Prozac vs. Xanax: 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 conditions that affect your mental health, you are among millions in the United States. Over 16 million American adults have major depressive disorder (MDD), and almost 7 million adults experience generalized anxiety disorder. 

Prozac (fluoxetine) and Xanax (alprazolam) are two popular medications prescribed for mental health conditions. Both medicines are approved by the United States Food and Drug Administration (FDA). Medication use with Prozac or Xanax is often employed along with psychotherapy with a psychologist or psychiatrist.

What are the main differences between Prozac and Xanax?

Prozac (fluoxetine) is part of a group of drugs called selective serotonin reuptake inhibitors (SSRIs). SSRI medications work by increasing levels of the neurotransmitter serotonin in the brain. This helps improve symptoms of depression. 

Prozac is available in both brand and generic formulations. Prozac is available in tablet and capsule form, as well as an oral solution. Although the dosage varies, a typical dose is 20 mg once a day. Prozac can be used in adults for all of the indications listed in the chart below. Prozac can be used in children over 8 years old for depression or over 7 years old for OCD.

Xanax (alprazolam) is in the benzodiazepine class of drugs and works in the CNS (central nervous system). Benzodiazepines work by increasing activity at receptors for a neurotransmitter called gamma-aminobutyric acid (GABA), resulting in a relaxing and calming effect. Because of the potential for abuse and/or psychological or physical dependence, Xanax is a controlled substance and is classified as a Schedule IV drug.

Xanax is available in both brand and generic form. Xanax is available in immediate-release tablets or extended-release tablets and as an oral concentrate.

Conditions treated by Prozac and Xanax

Prozac is indicated to treat major depression and obsessive-compulsive disorder (OCD) in children, adolescents, and adults. Prozac can also be used to treat bulimia nervosa, premenstrual dysphoric disorder, and panic disorder. Prozac is not approved for use in children under 7 years old. 

Note: Symbyax is a combination drug containing the ingredient in Prozac, fluoxetine, along with another medication called olanzapine. Symbyax is used to treat depressive episodes associated with bipolar I disorder and is also used for treatment-resistant depression. 

Xanax is indicated for the short-term relief of anxiety symptoms and the short-term relief of anxiety associated with depressive symptoms. Xanax is also indicated for the treatment of panic disorder, with or without agoraphobia. (Xanax XR is also indicated for panic disorder with or without agoraphobia.)

Sometimes, these drugs may be prescribed off-label for other uses than what they are indicated.

Is Prozac or Xanax more effective?

It is difficult to compare the two drugs. Studies do not compare the two drugs directly. Prozac is commonly used for depression and is used for a longer time, while Xanax is intended to be a short-term treatment for anxiety (although many people take Xanax long-term under their doctor’s supervision). Some patients take both an SSRI and a benzodiazepine to help with anxiety and depression. Although ironically, Prozac and Xanax interact with each other, so a dosage adjustment and close monitoring may be necessary. 

Your healthcare provider can determine which drug will be better for you, based on your symptoms, medical condition(s), and history, and any medications you take that can interact with Prozac or Xanax.

Coverage and cost comparison of Prozac vs. Xanax

Most insurance and Medicare prescription plans cover Prozac or Xanax—choosing the generic form will result in significant cost savings. The brand-name products have a much higher copay or may not be covered at all. 

The out-of-pocket cost for generic Prozac can run $25 to $50 for 30, 20 mg generic capsules. You can save money on generic Prozac with a SingleCare card, which can lower the price to $4 at participating pharmacies.

Xanax is typically covered by private insurance and Medicare prescription plans in the generic form of alprazolam. The brand-name Xanax may not be covered or may have a high copay. A typical prescription of alprazolam would be for 60 tablets of 0.5 mg and costs about $35 out-of-pocket. Using a SingleCare card for generic Xanax can bring the price down to as low as $13.

Contact your insurance plan for up-to-date coverage information on Prozac or Xanax. 

Get the SingleCare prescription discount card

Common side effects of Prozac vs. Xanax

The most common side effects of Prozac are headache, nausea, drowsiness, insomnia, appetite loss, sexual side effects, and nervousness or anxiety. 

