Lexapro vs. Effexor: Which is Right for Me?

By Craig Sorkin, DNP, APN
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May 4, 2022

Around 2​​80 million people around the world, including 5% of all adults, suffer from depression.

This doesn’t just mean people are feeling a little sad—the chronic low mood of depression can interfere with relationships, work, and daily functioning. 

If you’re one of these 280 million, you don’t have to suffer alone or without help.

Thanks to the numerous antidepressants approved by the U.S. Food and Drug Administration, you and your doctor or healthcare provider can work together to find a treatment that helps reduce your symptoms.

Lexapro and Effexor are two antidepressants that are often prescribed for people with depression.

These medications both work by changing how your brain works with certain chemicals, but they’re not exactly the same.

Which one is better?

In this article, I’ll discuss the similarities and differences between Lexapro and Effexor, going over how they work, their side effect profiles, what they treat, what a standard dose looks like, what precautions you should take before starting to take them, and more.

Your doctor will ultimately be the one to decide which antidepressant is best for you, but by the end of this article, you’ll be armed with the knowledge of what each drug does and how it can help you. 

What is Lexapro?

Lexapro (escitalopram) is a type of antidepressant called a selective serotonin reuptake inhibitor, or SSRI. It is available in a tablet or liquid format. 

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Lexapro uses

Lexapro is approved to help treat major depressive disorder (MDD) in adults and children ages 12 and up, and generalized anxiety disorder (GAD) in adults. 

MDD, which we will refer to as depression in the rest of this article, is a mood disorder with symptoms that negatively impact the way you think, feel, and react to situations.

To be diagnosed with depression, these symptoms—which can include feelings of irritability, sadness, hopelessness, guilt, and worthlessness—must last for more than two weeks.

GAD is an anxiety disorder in which patients experience persistent feelings of worry or dread for at least six months. Symptoms can include feelings of nervousness, restlessness, trouble concentrating, and irritability.  

How Lexapro works

SSRIs, including Lexapro, work by increasing the amount of serotonin in the brain.

Serotonin carries signals between nerve cells in the brain, and it regulates mood—it is often known as the “happy chemical.”

When it has finished carrying its message, serotonin is usually reabsorbed by the brain.

SSRIs block this reabsorption (or reuptake) of serotonin into the neurons, making more serotonin available in the brain, helping maintain mental balance.

What is Effexor?

Effexor (venlafaxine) is a type of antidepressant called a selective serotonin-norepinephrine reuptake inhibitor, or SNRI.

It is available as an immediate-release tablet or an extended-release capsule, both taken by mouth.

The extended-release capsule is known as Effexor XR, or venlafaxine hydrochloride.

Effexor uses

Effexor is approved to help treat depression in adults.

Effexor XR is also approved to help treat GAD, social anxiety disorder, and panic disorder in adults.  

Social anxiety disorder is the extreme, persistent fear of interacting with or being watched and judged by others.

Panic disorder is an anxiety disorder characterized by persistent, unexpected bouts of intense fear coupled with physical symptoms that happen out of the blue, unrelated to a fear. 

How Effexor works

Like SSRIs, SNRIs (including Effexor) increase the amount of serotonin in the brain by preventing reuptake in the neurons—but they also increase the amount of norepinephrine, another mood-stabilizing neurotransmitter.

Norepinephrine is known to boost alertness, happiness, and concentration.

How Are They Similar?

Effectiveness at treating depression

A 2009 comparative study of 12 different antidepressants found that Lexapro and Effexor were both effective at treating depression—and that they were similarly effective.

The study also found that Lexapro and Effexor were more effective than many of the other antidepressants studied.

Common side effects

Lexapro and Effexor share many common side effects.

These include:

The side effects above typically go away after a week or two of taking the medication.

People taking Lexapro and Effexor may also experience sexual side effects, which do not typically go away while taking the medication.

These sexual side effects include trouble with orgasm, as well as ejaculatory delay in people with penises. 

How Are They Different?

Drug class

Lexapro is an SSRI, a type of antidepressant that blocks the reuptake of serotonin, increasing the amount of serotonin in the brain.

Effexor is an SNRI, which blocks the reuptake of both norepinephrine and serotonin, increasing the amount of norepinephrine and serotonin in the brain. 

Side effects

While Lexapro and Effexor share most side effects, Effexor has been shown to increase blood pressure in those taking it.

This side effect has not been found in those taking Lexapro. 

Effexor typically has more pronounced side effects than Lexapro when comparing the two, with higher percentages of Effexor users experiencing side effects than Lexapro users for all of their shared symptoms.

For example, 17.8% of people taking Effexor experienced insomnia, while only 4% of people taking Lexapro reported it; 15.8% of people taking Effexor experienced dizziness, while only 3% of people taking Lexapro reported it; and 2.9% of people taking Effexor experienced increased sweating, while only 2% of people taking Lexapro reported it. 

This same pattern is true for digestive side effects like nausea, diarrhea, constipation, as well as  sexual side effects like trouble with orgasm and ejaculatory delay.

Because of Effexor’s harsher side effect profile, many doctors choose to prescribe Lexapro before Effexor. 

Conditions treated

While both Lexapro and Effexor (including Effexor XR) are approved to treat depression and GAD, Effexor XR is also approved to treat social anxiety disorder and panic disorder.

In addition to the conditions they are approved to treat, Lexapro and Effexor are both sometimes prescribed off-label for a number of conditions. (Off-label means they have not been FDA-approved to treat those conditions, but doctors believe they will be effective for their patients.) 

