Depression and anxiety disorders are two of the most common mental health conditions affecting adults in the United States.
With millions of Americans living with these conditions, antidepressant medications, which are often used for the treatment of depression and anxiety, are among the most commonly prescribed prescription drugs.
Lexapro, which is sold under the generic name escitalopram, and Cymbalta, which is sold under the generic name duloxetine, are both effective at treating mental health conditions like major depression and anxiety.
We’ve put together a list of differences and similarities to help you understand how the medications compare.
Drug Class
Lexapro and Cymbalta belong to two different drug classes.
Lexapro belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs), while Cymbalta belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs).
Both drug classes work by acting on the reuptake of certain neurotransmitters in the brain in order to elevate baseline levels of these neurotransmitters, which helps to improve and stabilize mood.
SSRIs act on serotonin only, while SNRIs act on both serotonin and norepinephrine.
Both SSRIs and SNRIs are considered “new” classes of antidepressants within psychiatry, with the first SSRI introduced in the 1980s and the first SNRI was introduced in the early 1990s.
SSRIs and SNRIs are typically better tolerated and produce fewer side effects than older classes of antidepressants, such as tricyclic antidepressants.
Both drugs are approved by the Food and Drug Administration (FDA).
Examples of SSRIs include citalopram (Cipramil), fluoxetine (Prozac or Oxactin), paroxetine hydrochloride (Paxil), sertraline (Zoloft), citalopram (Celexa), and paroxetine (Seroxat). SNRIs include venlafaxine (Effexor XR) and desvenlafaxine (Pristiq). These are not to be confused with antipsychotics, which include risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa).
Conditions Treated
Major Depressive Disorder
Both Lexapro and Cymbalta are used for the treatment of major depressive disorder, also known as clinical depression.
Major depressive disorder is a severe mental health condition that is characterized by persistent feelings of intense sadness that last for at least two weeks or more.
There are mental, physical, and emotional symptoms associated with major depressive disorder, and the condition can greatly affect a person’s quality of life.
When experiencing major depressive disorder, it is common to experience things like eating more or less than usual or sleeping more or less than usual.
It is also common for people with major depressive disorder to lose interest in activities that they previously enjoyed or struggle with completing daily tasks. It is also common for patients to have suicidal thoughts and tendencies.
Symptoms of major depressive disorder include:
- Feelings of worthlessness, guilt, hopelessness, or helplessness
- Sleeping or drowsiness and eating more or less than usual
- Feeling sad, empty, or tearful
- Difficulty concentrating
- Low energy
- Nervous energy
- Lost of interest in activities you used to enjoy
- Suicidal thoughts or behaviors
Generalized Anxiety Disorder
In addition to major depressive disorder, Lexapro and Cymbalta can also be used for the treatment of generalized anxiety disorder, or GAD.
Generalized anxiety disorder is characterized by persistent feelings of anxiety that last for six months or more, are severe, and begin to interfere with a person’s daily quality of life.
Symptoms of generalized anxiety disorder can include difficulty falling asleep, difficulty concentrating, restlessness, nervousness, and trouble concentrating.
Other Conditions
In addition to major depressive disorder and generalized anxiety disorder, Cymbalta is also used for the treatment of fibromyalgia and diabetic neuropathy.
Fibromyalgia is a chronic medical condition that causes widespread musculoskeletal pain across the body with no identifiable cause.
Fibromyalgia affects everyone differently, but common symptoms of the disorder include fatigue, memory issues, tension headaches, depression, sleep issues, and mood changes.
Diabetic neuropathy develops in people with diabetes who are unable to control their blood sugar levels.
Diabetic neuropathy is characterized by nerve pain that typically presents in the legs and feet. Symptoms associated with diabetic neuropathy include nerve pain, tingling and numbness in the legs and feet, cramps, weakness, and increased sensitivity to touch.
Effectiveness
Several studies have examined the differences in effectiveness between Lexapro and Cymbalta.
In one study, Lexapro was found to be at least as effective as Cymbalta while being better tolerated and producing fewer side effects for most patients when used for the treatment of major depressive disorder.
However, some patients may find that one medication works better than the other based on their individual response to the medication.
It may take around 2 to 6 weeks for antidepressants to fully start working. Both SSRIs and SNRIs act slowly to rebalance the brain chemistry, so many patients may not experience the full effects of the medication until around a month after consistent use.
Side Effects
The side effects of Lexapro may be better tolerated than those associated with Cymbalta.
