Children, adolescents, and young adults (up to 24 years old) who take antidepressants have an increased risk of suicidal thoughts and behavior. All patients on antidepressants should be carefully monitored.

Other warnings include:

• Serotonin syndrome is a serious, life-threatening emergency that is caused by the buildup of too much serotonin. Patients who take Lexapro or Prozac should be carefully monitored for signs and symptoms of serotonin syndrome such as hallucinations, seizures, and agitation. Patients should seek emergency medical treatment if any of these symptoms occur. Patients who take other drugs that increase serotonin levels (triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, dextromethorphan, amphetamines, St. John’s wort, and MAOIs) are at higher risk for serotonin syndrome.
• When discontinuing Lexapro or Prozac, withdrawal symptoms such as agitation may occur. Patients should taper off the drug very slowly and never stop abruptly. Your healthcare provider can advise you on the best way to discontinue Lexapro or Prozac.
• In patients who have seizures, Lexapro or Prozac should be used with caution.
• Hyponatremia (low sodium) due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) may occur. Patients may experience headaches, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. More serious cases can occur. Patients should seek emergency treatment if symptoms occur, and the SSRI should be stopped.
• SSRIs should be avoided in patients with untreated anatomically narrow angles (angle-closure glaucoma).
• SSRIs may increase bleeding risk. The risk increases with concomitant use of aspirin, NSAIDs, or warfarin.
• Activation of mania or hypomania may occur. In patients with bipolar disorder, an antidepressant may precipitate a mixed/manic episode.
• Do not drive or operate machinery until you know how Lexapro or Prozac affects you.
• Use with caution in patients with kidney problems.
• In rare cases, there have been reports of rash and allergic reactions/systemic anaphylaxis reactions, which can be fatal. If you experience a rash or allergic symptoms, stop taking Lexapro or Prozac and seek medical treatment immediately.
• SSRIs may cause significant weight loss, especially in underweight depressed patients or bulimic patients, more commonly with Prozac. Changes in weight should be monitored during treatment.
• Lexapro or Prozac may cause QT prolongation and ventricular arrhythmia. Certain patients are at higher risk due to medical conditions or other medications. Ask your healthcare provider if Lexapro or Prozac is safe for you.
• Prozac may cause anxiety, nervousness, or insomnia.

Lexapro or Prozac should only be used in pregnancy if the benefit to the mother is greater than the risk to the baby. Stopping the medication may cause a relapse of depression or anxiety. Therefore, patients should be evaluated on a case-by-case basis. Your healthcare provider can weigh the risk versus benefits of using an SSRI during pregnancy. Neonates exposed to SSRIs in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. If you are already on Lexapro or Prozac and find out you are pregnant, contact your healthcare provider immediately.

Frequently asked questions about Lexapro vs. Prozac

What is Lexapro?

Lexapro is an SSRI (selective serotonin reuptake inhibitor) that is used for depression and anxiety. It is available in both brand and generic (escitalopram).

What is Prozac?

Prozac is an SSRI that treats depression, obsessive compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder, and panic disorder. Its generic name is fluoxetine. Prozac is available in brand and generic.

Are Lexapro and Prozac the same?

Lexapro and Prozac are both in the SSRI category of prescription drugs. They are similar, but not exactly the same. They have some differences, as outlined above. Other SSRI drugs you may have heard of include Celexa (citalopram), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline).

Another class of drugs you may have heard of is the SNRI class of drugs, which includes Cymbalta (duloxetine), Effexor (venlafaxine), and Pristiq (desvenlafaxine).

Is Lexapro or Prozac better?

Studies (see above) show Lexapro and Prozac to be similarly effective. Consult your healthcare provider, who can help you determine if Lexapro or Prozac may be a better choice for you.

Can I use Lexapro or Prozac while pregnant?

It depends—consult your healthcare provider for advice. He or she will weigh the benefits of taking an antidepressant vs. the risk to the baby. Neonates exposed to certain antidepressants, including SSRIs, in the third trimester of pregnancy, have developed complications.

If you are already on Lexapro or Prozac and find out that you are pregnant, consult your OB-GYN immediately for advice. If you are breastfeeding, consult your OB-GYN as well.

Can I use Lexapro or Prozac with alcohol?

No. Lexapro or Prozac should not be taken with alcohol, because the combination may increase the risk of respiratory depression (slowed breathing, not getting enough oxygen) and increase sedation and drowsiness and impair alertness. The combination can also worsen anxiety and/or depression.

Which is the best SSRI for anxiety?

While benzodiazepines such as Xanax (alprazolam) are often used in the short-term treatment of anxiety, SSRIs are often prescribed as a longer-term treatment for anxiety. The best SSRI for anxiety, though, is the one that works best for you. Ask your healthcare provider if an SSRI will help treat your anxiety.

Is Prozac good for anxiety?

Indicated for depression and other conditions, Prozac is sometimes prescribed off-label for anxiety. In clinical studies, 12% to 13% of patients taking Prozac experienced nervousness or anxiety. Consult your healthcare provider for medical advice.

Can Prozac make you jittery?

Prozac can have some side effects on the nervous system such as insomnia, tremor, anxiety, or nervousness, which could make you feel jittery. However, feeling symptoms of tremor, fast heartbeat, or agitation could possibly be signs of serotonin syndrome (see above for warnings). If you notice changes in mental status or coordination, changes in heart rate or blood pressure, and/or GI (gastrointestinal) symptoms such as diarrhea, this could possibly be serotonin syndrome. It can be life-threatening, so seek emergency medical attention.

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• Zoloft vs. Prozac
• Paxil vs. Prozac
• Lexapro vs. Xanax