Xanax side effects usually increase with higher doses. The most common side effects of Xanax are sedation, dizziness, and weakness. Other side effects may include fatigue, lightheadedness, memory problems, confusion, depression, euphoria, suicidal thoughts/attempt, incoordination, lack of energy, dry mouth, convulsions/seizures, vertigo, visual problems, slurred speech, sexual problems, headache, coma, respiratory depression, weight gain or weight loss, worsening of sleep apnea or obstructive pulmonary disease, and gastrointestinal symptoms including nausea, constipation, or diarrhea. 

Each time you fill or refill your Prozac or Xanax prescription, you will receive a medication guide that discusses side effects, warnings, and other important information about your medication. 

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

Source: DailyMed (Prozac), DailyMed (Xanax)

Drug interactions of Prozac vs. Xanax

Do not use an MAO inhibitor (MAOI, or monoamine oxidase inhibitor) within 14 days of Prozac. The combination may increase the risk of serotonin syndrome, a life-threatening medical emergency due to excess serotonin. Triptans—migraine medications, such as Imitrex (sumatriptan), and other antidepressants, such as Elavil or Cymbalta, should not be used in combination with Prozac due to the risk of serotonin syndrome. Also, the cough suppressant dextromethorphan, which is found in Robitussin-DM and many other cough and cold products, should be avoided as it can also cause serotonin syndrome when combined with Prozac. 

Xanax should not be taken in combination with opioid painkillers due to increased risk of sedation, respiratory depression, and overdose, possibly leading to death. If no other combination is possible, the patient should receive each medication at the lowest possible dose and for the shortest duration and be closely monitored. Benzodiazepines also should not be taken with other CNS depressants such as alcohol, antipsychotics, antidepressants, sedating antihistamines, and anticonvulsants.

Avoid alcohol when taking Prozac or Xanax. 

This is not a full list of drug interactions. Consult your healthcare provider for a complete list of drug interactions. Tell your doctor about all the medications you take, including prescription, over-the-counter (OTC), and vitamins. 

Warnings of Prozac and Xanax

Prozac

SSRIs, including Prozac, have a black box warning of suicidality. A black box warning is the strongest warning required by the FDA. Children, adolescents, and young adults (up to 24 years old) taking antidepressants are at an increased risk of suicidal thoughts and behavior. Anyone who takes antidepressants should be carefully monitored.

Other Prozac warnings:

• Serotonin syndrome is a life-threatening emergency caused by too much serotonin. Patients taking Prozac should be monitored for signs and symptoms of serotonin syndrome—such as hallucinations, seizures, heart rhythm or blood pressure changes, and agitation. Seek emergency medical treatment if any of these symptoms occur. Taking other drugs that increase serotonin levels (triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, dextromethorphan, amphetamines, St. John’s Wort, and MAOIs) increase the risk of serotonin syndrome. 
• When discontinuing Prozac, withdrawal symptoms such as agitation may occur. Your healthcare provider can advise you on the best way to discontinue Prozac, with a slow taper schedule. Never stop Prozac abruptly. 
• Use with caution in patients who have seizures.
• Hyponatremia (low sodium) due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) may occur and can be severe. Symptoms may include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. Seek emergency treatment and stop Prozac if symptoms occur.
• Avoid SSRIs in patients with untreated anatomically narrow angles (angle-closure glaucoma).
• SSRIs may increase bleeding risk—this risk increases with concomitant use of aspirin, NSAIDs, or warfarin.
• Do not drive or operate machinery until you know how 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 have been fatal. If you experience a rash or allergic symptoms, stop taking Prozac and seek immediate medical treatment. 
• Prozac may cause QT prolongation and ventricular arrhythmia, which can be life-threatening. Certain patients are at higher risk due to medical conditions or other medications. Ask your healthcare provider if Prozac is safe for you. 
• 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. However, neonates exposed to SSRIs in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Your healthcare provider can weigh the risk versus benefits of using an SSRI during pregnancy. If you already take Prozac and find out you are pregnant, contact your healthcare provider immediately for guidance. 

