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

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

Cymbalta and Lexapro are two prescription drugs most commonly used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). Major depressive disorder is estimated to affect over 17 million people in the U.S. Depression may manifest differently in men and women. Men tend to express irritation and anger, and they are often tired. Women may express sadness, guilt, or loss of purpose. Some patients experience pain without any known cause. Anxiety is the most common mental disorder in the U.S., affecting over 40 million U.S. adults. Fortunately, there are a variety of treatment options for both depression and anxiety.

While Cymbalta and Lexapro are two great options to treat depression and anxiety, there are some significant differences between the two medications.

Main differences between Cymbalta and Lexapro
	Cymbalta	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? Or What is the brand 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

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 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 for the treatment of MDD and GAD. It 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, effectively leaving 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 and as an oral solution in a 5 mg/5 ml concentration.

Conditions treated by Cymbalta and Lexapro

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 for 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
Migraine prophylaxis	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
Social anxiety disorder	No	Off-label
Irritability associated with autistic 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 is important when choosing a therapy. 

Coverage and cost comparison of Cymbalta vs. Lexapro

Cymbalta is a prescription medication typically covered by commercial and Medicare drug plans. The out-of-pocket price for one month of Cymbalta 60 mg can be more than $360, but with a coupon from SingleCare, you could get the generic for as low as $14 at participating pharmacies.

Lexapro is also a prescription medication 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 $554. SingleCare offers a coupon for generic Lexapro, which can lower the price to $8 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	$14+	$8+

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 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, healthcare provider, 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 P450 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	Aminoquinoline/ 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 norepinephrine/serotonin reuptake inhibitors (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 at least two weeks to notice any change in most patients and up to four to six weeks to realize the medication’s full effect. 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 condition is related to abnormally high levels of serotonin and can result in the patient feeling agitated, dizzy, and having an increased heart rate. It 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

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.

What is the safest way to switch from Cymbalta to Lexapro?

There are a few different strategies when switching from one type of antidepressant medication to another. Most strategies combine a slow step down of the first drug over approximately 4 weeks and then starting the new drug and tapering up from the starting dose. There may be a break of a few days or even a week between the 2 drugs, or your prescriber may jump right over to the new drug. There is no single correct way to transition from one drug to another, but whichever method your healthcare provider chooses, keep an open dialogue about symptoms and side effects as you see how the new drug works for you.

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 on 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.