Effexor vs Lexapro: What's the Difference?

Introduction

Effexor and Lexapro have both been on the market for a long time and both have been described for patients with symptoms of depression. But each medication has its pros and cons, and each may have different side effects or possible drug interactions.

Learn about which antidepressants might be right for you, what questions to ask your doctor about each, and what to expect while you’re on these medications.

These medications can be lifesavers, or they can be difficult. Learning as much as you can now will help you navigate the hard times.

What are the main differences between Effexor and Lexapro?

While both Effexor and Lexapro are considered antidepressants, they work in the body differently. Effexor, also known as venlafaxine, is an SNRI, or selective serotonin-norepinephrine reuptake inhibitor. SNRIs help the body by increasing the availability of multiple neurotransmitters including norepinephrine, serotonin, and dopamine. Lexapro, also known as escitalopram, is an SSRI, or selective-serotonin reuptake inhibitor. Escitalopram directly affects the availability of serotonin in the body.

Is Effexor or Lexapro more effective?

Both Effexor and Lexapro are effective in treating depression. However, effectiveness is based on a broad population. In every population there are those who may experience greater side effects than the rest and this may be a factor of their genetics. If your genetics were tested prior to using these medications, you may find that one is a better choice than the other. Effexor is stopped more frequently than Lexapro due to adverse reactions. When surveyed, 25% of patients reported a negative experience with Effexor use while only 16% of patients reported a negative experience with Lexapro. Lexapro was also shown in a meta-analysis to be generally more effective with fewer side effects than many other antidepressants, including Effexor.

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Conditions treated by Effexor and Lexapro?

Effexor
Adult patients have FDA approval to treat major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder, and panic disorder. Off-label treatment includes migraine prophylaxis, post-traumatic stress disorder (PTSD), neuropathic pain, and cataplexy.
Off-label means the FDA has not officially approved that indication.
Pediatric patients have been treated with Effexor, off-label, to treat major depressive disorder (MDD), generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), and cataplexy.
Lexapro
Adult patients have FDA approval to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD).
Pediatric patients have FDA approval to treat major depressive disorder (MDD). Off-label, pediatric patients may be for social anxiety disorder and autism.

What are the Pros and Cons of Effexor?

What are the benefits of Effexor?

Effexor affects multiple neurotransmitters and may benefit your mental disorder better than an SSRI, or selective serotonin reuptake inhibitor, alone.
Effexor has the side benefit of helping with chronic pain, including nerve pain.
Effexor is available to treat numerous different mental health indications.

What are the side effects of Effexor?

Common side effects: abnormal dreams, blurred vision, constipation, decreased appetite, diarrhea, dizziness, drowsiness, dry mouth, flu-like syndrome, headache, high cholesterol, insomnia, nausea, sexual dysfunction, sweating, weight loss, yawning
Severe side effects: suicidal thoughts, increased depression, hypomania/mania, serotonin syndrome, bleeding, severe rash, angle-closure glaucoma, seizures, low sodium, heart irregularities, hepatotoxicity, extrapyramidal symptoms

What possible drug interactions does Effexor have?