Lexapro is prescribed off-label for mental health conditions like obsessive compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and eating disorders like binge eating disorder and bulimia nervosa.

Effexor is prescribed off-label for mental health conditions such as OCD, PTSD, PMDD, and attention-deficit/hyperactivity disorder (ADHD), as well as other health conditions like diabetic neuropathy, migraines, and hot flashes caused by menopause.

Dosage

For both Lexapro and Effexor, your doctor will typically prescribe a low dose to start, then increase the dosage over time in order for your body to adjust to it. 

The recommended dose for Lexapro is 10 mg, and dosage typically ranges from 10-20 mg, as prescribed by your doctor.

The recommended dose for Effexor is 75 mg, and dosage typically ranges from 37.5-300 mg, as prescribed by your doctor.

Never increase your dosage without a doctor’s permission, and don’t take either medication more frequently than prescribed.

If you do, are putting yourself at risk for side effects, complications, and risk of morbidity and mortality.

Lexapro Precautions

Before taking Lexapro, be aware of the following:

  • Lexapro can cause drug interactions: Tell your doctor about all other medications you are taking, as well as any herbal or nutritional supplements, to ensure none of them will interact with Lexapro. Using Lexapro with some other medicines can cause serotonin syndrome, a potentially fatal drug reaction caused when too much serotonin builds up in the body.
  • Heavy alcohol consumption is not recommended: Alcohol can amplify the side effect of drowsiness, so be mindful of your consumption—especially if you plan to drive. 
  • Lexapro can cause angle-closure glaucoma: Angle-closure glaucoma is a condition which can lead to loss of vision. Your doctor may recommend an eye exam prior to starting Lexapro. If you start experiencing changes to your vision or eye area, contact your doctor immediately. 
  • Tell your doctor if you are pregnant, breastfeeding, or may become pregnant: Lexapro can cause problems in newborns post-delivery if it is taken in the last few months of pregnancy. 
  • Lexapro can cause bleeding problems: Tell your doctor if you have ever had low levels of blood sodium, high blood pressure, or take blood thinning medications. 
  • Lexapro can worsen depression, especially at first: In the first few weeks of taking Lexapro, users may experience worsened depression or suicidal thoughts, especially in teenagers or young adults. Tell your doctor if you or anyone in your family has bipolar disorder or has ever been suicidal. Seek medical attention immediately if you experience suicidal thoughts or behaviors.

Effexor Precautions

Before taking Effexor, be aware of the following:

  • Effexor can cause drug interactions: Like with Lexapro, tell your doctor about all other medications you are taking, as well as any herbal or nutritional supplements, to ensure none of them will interact with Effexor. Serotonin syndrome can also occur when Effexor is mixed with other drugs.
  • Heavy alcohol consumption is not recommended: Like Lexapro, Effexor can cause drowsiness in users, and alcohol can amplify this side effect. Effexor can also cause blurred vision, which may also be amplified by alcohol. 
  • Effexor can cause angle-closure glaucoma: Like Lexapro, Effexor can cause angle-closure glaucoma. Contact your doctor immediately if you start experiencing changes to your vision or eye area.
  • Effexor can cause bleeding problems: Effexor can cause high blood pressure, hyponatremia (low sodium in the blood), and other bleeding problems. Let your doctor know of any related history so they can plan accordingly. 
  • Tell your doctor if you are pregnant, breastfeeding, or may become pregnant: Like Lexapro, Effexor can cause problems in newborns post-delivery if it is taken in the last few months of pregnancy. 
  • Effexor can worsen depression, especially at first: Like with Lexapro, in the first few weeks of taking Effexor, users may experience worsened depression or suicidal thoughts. Tell doctor if you or anyone in your family has bipolar disorder or has ever been suicidal, and seek medical attention immediately if you experience suicidal thoughts or behaviors. 
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When to See a Doctor for Depression

Depression is treatable, so if you think you may be suffering from it, see a doctor.

Whether you have mild, moderate, or severe depression, there are effective treatment options—medications like Lexapro or Effexor, therapy, lifestyle changes, and more—and a doctor can get you started on the right treatment plan. It can be hard to get started, but treatment can be life-changing.

If you are suffering from depression and are experiencing suicidal thoughts or behaviors, seek help immediately. The National Suicide Prevention Lifeline is free, confidential, and available 24 hours a day at 800-273-8255.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app?

Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Frequently Asked Questions

Is Effexor stronger than Lexapro?
Effexor and Lexapro are seen as equal in “strength” when it comes to effectiveness against treating depression. Effexor’s side effects are typically harder to tolerate than Lexapro’s side effects.
What antidepressant is better than Effexor?
There is no one antidepressant that is best for everyone. Some antidepressants will work better than others for your body and brain—your doctor will help you find the best antidepressant for your needs.
Which is better: escitalopram or venlafaxine?
It depends on your body and your needs. Everyone reacts to drugs differently, so one may work better for you, while the other works better for a friend or family member.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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Craig Sorkin, DNP, APN

Craig Sorkin, DNP, APN is a board certified Family Nurse Practitioner with over 15 years experience. He received his Undergraduate and Graduate degrees from William Paterson University and his doctoral degree from Drexel University. He has spent his career working in the Emergency Room and Primary Care. The last 6 years of his career have been dedicated to the field of digital medicine. He has created departments geared towards this specialized practice as well as written blogs and a book about the topic.