Xanax

• Xanax also has a boxed warning. Xanax should not be taken with opioid pain relievers because of an increased risk of extreme sedation, severe respiratory depression, coma, or death. If the combination of a benzodiazepine and opioid cannot be avoided, the patient should be prescribed the lowest dose for the shortest period of time and must be closely monitored. Patients should not drive or operate machinery until effects are known.
• Xanax may cause dependence—the risk increases with higher doses, longer duration of use, and/or a history of drug or alcohol abuse. If you take Xanax, take only as prescribed—do not take additional doses. 
• Keep Xanax out of the reach of children and others. Keep under lock and key if possible. 
• Xanax is for short-term treatment. When discontinuing Xanax, taper slowly to avoid withdrawal symptoms. Patients with seizure disorders are at higher risk for withdrawal symptoms. Your prescriber can provide a tapering schedule.
• There is a risk of suicide in patients with depression. Patients with depression should also be treated with an antidepressant and should be closely monitored.
• Use with caution in patients with breathing problems such as COPD or sleep apnea.
• Use with caution and/or use lower doses in patients with severe liver problems.
• Xanax should not be used in pregnancy because of the risk to the fetus. If you are taking Xanax and find out that you are pregnant, consult your doctor immediately.

Prozac and Xanax are on the Beers’ List (drugs that may be inappropriate in older adults). Consult your healthcare provider to see if Prozac or Xanax is safe for you. 

Frequently asked questions about Prozac vs. Xanax

What is Prozac?

Prozac, also known by its generic name, fluoxetine, is an SSRI or selective serotonin reuptake inhibitor. Prozac treats depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder, and panic disorder. Prozac is available in both brand and generic form. 

What is Xanax?

Xanax, also known by its generic name, alprazolam, is a benzodiazepine drug that treats anxiety and panic disorder. Xanax is a controlled substance due to its potential for abuse and dependence.

Are Prozac and Xanax the same?

No. While people may mention these drugs together, they are actually quite different. They are in different categories of medication, work in different ways, and have different dosing, indications, and side effects. 

Prozac is an SSRI. Other SSRI drugs you may have heard of include Celexa (citalopram), Lexapro (escitalopram), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline). 

Xanax is a benzodiazepine. Some other benzodiazepines you may have heard of include Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam). 

Is Prozac or Xanax better?

Because each drug is used for different purposes, the drugs are not compared in clinical studies. The best drug for you can be determined by your healthcare provider, who can take into account your symptoms, medical conditions, history, and other medications you take that could possibly interact with Prozac or Xanax. 

Can I use Prozac or Xanax while pregnant?

Neonates exposed to certain antidepressants, including SSRIs like Prozac, in the third trimester of pregnancy, have developed serious complications. 

Xanax may cause fetal abnormalities and should not be used during pregnancy. 

If you are already taking Prozac or Xanax and find out that you are pregnant, consult your healthcare provider. If you are breastfeeding, consult your OB/GYN as well. 

Can I use Prozac or Xanax with alcohol?

No. Prozac or Xanax should not be combined with alcohol. The combination may increase the risk of respiratory depression—slowed breathing, not getting enough oxygen—and increase sedation and drowsiness and impair alertness. 

Is Prozac good for anxiety?

Prozac is commonly used to treat depression and panic disorder, which is a type of anxiety disorder. However, some people who take Prozac do experience anxiety as a side effect. Because of the risk of suicidal thoughts or behavior, your healthcare provider will monitor you closely while on Prozac. If you experience anxiety or any other mood or personality changes, notify your doctor right away. 

Can Prozac cause weight gain?

Prozac can affect weight, but usually causes a decrease in appetite and weight loss rather than a weight gain. Your doctor will monitor your weight during treatment with Prozac. 

Does Prozac change your personality?

The prescribing information for Prozac states that in studies, greater than 2% of patients experienced a personality disorder while taking Prozac. However, most people tolerate Prozac very well. Consult your healthcare provider for personalized medical advice.