Cymbalta vs. Lexapro: Comparing medications

If you struggle with generalized anxiety disorder or major depressive disorder, you might be considering medications that can help you feel better. Two examples that doctors commonly prescribe for anxiety and depression are Cymbalta (the brand name for duloxetine) and Lexapro (the brand name for escitalopram). Both of these drugs are antidepressants that work similarly.

Read on to learn more about what Cymbalta and Lexapro treat, how they work to relieve symptoms, their side effects, drug interactions, and whether one is more effective than the other.  

What do they treat?  

Cymbalta and Lexapro are frequently used medications for treating mental health conditions.  

Although these medications are similar, they have different FDA-approved indications.  

Cymbalta is FDA-approved to treat:

• Generalized anxiety disorder (in adults and children over 7)

• Major depressive disorder (in adults)

• Chronic musculoskeletal pain (in adults)

• Fibromyalgia (in adults and adolescents over 13)

• Diabetic peripheral neuropathic pain (in adults)  

Lexapro is FDA-approved to treat:

• Generalized anxiety disorder (in adults)

• Major depressive disorder (in adults and adolescents over 12)

Off label uses

These prescription drugs also have off-label uses, meaning uses that aren’t FDA-approved. Despite this, doctors may prescribe the drug if they think it could be a good fit for the patient based on existing research surrounding the medication and the off-label use in question.

Cymbalta is used off-label for:

• Stress urinary incontinence

• Chemotherapy-induced peripheral neuropathy  

Lexapro is used off-label for

• Panic disorder

• Obsessive-compulsive disorder (OCD)

• Social anxiety disorder

• Posttraumatic stress disorder (PTSD)

• Premenstrual dysphoric disorder (PMDD)

• Vasomotor symptoms linked to menopause  

How do they work?

SSRIs and SNRIs work similarly in the brain, but there’s one key difference.

Selective serotonin reuptake inhibitors (SSRIs) like Lexapro affect serotonin, a chemical messenger (AKA neurotransmitter) in the brain. SSRIs inhibit the reuptake of serotonin in the brain, meaning they block the reabsorption of serotonin. This makes more serotonin available in the brain, helping to lessen symptoms of depression and anxiety.  

Serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta also affect serotonin, but they also impact norepinephrine, another neurotransmitter in the brain. SNRIs block the reabsorption of both of these neurotransmitters, making more serotonin and norepinephrine available, also helping to lessen depression and anxiety symptoms.

What are their side effects?

As with any other drugs, Cymbalta and Lexapro do come along with the risk of side effects. Since they work similarly, they share many similar adverse effects and risks.

Lexapro side effects

Common side effects of Lexapro include:

• Drowsiness

• Dizziness

• Nausea

• Constipation

• Insomnia

• Sweating

• Feeling weak

• Shaking

• Loss of appetite

• Dry mouth

• Yawning

• Sexual dysfunction

• Anxiety

Serious, more rare Lexapro side effects are:

• Allergic reaction

• Abnormal bleeding

• Seizures

• Manic episodes

• Low sodium levels  

Cymbalta side effects

Common side effects of Cymbalta include:

• Drowsiness

• Dizziness

• Nausea  

• Constipation

• Sweating  

• Loss of appetite

• Dry mouth
  

Serious, more rare Cymbalta side effects are:

• Liver damage

• Changes in blood pressure

• Abnormal bleeding

• Skin reactions (blisters, rash, or hives)

• Changes to vision

• Manic episodes

• Seizures

• Low sodium levels

• Trouble urinating

Generally speaking, the common side effects will probably be worse when you first start taking the drug and then subside as your body adjusts to it. However, if your side effects won’t go away or get worse, let your psychiatrist know. In this case, your doctor might have to adjust your dosage or switch you to a different medication.  

Shared risks of Lexapro and Cymbalta: What to look out for

Both of these drugs come along with two major risks that you should be aware of before taking them so you can look out for warning signs.

• Suicidal thoughts or behaviors: While it seems counterintuitive for antidepressants to cause this, these medications can possibly worsen depression and/or result in new or worsening suicidal thoughts. This risk is particularly higher in teens and young adults under 24 years old. If you have any suicidal thoughts when taking these medications, let your doctor know immediately.

• Serotonin syndrome: Since these drugs affect serotonin, it’s possible for this rate, but serious syndrome to occur. This is when your body has dangerously high levels of serotonin. Your risk is even higher if you’re taking any other drugs that also affect your serotonin levels. Serotonin syndrome is a medical emergency that warrants immediate attention.

Signs to look out for include:

• Agitation

• Confusion

• Fast heart rate

• High blood pressure

• Fever

• Muscle rigidity

• Tremors

• Dilated pupils

• Seizures

• Unconsciousness

Can you switch from Lexapro to Cymbalta?

