Prozac vs. Lexapro for Depression: Which Is Best for You?
Key takeaways:
Prozac (fluoxetine) and Lexapro (escitalopram) are part of a group of medications called selective serotonin reuptake inhibitors (SSRIs).
Prozac and Lexapro are both FDA approved to treat depression. Lexapro is also approved to treat anxiety, and Prozac is approved for a few other mental health conditions, including panic disorder.
Prozac and Lexapro have similar side effects, including sexual side effects. But they have some differences that might make one a better option for you.
Antidepressants are some of the most commonly prescribed medications in the U.S. One group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) are first-choice medications for depression and anxiety.
Below, we’ll focus on two SSRIs: Prozac (fluoxetine) and Lexapro (escitalopram). These two medications are available in brand-name and generic forms. They work in similar ways and have common side effects, but there’s also differences to keep in mind.
What is Prozac?
Prozac comes in the form of a capsule, tablet, and liquid solution. The following dosages are available:
Capsules: 10 mg, 20 mg, 40 mg
Delayed-release capsules: 90 mg
Tablets: 10 mg, 20 mg, and 60 mg
Liquid solution: 20 mg per 5 mL
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What health conditions does Prozac treat?
Like all SSRIs, Prozac is FDA approved to treat major depressive disorder (MDD) in adults. It can also treat MDD in children 8 years and older. But it’s FDA approved to treat other mental health conditions, too — like bulimia, panic disorder, and obsessive-compulsive disorder (OCD) — in adults and children 7 years and older.
When combined with olanzapine (Zyprexa), certain forms of fluoxetine are also FDA approved to treat depression associated with bipolar 1 disorder and treatment-resistant depression. A combination pill called Symbyax is available in brand-name and generic forms.
Prozac is also used off-label for some mental health conditions, including social anxiety disorder, post-traumatic stress disorder (PTSD), and borderline personality disorder (BPD).
Another fluoxetine product, Sarafem, was FDA approved for premenstrual dysphoric disorder (PMDD). But it was discontinued in 2020.
What is Lexapro?
Lexapro comes as 5 mg, 10 mg, and 20 mg tablets. It also comes as a 5 mg per 5 mL liquid solution.
What conditions is Lexapro approved to treat?
Lexapro is FDA approved to treat two mental health conditions: MDD and generalized anxiety disorder (GAD) in adults. It’s also approved to treat MDD in adolescents 12 years and older. Lexapro is used off-label for many other health conditions, including:
OCD
Panic disorder
PTSD
PMDD
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How do SSRIs work for depression and anxiety?
SSRIs raise the levels of a certain chemical in the brain called serotonin. Serotonin is an important chemical messenger (neurotransmitter) in the body. It’s important for mood regulation and lowering feelings of anxiety.
In mental health conditions like depression and anxiety, serotonin levels are usually low. SSRIs make serotonin more available to the brain, which helps improve symptoms of depression and anxiety.
But raising serotonin levels may not be the only way that SSRIs treat mental health conditions. Research suggests that SSRIs may raise the amount of a protein in the brain called brain-derived neurotrophic factor (BDNF). BDNF is thought to be involved in mood regulation. Antidepressants like SSRIs may make BDNF more active, which may improve depression symptoms.
How are Prozac and Lexapro dosed and given?
Most people who take Prozac and Lexapro take their dose by mouth once daily. Your healthcare provider will likely start you at a low dose. They may slowly raise the dose depending on how you respond.
Prozac dose
The usual starting dose of Prozac is between 10 mg to 20 mg taken each morning, except if you’re taking it for bulimia. The starting dose for bulimia is usually 60 mg in the morning.
Sometimes, Prozac 90 mg delayed-release capsules may be taken just once a week. This may be a good option if you have trouble taking a daily medication.
Prozac can be taken with or without food. It can cause trouble sleeping, so it’s best to take it in the morning.
Lexapro dose
The starting dose of Lexapro is usually 10 mg per day. Doses higher than 10 mg aren’t necessarily more effective, but the maximum dose of Lexapro is 20 mg per day.
