Lexapro vs. Paxil: Differences and Similarities

By Nena Luster DNP, MBA, FNP-BC
Medically reviewed checkmarkMedically reviewed
February 25, 2022

Anxiety and depression are common mental health disorders in the United States and many people who suffer from one disorder often also suffer from both.

In fact, about one half of the people diagnosed with depression also receive diagnoses of an anxiety disorder, according to the Anxiety & Depression Association of America.

Though anxiety and depression can have a negative impact on overall quality of life, treatment options are available, including talk therapy, mindfulness, and prescription medication.

Prescription antidepressants help millions of people find relief from symptoms of anxiety, depression, and other mental health conditions every year. 

Selective serotonin reuptake inhibitors (SSRIs) are often considered the first-line medication treatment for depression and anxiety because of their safety and efficacy.

Paxil (paroxetine) and Lexapro (escitalopram) are two SSRI medications that can be prescribed to treat anxiety and depression. 

When researching the differences between Paxil, Lexapro, and other antidepressant medications, it’s important to remember that it may take some time to find the right prescription for your symptoms.

In this article, I’ll describe the differences and similarities between these two medications as well as their uses, side effects and precautions.

What are the differences between Paxil and Lexapro?

Paxil and Lexapro are FDA-approved SSRIs antidepressant medications that can help to improve symptoms of anxiety and depression by increasing the levels of serotonin in your brain.

Serotonin helps to regulate mood, sleep, and other bodily functions.

Below is a chart of some of the main differences between the two medications:

ItemPaxilLexapro
Drug classSSRISSRI
Generic available?YesYes
Generic nameParoxetineEscitalopram
Forms availableImmediate-release tablets, extended-release tablets, liquid suspensionTablets and liquid suspension
Standard dosage for anxiety and/or depression20 mg per day10 mg per day
Treatment timeLong-termLong-term
Who can use the medication?Adults onlyAdults and adolescents
How long does it take for the medication to take effect?Up to 8 weeksUp to 8 weeks
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Conditions Treated

Paxil and Lexapro can be prescribed to treat:

ConditionPaxil Lexapro
Major depressive disorder (MDD). Also called clinical depression, MDD is a common mood disorder that can cause a persistent feeling of sadness, tiredness, emptiness, or hopelessness. Additional symptoms include a loss of interest in daily pursuits and decreased motivation.  Severe symptoms may include suicidal thoughts.YesYes
Generalized anxiety disorder (GAD). GAD often co-occurs with MDD but it can occur alone.  It is characterized by excessive worry and anxiety that makes it difficult to cope with everyday tasks.YesYes
Obsessive compulsive disorder (OCD). People with OCD often experience an urge to complete repetitive actions and/or have  uncontrollable obsessions and compulsions. They feel that certain behaviors must be done in order to ease their fears and anxieties.YesOff-label 
Premenstrual dysphoric disorder (PMDD). People with PMDD experience a severe form of premenstrual syndrome (PMS). Symptoms usually begin in the week before menstruation and continue up until a few days after the menstrual period begins. YesOff-label
Social anxiety disorder. Sometimes called social phobia, this disorder is characterized by severe anxiety in social or performance situations.YesNo
Panic disorder. People with panic disorder have sudden episodes of intense anxiety and fear accompanied by physical symptoms, like chest pain, shortness of breath, heart palpitations, dizziness, and abdominal stress. YesNo
Post-traumatic stress disorder (PTSD). PTSD occurs after a trauma or stressful event when feelings of helplessness, fear, or anxiety can persist long after the event.YesOff-label
Bulimia nervosa (bulimia). Bulimia is an eating disorder in which a person experiences episodes of overeating followed by periods of compensatory behavior, like abusing laxatives or forced vomiting. NoOff-label
Binge eating. Binge eating is an eating disorder in which a person has periods of binge eating or overeating. The disorder can occur on its own or alongside another eating disorder, like bulimia.NoOff-label
Premature ejaculation. When a person with a penis ejaculates sooner than they or their partner would like.Off-labelOff-label

*  Off-label means it can be used for the condition but is not an official indication

Which is More Effective?

Paxil and Lexapro have both been approved by the FDA for the safe and effective treatment of clinical depression, anxiety disorders, and other conditions.