Alcohol with Effexor may make you dizzy, drowsy, or have a difficult time concentrating. It is recommended to avoid alcohol while being treated with Effexor.
Cimetidine: If you have high blood pressure, liver disease, or are becoming elderly it would be best to avoid taking cimetidine while you are being treated with Effexor.
Clozapine and Effexor can increase clozapine levels making it more likely for you to have an adverse reaction.
Drug testing: False-positive urine tests for phencyclidine (PCP), and amphetamine have been found while taking Effexor.
Haloperidol levels may increase while taking Effexor leading to higher risk of adverse reactions.
Imipramine levels may increase with Effexor.
Indinavir levels may be reduced, potentially bringing the concentration down to a level that is insufficient for treatment.
Ketoconazole use can increase the concentrations of Effexor, which may increase the risk of an adverse reaction.
MAOIs: Increases risk of serotonin syndrome.
Risperidone metabolism is reduced in the presence of venlafaxine.
Serotonergic drugs increase the risk of serotonin syndrome. Serotonergic medications include SSRIs, SNRIs, quetiapine, sumatriptan, buspirone, lithium, St. John’s Wort, MDMA (ecstasy), and psilocybin (magic mushrooms) as well as many others. There are multiple drug interactions with Effexor.
Taking Effexor with other medications that affect serotonin levels in the body can increase the risk of serotonin syndrome. Serotonin affects multiple parts of our body including our brains, heart, and digestive system. With serotonin toxicity, you may experience an elevated blood pressure, fast heart rate, fever, shivering, sweating, muscle spasms, confusion, hallucinations, seizures, and coma.
Warfarin, a blood thinner, with concurrent use of Effexor increases INR, prothrombin time, partial thromboplastin time, increasing your risk of internal bleeding.
Avoid 5-HTP, ephedra, kava, SAMe, and yohimbe. (These are all available without a prescription.)

What are the Pros and cons of Lexapro?

What are the benefits of Lexapro?

Lexapro, or escitalopram, is the active metabolite of citalopram. This means that when you take Lexapro, the liver does not have to make it active to work. It may work better for you than citalopram and you may not need as large a dose to notice a benefit.
Comes as a solution or a tablet and is long acting.
Lexapro is one of the few antidepressants with FDA approval for children and is approved for the treatment of major depressive disorder.

What are the side effects of Lexapro?

Common side effects: abnormal dreams, constipation, decreased appetite, diarrhea, dizziness, drowsiness, dry mouth, flu-like syndrome, headache, insomnia, nausea, sexual disfunction, sweating, vomiting, yawning
Severe side effects: suicidal thoughts, increased depression, mania, serotonin syndrome, bleeding, severe rash, seizure, low sodium, priapism, extrapyramidal symptoms

What possible drug interactions does Lexapro have?

Alcohol is not recommended with Lexapro due to possible increased dizziness, drowsiness, and reduced concentration.
Blood clotting agents: All SSRIs, including Lexapro, increase the risk of bleeding.
Carbamazepine may alter the clearance of Lexapro increasing the side effects of Lexapro.
Cimetidine may increase the levels of Lexapro in the blood, potentially increasing the risk for adverse reactions.
CNS drugs: Any medication or drug that affects your central nervous system may be impacted negatively when taken with another central nervous system medication. Monitor for increased side effects and discontinue medications that are no longer needed.
Ketoconazole taken while using Lexapro will reduce the concentration of ketoconazole potentially making ketoconazole less effective.
Lithium can increase the serotonergic effects of escitalopram which can lead to serotonin syndrome.
MAOIs increase the risk of serotonin toxicity.
Pimozide and Celexa, citalopram, may increase the QTc of the heart which could lead to a heart attack or heart failure. Escitalopram (or Lexapro) is the active metabolite of Celexa.
Serotonergic drugs increase the risk of serotonin syndrome. Taking more than one medication that affects serotonin levels greatly increases your risk of serotonin syndrome. This is an additive effect. You may be on one or two medications that affect serotonin levels and tolerate them well, but when you add a third or increase a dose the levels may reach a point of serotonin toxicity.
Sumatriptan use with Lexapro may lead to weakness, hyperreflexia, and incoordination. Monitor carefully if you need to use sumatriptan to treat a migraine.
Triptans increase the risk of serotonin syndrome.

Conclusion

While there are always risks when taking any medication, you can reduce that risk by knowing ahead of time how your body will metabolize that medication. ClarityX offers the Mindwell test to help. The Mindwell test checks your genes against over 130 mental health medications. A simple cheek swab can help you and your prescriber determine which medication has the greatest potential for benefit and the least potential for side effects. Why go through trial-and-error when you may not have to?