You can take Lexapro at any time of day, with or without food. But, if you have trouble sleeping after starting Lexapro, take it in the morning. This makes it less likely you’ll have trouble falling asleep.
Is Prozac or Lexapro better at treating depression?
SSRIs like Prozac and Lexapro are considered more effective at treating depression and anxiety than placebo (a pill with nothing in it). A review of studies comparing Lexapro to other antidepressants found that Lexapro may be better than Prozac at improving depressive symptoms.
Treatment guidelines for depression may suggest one SSRI over another depending on your situation. Ultimately, the SSRI that’s best for you depends on what you're using it for and potential side effects. For example, Prozac can make you feel more energetic, so it isn’t the best choice for GAD. But if you’re experiencing depression with low energy, Prozac might be a good choice.
If you don’t respond well to one SSRI, you may be able to try another. You may need to try more than one antidepressant before finding a good option for you.
What are the known side effects of Prozac and Lexapro?
Prozac and Lexapro share common side effects, but there are some differences. For example, Prozac is more likely to cause nausea, trouble sleeping, and a low appetite. Lexapro is less likely to cause side effects, but it’s more likely to lead to ejaculation problems.
Below are some common side effects of Prozac and Lexapro when used to treat depression along with their frequency of occurrence.
| Prozac | Lexapro |
|---|---|
|
|
What are the serious side effects of Prozac and Lexapro?
All SSRIs include a boxed warning about a risk of suicidal thoughts and behaviors. A boxed warning is the most serious warning the FDA can give a prescription medication. The risk of suicide appears to be higher if you’re under the age of 25. Contact your healthcare provider right away if you start to experience suicidal thoughts while taking an SSRI.
Other rare but serious side effects of Prozac and Lexapro can include:
Too much serotonin in the body (serotonin syndrome)
Discontinuation syndrome or withdrawal symptoms
Higher risk of bleeding
Abnormal heart rhythms — the risk may be higher with Lexapro than with Prozac
Low sodium levels
A manic episode (intense feelings of energy) in people with bipolar disorder
What interactions do Prozac and Lexapro have?
Prozac and Lexapro both have drug interactions. But they’re more likely with Prozac.
Certain enzymes — cytochrome P450 (CYP) enzymes — are involved in breaking down (metabolizing) medications in the body. Prozac strongly blocks a CYP enzyme known as CYP2D6. Other medications metabolized by CYP2D6 can be impacted and stick around in the body longer. These include:
Tricyclic antidepressants (TCAs)
Certain antipsychotics, like clozapine (Clozaril)
Drug interactions can also happen if two medications have similar effects. The added effects can overwhelm the body. For this reason, Prozac and Lexapro may interact with:
Other antidepressants e.g., monoamine oxidase inhibitors (MAOIs)
Medications and substances that affect the brain or spinal cord e.g., benzodiazepines and alcohol
Medications that raise serotonin levels e.g., triptans and tramadol (Ultram)
Medications that raise your risk of bleeding e.g., nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants
Medications that affect your heart and potentially change your heart rhythm, e.g., TCAs and some antipsychotics
Make sure your healthcare provider and pharmacist know about all the medications and supplements you take. They can check for any drug interactions.
How much do Prozac and Lexapro cost?
Prozac and Lexapro are both available in brand-name and generic forms.
You may be able to get 30 capsules of generic Prozac 20 mg for less than $1 using a free GoodRx coupon. The average retail price is about $23.
You may be able to get 30 tablets of generic Lexapro 10 mg for less than $7 with a GoodRx coupon. The average retail price is about $48.
Can I take Prozac and Lexapro together for depression and anxiety?
No. Prozac and Lexapro work the same way to manage symptoms of depression and other mental health conditions. Taking them together may cause more side effects without any additional benefit.
The bottom line
Prozac and Lexapro are effective medication options for treating depression and other mental health conditions. They’re in the same medication class (SSRIs) and work in similar ways.
If you’re experiencing symptoms of depression, discuss your medication options with your healthcare provider. And, if you or someone you know is struggling and has had thoughts of harming themselves or taking their own life, know that help is available. The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free, confidential support for people in distress, as well as best practices for professionals and resources to aid in prevention and crises.
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