Yes, you can switch from Lexapro to Cymbalta, but only if your psychiatrist suggests this and develops a plan for you to do so safely. Your provider might recommend this if you aren’t experiencing optimal symptom relief from Lexapro or have intolerable side effects.  

If your psychiatrist thinks that Cymbalta is a better fit for you, they’ll come up with a plan on how to best and most safely switch medications. They might recommend:

• Gradually tapering (lessening the dose) Lexapro medication while simultaneously titrating (starting and increasing the dose) of Cymbalta. This is know as cross-tapering.

• Tapering (lessening the dose) of one Lexapro, taking a brief period of time to be drug-free, and then starting Cymbalta.

Do not change your dosage or stop taking a medication unless your doctor gives you specific instructions to do so. If you have any uncomfortable symptoms when you’re coming off Lexapro, let your provider know.  

What are their different drug interactions?

Make sure you’re aware of drug interactions before you start taking any new medication.

Lexapro and Cymbalta drug interactions include:  

• Monoamine oxidase inhibitors (MAOIs)

• Tricyclic antidepressants (TCAs)

• Triptans

• Certain opioids  

• Buspirone

• St. John’s Wort

• Lithium

• Amphetamines

• Certain antipsychotics

• Certain blood thinners

• Non-steroidal anti-inflammatory drugs (NSAIDs)

• Alcohol

If you mix Lexapro or Cymbalta with any of these other drugs, you pose the risk of dangerous side effects. Too much serotonin in your body can lead to serotonin syndrome. Go go to the nearest ER if you are experiencing symptoms.

Keep in mind that this is not an exhaustive list of drug interactions. When discussing your treatment plan with your psychiatrist, tell them about all over-the-counter medications, prescription drugs, and supplements that you take so they can ensure that Lexapro or Cymbalta is safe for you to take.

Which one is better?

One drug is not inherently “better” than the other. Some studies have found Lexapro to be more effective in the treatment of major depressive disorder compared to Cymbalta. Additionally, research shows that Lexapro is generally better tolerated than Cymbalta, meaning it causes fewer intolerable side effects.  

However, this doesn’t mean that the same will hold true for you since everyone is different, and individual responses to medications vary — regardless of clinical trials and studies. While Lexapro might be more effective and cause fewer side effects for one person, Cymbalta might be more effective and tolerable for another.  

It’s important to work with an experienced, qualified psychiatrist to receive a diagnosis and determine the best course of treatment for you. Remember to be patient. These drugs don’t work immediately, and it can take several weeks to notice a significant difference in your symptoms. Not to mention, it can take some trial and error to determine which prescription medication or combination of medications is most effective for you. Your psychiatrist will be your guide in helping you figure out what will help you feel better.

If you’re looking for a psychiatrist, consider Talkiatry. We’re a national psychiatry practice that treats mental health conditions ranging from anxiety to depression and everything in between. We provide virtual, in-network services so you can get the care you need from home.  

To get started, complete our free online assessment to get matched with a psychiatrist.

FAQs

How are Lexapro and Cymbalta similar?

Both Lexapro and Cymbalta make more serotonin available in the brain, which can lead to reduced anxiety and depression symptoms. Both medications are commonly prescribed and FDA-approved for treating generalized anxiety disorder and major depressive disorder.  

How are they different?

Lexapro is a selective serotonin reuptake inhibitor (SSRI), and Cymbalta is a serotonin and norepinephrine reuptake inhibitor (SNRI). This means that Lexapro targets only serotonin, whereas Cymbalta targets both serotonin and norepinephrine. Cymbalta also has more FDA-approved indications, such as for pain-related disorders (chronic musculoskeletal pain, fibromyalgia, and diabetic peripheral neuropathic pain).

Which one should I take?

Your psychiatrist will determine whether Lexapro or Cymbalta is a better fit for you based on your symptoms, diagnoses, co-occurring health conditions, tolerance of medications, and more. If you start out with one and don’t experience the results you hoped for, you can always try the other, as long as your psychiatrist thinks it’s safe for you.  

What are other alternatives to Lexapro and Cymbalta?

There are various other SSRI and SNRI options aApart from Lexapro and Cymbalta.  

Other SSRIs are:

• Celexa (citalopram)

• Prozac (fluoxetine)

• Luvox (fluvoxamine)

• Paxil (paroxetine)

• Zoloft (sertraline)

Other SNRIs are:

• Effexor (venlafaxine)

• Fetzima (levomilnacipran)

• Pristiq desvenlafaxine

Additionally, there are other classes of antidepressants that your doctor can prescribe if SSRIs or SSRIs aren’t the right fit for you, such as:

• Monoamine oxidase inhibitors (MAOIs)

• Tricyclic antidepressants (TCAs)

• Atypical antidepressants like Viibryd (vilazodone) and Trintellix (vortioxetine)

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.