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

In this article:

• What are the main differences between Effexor and Lexapro?
• Conditions treated
• Efficacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• What are the main differences between Effexor and Lexapro?
• Conditions treated
• Efficacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

Effexor and Lexapro are both prescription-only medications used in the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD). Symptoms of depression may include low mood for at least a two-week period and loss of interest in normal activities. Generalized anxiety disorder is characterized by excessive worry about a variety of issues including money, health, family, and work occurring more days than not for the past six months. Both MDD and GAD affect millions of Americans, and adequate treatment is important for quality of life. Treatment of depression or anxiety may include increased physical activity, meditation, or psychotherapy. Some cases will require medication for effective treatment.

What are the main differences between Effexor and Lexapro?

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

Effexor is available in the generic form venlafaxine as immediate-release tablets in strengths of 25 mg, 37.5 mg, 50 mg, 75 mg, and 100mg. It is also available as both a generic and as the branded drug Effexor XR in extended-release tablets and capsules in strengths of 37.5 mg, 75 mg, and 150 mg. The extended-release tablet also comes in a 225 mg strength.

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) and works by blocking the reuptake of serotonin at the neuronal membrane transport pump. This action leaves more free serotonin in the neuron synapse, and higher serotonin levels are associated with a better mood. Other SSRIs you may be familiar with include Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), and Paxil (paroxetine).

Lexapro is available as both the branded form and the generic form escitalopram 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.

Related: What is Effexor | What is Lexapro

Main differences between Effexor and Lexapro
	Effexor	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?	Venlafaxine	Escitalopram
What form(s) does the drug come in?	Immediate-release tablet and extended-release capsule and tablet	Tablet and oral solution
What is the standard dosage?	75 mg extended release once per day or 75 mg immediate release administered in two or three divided doses	10 mg once per day
How long is the typical treatment?	Indefinite	Indefinite
Who typically uses the medication?	Adolescents and adults	Adolescents and adults

Conditions treated by Effexor and Lexapro

Effexor and Lexapro are both indicated in the treatment of major depressive disorder and generalized anxiety disorder. Effexor also carries indications for both social phobia and panic disorder. There are some off-label uses of both drugs as well. Off-label use is the utilization of a drug for an indication not approved by the Food and Drug Administration (FDA). Effexor has been used without FDA approval for obsessive-compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), and hot flashes related to menopause. Lexapro is sometimes used off-label for conditions such as OCD, bulimia nervosa, and binge eating.

The following chart provides a list of conditions treated by Effexor 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	Effexor	Lexapro
Major depressive disorder	Yes	Yes
Generalized anxiety disorder	Yes	Yes
Social phobia	Yes	No
Panic disorder	Yes	Off-label
Obsessive-compulsive disorder	Off-label	Off-label
Premenstrual dysphoric disorder	Off-label	Off-label
Hot flashes due to menopause	Off-label	No
Bulimia nervosa	No	Off-label
Binge eating	No	Off-label
Post-traumatic stress disorder	No	Off-label
Premature ejaculation	No	Off-label

Is Effexor or Lexapro more effective?

A meta-analysis compared Effexor, Lexapro, and several other common antidepressant drugs based on efficacy and tolerability in 117 randomized trials over a 16-year period. The results found that both Effexor and Lexapro were similarly effective at treating depression, and both were more effective than many other antidepressant medications. However, Effexor’s side effect profile may make it more difficult to tolerate than Lexapro. This may lead prescribers to attempt treatment with Lexapro before attempting Effexor. 

Coverage and cost comparison of Effexor vs. Lexapro

Effexor is a prescription-only medication that is typically covered by both commercial and Medicare insurance plans. The out-of-pocket price for a 30-day supply of the branded version Effexor XR 75 mg can be as much as $698. Effexor XR is also available in a lower cost generic.  With a venlafaxine ER coupon from SingleCare, you can purchase 30 of the generic extended release 75 mg version for around $15. 

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 cost up to $466. SingleCare offers a coupon for the generic escitalopram 10 mg which can lower the price to approximately $15 at participating pharmacies.

	Effexor	Lexapro
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Standard dosage	30, 75 mg XR capsules	30, 10 mg tablets
Typical Medicare copay	Less than $10	Less than $10
SingleCare cost	$15+	$15+

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Common side effects of Effexor vs. Lexapro

Effexor and Lexapro both have side effects which may potentially have an effect on patient compliance. Patients may experience bothersome side effects before they experience a remission in symptoms of their disorder, however many of these side effects improve over time. 

The most common side effects of Lexapro include: 

• Insomnia
• Nausea
• Increased sweating 
• Fatigue
• Drowsiness
• Sexual problems (ejaculation disorder)
• Diarrhea 

The most common side effects of Effexor include:

• Nausea
• Drowsiness
• Dry mouth 
• Increased sweating 
• Sexual problems 
  • ejaculation disorder
  • impotence 
  • decreased libido 
• Anorexia 
• Constipation

This is not intended to be a complete list of potential side effects. Please consult a medical professional for a complete list.

Drug interactions of Effexor vs. Lexapro

Because they work in similar ways, Effexor and Lexapro can interact with many of the same drugs. Both medications have direct effects on blood platelets and interfere with platelet aggregation. Anticoagulants, or blood thinners, can also interfere with platelets and the blood clotting process. Therefore, it is recommended to avoid taking anticoagulants, like warfarin, with Effexor or Lexapro due to an increased risk of bleeding. If taken together, the use of these medications should be monitored. 

