Trintellix vs. Lexapro: 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

More than 16 million American adults have depression (major depressive disorder), and nearly 7 million adults have a generalized anxiety disorder. Recent events like the COVID-19 pandemic, have been a source of anxiety for many people.

Trintellix (vortioxetine) and Lexapro (escitalopram) are two prescription medications used for depression. Lexapro is also used for anxiety. Both medicines are approved by the United States Food and Drug Administration (FDA).

Trintellix and Lexapro are part of a group of medications called SSRIs (selective serotonin reuptake inhibitors). SSRIs work by increasing serotonin levels in the brain, which helps improve symptoms of depression. Although Trintellix and Lexapro are both SSRIs, they have some differences, which we will outline below.

What are the main differences between Trintellix and Lexapro?

Trintellix (vortioxetine) is an SSRI medication. It is available in brand name only, in tablet form. It can be used in adults only. It has not been studied in children. Trintellix was originally called Brintellix, but the name was changed to avoid confusion with an antiplatelet medicine called Brilinta.

Lexapro (escitalopram) is an SSRI. Lexapro is available in both brand and generic form and as a tablet or oral solution. Lexapro is used in adults and adolescents 12 years and older for depression, or adults 18 years and older for anxiety.

Conditions treated by Trintellix and Lexapro

Trintellix is indicated to treat major depressive disorder (MDD). It is sometimes used off-label for generalized anxiety disorder.

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

RELATED: Trintellix for anxiety

Is Trintellix or Lexapro more effective?

A meta-analysis (an analysis of many studies) published in 2018 evaluated 21 antidepressants. Both Trintellix and Lexapro were found to be more effective than other antidepressants. They were both better tolerated than other antidepressants as well.

A study done by the manufacturer of Trintellix concluded that Trintellix and Lexapro are both effective antidepressants. The study also reported that Trintellix had a higher incidence of certain side effects, such as nausea and itching than Lexapro.

Your healthcare provider can determine the most effective drug for you, taking into consideration your medical conditions and history as well as any drugs you take that can interact with Trintellix or Lexapro.

Coverage and cost comparison of Trintellix vs. Lexapro

Trintellix is covered by most insurance and Medicare Part D plans. However, it is best to check with your plan for specific coverage details. Trintellix is only available in brand name. It can cost more than $500 for #30, 20 mg tablets. You can use a free SingleCare coupon to reduce the price to approximately $350.

Lexapro is usually covered by insurance and Medicare Part D. The generic version usually has a lower copay. The brand-name product usually has a much higher copay or may not be covered at all. Generic Lexapro costs about $70 for #30, 10 mg generic tablets. A SingleCare card can lower the generic price to about $8.

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Common side effects of Trintellix vs. Lexapro

The most common side effect of Trintellix is nausea, which is usually mild to moderate and lasts about two weeks. Other common adverse events include sexual side effects, nausea, constipation, vomiting, diarrhea, dry mouth, and dizziness.

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

With each new or refilled prescription of Trintellix or Lexapro, 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 possible side effects.

*side effects depend on dosage
Source: DailyMed (Trintellix), DailyMed (Lexapro)

Drug interactions of Trintellix vs. Lexapro

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

MAOI (monoamine oxidase inhibitors) interact with Trintellix and Lexapro. Their use must be separated by 14-21 days, depending on the individual treatment plan. The combination of an MAOI with Trintellix or Lexapro may increase the risk of serotonin syndrome, a life-threatening medical emergency due to serotonin buildup.

Triptans used to treat migraines, such as Imitrex (sumatriptan), and other antidepressants, such as Elavil or Cymbalta, should not be used in combination with Trintellix or Lexapro due to the risk of serotonin syndrome. Also, the cough suppressant dextromethorphan—which is found in Robitussin-DM as well as many other cough and cold products—should be avoided as it can also cause serotonin syndrome when combined with Trintellix or Lexapro.

Other drugs that may interact with Trintellix or Lexapro include non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, and anticoagulants (blood thinners), like warfarin. Avoid alcohol when taking Trintellix or Lexapro.

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

Warnings of Trintellix and Lexapro

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

Other warnings include:

• Serotonin syndrome is a serious, life-threatening emergency caused by the buildup of too much serotonin. Patients who take Trintellix or Lexapro should be carefully monitored for signs and symptoms of serotonin syndrome such as hallucinations, seizures, changes in blood pressure, 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.
• 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.
• Avoid SSRIs or use with caution in patients with untreated anatomically narrow angles (angle-closure glaucoma). Trintellix and Lexapro can cause vision problems such as eye pain, vision changes, redness, and swelling. Ask your healthcare provider if you are at risk.
• Hyponatremia (low sodium levels) due to 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 severe cases can occur. Patients should seek emergency treatment if symptoms occur, and discontinue the SSRI.
• When discontinuing Lexapro, withdrawal symptoms such as agitation may occur. Patients should taper off the drug very slowly and never stop abruptly.
• Trintellix can be abruptly tapered if necessary, but the manufacturer recommends a short taper to avoid symptoms like headaches and muscle tension. Your healthcare provider can advise you on the best way to discontinue Trintellix or Lexapro.
• Do not drive or operate machinery until you know how Trintellix or Lexapro affects you.
• Talk to your healthcare provider about using Trintellix or Lexapro if you have a history of seizures.
• In rare cases, there have been reports of rash and allergic reactions/systemic anaphylaxis reactions that have been fatal. If you experience a rash or allergic symptoms, stop taking Trintellix or Lexapro and seek medical treatment immediately.
• Lexapro 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 is safe for you.
• Use Lexapro with caution in patients with kidney problems.

Trintellix or Lexapro 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 Trintellix or Lexapro and find out you are pregnant, contact your healthcare provider immediately.

Frequently asked questions about Trintellix vs. Lexapro

What is Trintellix?

Trintellix is an SSRI, or selective serotonin reuptake inhibitor. It is available in brand name form and is used to treat depression in adults.

What is Lexapro?

Lexapro is an SSRI. Lexapro can treat depression and anxiety. It is available in both brand and generic (escitalopram) form.

Are Trintellix and Lexapro the same?

Trintellix and Lexapro 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), Prozac (fluoxetine), 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 Trintellix or Lexapro better?

See the above section on efficacy—there is very little data comparing Trintellix and Lexapro directly. Studies show that both drugs are effective and similarly tolerated, although both drugs have side effects that can be troublesome for some people, such as nausea or sexual side effects.

Your healthcare provider can determine which drug is better for you, taking your unique circumstances into account. For example, if price is a determining factor, generic Lexapro may be more affordable, and you will be more likely to adhere to the regimen. Or, if sexual side effects are a concern, you may do better with Trintellix, which may have less sexual adverse effects.

Can I use Trintellix or Lexapro while pregnant?

Consult your healthcare provider for advice. He or she will weigh the benefits of taking an antidepressant versus 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 Trintellix or Lexapro 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 Trintellix or Lexapro with alcohol?

No. Trintellix or Lexapro 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 depression.

How is Trintellix different from other antidepressants?

Trintellix acts as an antagonist, agonist, and partial agonist of multiple serotonin receptors to help depression symptoms. Other medications in the SSRI class, like Lexapro, work by increasing serotonin activity in the central nervous system.

Does Trintellix cause weight gain?

Clinical studies showed that Trintellix does not affect weight. There was no difference in weight changes between people who took Trintellix and people who took a placebo (inactive pill). Post-marketing data mentions weight gain but does not state the percent of people who experienced weight gain. Consult your healthcare professional if weight gain is a concern.