One study found that patients treated with Lexapro were more significantly more likely to continue their treatment for at least eight weeks than patients treated with Cymbalta (87 percent compared to 69 percent, respectively).
However, some patients may find that they prefer Cymbalta and tolerate the medication better.
Lexapro Side Effects
Common side effects of Lexapro include:
- Nausea
- Dry mouth
- Insomnia
- Ejaculation disorder
- Increased sweating
- Fatigue
- Drowsiness
- Decreased libido
- Anorgasmia
- Indigestion
- Diarrhea
- Constipation
- Dizziness
- Yawning
Other side effects in children and adolescents may include:
- Increased thirst
- Heavy menstrual periods
- Trouble urinating
- Abnormal increase in muscle movement or agitation
- Nosebleeds
- Slowed growth and weight change or weight loss
Rare but serious side effects or adverse events associated with Lexapro include:
- Severe allergic reaction with signs and symptoms such as:
- Trouble breathing
- Swelling of the face, tongue, eyes, or mouth
- Severe rash
- Seizures or convulsions
- Low salt levels with signs and symptoms such as::
- Headache
- Irregular heart rate
- Thinking or memory problems
- Weakness
- Seizures
- Trouble concentrating
- Confusion
- Unsteadiness that can lead to falls
- Serotonin syndrome with signs and symptoms such as:
- Severe muscular tightness
- Shivering
- Seizures
- Fever
- Confusion
- Manic episodes with signs and symptoms such as:
- Greatly increased energy
- Racing thoughts
- Unusually grand ideas
- Reckless behavior
- Talking quickly or more than normal
- Severe sleeping trouble
- Excessive happiness or irritability
- Vision problems with signs and symptoms such as:
- Eye pain
- Swelling or redness in or around your eye
- Changes in vision
If you experience any of these side effects, or they persist or worsen, seek medical advice immediately from your healthcare provider. This may not be a complete list of side effects.
Possible side effects associated with Cymbalta generally fall into two categories: common and less common. Common side effects associated with Cymbalta include:
- Dry mouth
- Constipation
- Diarrhea
- Drowsiness
- Abdominal Pain or Stomach Pain
- Nausea
- Insomnia
- Loss of appetite
- Increased sweating
- Headache
Less common adverse effects that may occur while using Cymbalta include:
- Suicidal thoughts and behaviors
- Liver problems
- Orthostatic hypotension
- Serotonin syndrome
- Abnormal bleeding
- Severe skin reactions
- Manic/hypomanic episodes
- Glaucoma
- Seizures
- Changes in blood pressure
- Low sodium levels
- Urinary retention
This may not be a complete list of side effects.
Drug Interactions
Both Lexapro and Cymbalta can cause potentially dangerous reactions when interacting with certain medications.
Monoamine oxidase inhibitors, or MAOIs, are a type of antidepressant that can interact dangerously with Lexapro and Cymbalta.
Lexapro and Cymbalta should not be taken within 14 days of discontinuing an MAOI due to an increased risk of serotonin syndrome.
Serotonin syndrome is a serious medical condition resulting from high serotonin levels in the brain.
Common symptoms of serotonin syndrome include shivering, confusion, severe muscular tightness, fever, seizures, diarrhea, and vomiting.
Serotonin syndrome can also be caused by combining Lexapro or Cymbalta with other medications that may increase serotonin levels in the brain.
These drugs include antidepressants and triptans, as well as the cough suppressant dextromethorphan.
Lexapro and Cymbalta may also interact with painkillers like tramadol, non-steroidal anti-inflammatory drugs (NSAIDs), and alcohol.
Consult a healthcare provider for other possible drug interactions.
Summary
Lexapro and Cymbalta are both similarly effective in the treatment of mental health conditions like major depressive disorder and generalized anxiety disorder, but Lexapro has been shown to be better tolerated than Cymbalta in some studies.
However, antidepressants may work differently for different people. It’s important to consult a healthcare provider for the best medication for your specific condition.
Both Lexapro and Cymbalta are available in both generic and brand-name forms and are usually covered by commercial health insurance in their generic form.
Regardless of which medication your doctor prescribes, you can save on the cost of your prescription with a pharmacy discount card from Pharmacists.org.
References, Studies and Sources.
https://pubmed.ncbi.nlm.nih.gov/17563128/
https://www.healthline.com/health/depression/lexapro-side-effects
https://www.healthline.com/health/clinical-depression
https://www.medicinenet.com/lexapro_escitalopram_vs_cymbalta_duloxetine/article.htm