There is an increased risk of serotonin syndrome when SSRIs or SNRIs are taken with other serotonergic drugs, like opioids, triptans, or monoamine oxidase inhibitors (MAOIs). These antidepressants should also be avoided with other antidepressants, like tricyclic antidepressants, and certain herbal supplements, like St. John’s wort. 

This is not intended to be a complete list of potential drug interactions. Consult your doctor or pharmacist for a complete list.Drug interactions of Effexor vs. Lexapro

Effexor and Lexapro each work by increasing available serotonin. When one of these drugs is combined with other drugs that have serotonergic activity, it increases the chance that a patient may experience serotonin syndrome. Serotonin syndrome is a condition caused by having too much free serotonin and can lead to increased blood pressure and heart rate, agitation, and dizziness. Drugs with serotonergic activity include the pain medication tramadol and a supplement often used by patients for mood, St. John’s Wort. Other classes of medication may interact in this manner as well, so it is important for your doctor and pharmacist to have a complete list of medications you are taking.

Ondansetron, when taken with Effexor or Lexapro, may increase the incidence of QT prolongation and a type of arrhythmia known as torsades de pointes (TdP). Each of these drugs carries a risk for these cardiac events, but their combined use increases the risk significantly. These cardiac events can be fatal in some cases, and the combination of these drugs with Ondansetron should be avoided when possible.

This is not intended to be a complete list of potential drug interactions. Consult your doctor or pharmacist for a complete list.

Drug	Drug Class	Effexor	Lexapro
Almotriptan Eletriptan Oxitriptan	5HT Agonist/ Triptans (antimigraine agents)	No	Yes
Amphetamine salts Dexmethylphenidate Methylphenidate	Amphetamines	Yes	Yes
Ondansetron	5HT3 Antagonists (anti-nausea agents)	Yes	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	Yes	Yes
Buspirone	Antianxiety	Yes	Yes
Carbamazepine	Anticonvulsant	No	Yes
Esomeprazole Omeprazole	Proton pump inhibitor	No	Yes
Fluconazole	Antifungal	Yes	Yes
Fluoxetine Duloxetine Paroxetine Sertraline	SSRIs	Yes	Yes
Hydroxychloroquine	Aminoquinolone/ Antimalarial	Yes	Yes
Linezolid	Antibiotic	Yes	Yes
Pimozide	Antipsychotic	Yes	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
Bupropion	Dopamine/ norepinephrine reuptake inhibitor	No	Yes

Warnings of Effexor and Lexapro

Effexor and Lexapro are used to treat mental health disorders such as major depression and generalized anxiety. The effects of Effexor and Lexapro are not immediate. It may take between two and six weeks to see any effect from the drugs. It is important to understand that the remission of symptoms may not be immediate, and patients should not discontinue treatment without first consulting their prescriber.

Patients with depression may experience a worsening of symptoms or suicidal thoughts whether or not they are taking antidepressant medications. These conditions may worsen until remission is achieved. Effexor 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, and a change may be necessary if symptoms suddenly arise or get worse.

Serotonin syndrome has been associated with the use of Effexor, Lexapro, and other similar antidepressant medications. It is associated with too much free serotonin and can cause increased heart rate, agitation, and dizziness. The risk of serotonin syndrome is increased when other serotonergic drugs are used with Effexor or Lexapro.

Effexor and Lexapro should not be stopped suddenly or without your prescriber’s knowledge. Stopping these medications suddenly may lead to withdrawal symptoms such as headaches, dizziness, fatigue, and irritability.

Frequently asked questions about Effexor vs. Lexapro

Are Effexor and Lexapro the same?

While both Effexor and Lexapro treat depression and anxiety, they are not the same. Effexor blocks the reuptake of both serotonin and norepinephrine in the neuronal synapse, while Lexapro blocks only serotonin reuptake.

Is Effexor or Lexapro better?

Effexor and Lexapro have been shown to be comparable in terms of efficacy in treating depression, however, studies suggest that Lexapro may be easier to tolerate. Patients on Lexapro are less likely to discontinue treatment early.

Can I use Effexor or Lexapro while pregnant?

The Food and Drug Administration (FDA) considers both Effexor and Lexapro to be in pregnancy category C, meaning there have not been adequate human studies to determine safety. The use of these drugs should be limited to use when the benefits clearly outweigh the risks. Both Effexor and Lexapro should be avoided in breastfeeding mothers as well.

Can I use Effexor or Lexapro with alcohol?

Alcohol can increase the adverse effects of both Effexor 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 these drugs.

Is Effexor the best antidepressant?

Effexor has been shown to be just as effective, if not more, than most other antidepressant drugs. However, it may be more difficult to tolerate for patients. Your doctor will decide which treatment option is best for you.

What is the difference between Effexor and venlafaxine?

Venlafaxine is the generic name of Effexor, which is a brand name product. Generic venlafaxine products are considered substitutable for Effexor by the FDA.

Does Effexor or Lexapro cause weight gain? 

In clinical trials, patients treated with Effexor and Lexapro did not experience clinically important gains in body weight, however some patients taking antidepressants have reported weight gain as a side effect.

Does Effexor affect memory?

Amnesia has been reported in a small number of patients taking Effexor products. If you notice this adverse event, let your prescriber know immediately, as a change in therapy may be warranted.