There are several findings from clinical trials and studies that compare the two medications; however, these reviews only provide general information on the medications’ effects.  

While these findings are important, it’s equally important to remember that the effectiveness of one medication will vary depending on the individual and their circumstances, including their medical history, genetics, and more. One of the primary factors that influence the effectiveness of the medication is the condition you are being treated for. 

As we discussed earlier, each medication treats a specific set of conditions; there is no one medication that treats everything.  Because of this, it is important that you have discussed all of your symptoms, thoughts, and feelings with your provider to ensure you receive the correct diagnosis and treatment.  

Potential Side Effects

Taking Paxil or Lexapro can cause some side effects. The most common side effects are usually mild and resolve on their own as your body adjusts to the medication.

But if you experience any severe or long-lasting side effects, be sure to reach out to your provider as soon as possible.

Side EffectPaxilLexapro
HeadacheYesYes
HeartburnYesYes
GasNoYes
WeaknessYesYes
DizzinessYesYes
FatigueYesYes
Increased sweatingYesYes
AnxietyYesYes
Shaking of the handsYesNo
InsomniaYesYes
Loss of appetiteYesYes
Weight changeYesYes
NauseaYesYes
VomitingYesYes
Dry mouthYesYes
Diarrhea or constipationYesYes
YawningYesYes
Vision changesYes*No
Sexual dysfunction (including a decrease in sex drive, impotence, difficulty ejaculating, or difficulty reaching orgasm)YesYes
Increased risk for glaucomaNoYes

Drug Interactions

Before starting a new medication it’s important to tell your provider about any medications or supplements you’re currently taking, as some may interact with Lexapro or Paxil to cause adverse reactions, including serotonin syndrome.

Serotonin syndrome symptoms include agitation, confusion, and an irregular heartbeat. 

This list does not include all of the possible drug interactions however, these are some of the more common ones.

DrugInteraction with PaxilInteraction with Lexapro
AntipsychoticsYesYes
DiureticsYesYes
FentanylYesYes
LithiumYesYes
MeperidineYesYes
Monoamine oxidase inhibitors (MAOIs)YesYes
Non-steroidal anti-inflammatory drugs (NSAIDs)YesYes
Other SSRIsYesYes
PimozideYesYes
Serotonin and norepinephrine reuptake inhibitors (SNRIs)YesYes
St. John’s WortYesYes
TramadolYesYes
Tricyclic antidepressantsYesYes
TryptophanYesYes
WarfarinYesYes
HIV medicationsYesYes
CodeineYesYes

Warnings for Paxil and Lexapro

In addition to the risk of serotonin syndrome, Paxil and Lexapro carry other warnings and precautions. 

Some rare but severe side effects are possible when taking Lexapro and Paxil, including suicidal ideation or suicidal thoughts. 

To ensure you’re taking the medication safely, it’s important to disclose any existing medical conditions, medications or supplements you’re currently taking, and whether or not you’re pregnant or plan to become pregnant with your provider.

Alcohol consumption should also be limited while taking these medications.  

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When to See a Healthcare Provider

It’s a good idea to reach out to your provider if you experience any persistent or worsening signs and symptoms of anxiety, depression, or another mental health condition.

Talking with your provider can help you determine whether or not an SSRI like Lexapro or Paxil is right for you. 

Do not stop taking the medication without speaking to a healthcare provider.

If you’ve already started taking an SSRI, be sure to reach out to your provider and go to the nearest healthcare facility immediately if you experience any uncontrollable thoughts, major mood changes, hallucinations, suicidal thoughts, or thoughts of hurting yourself or someone else. 

Though rare, you should seek immediate medical attention if you experience any severe side effects, such as:

  • Severe dizziness
  • Hives, or a red or purple rash with blistering or peeling
  • Itching or swelling, particularly of the mouth, face, or throat
  • Difficulty breathing
  • Seizure
  • Irregular heartbeat 
  • Chest pain
  • Confusion
  • Altered level of consciousness 
  • Fainting

How K Health Can Help

Think you might need a prescription for Lexapro (escitalopram) or a prescription for Paxil (paroxetine)?

K Health has clinicians standing by 24/7 to evaluate your symptoms and determine which prescription is right for you.

Get started with our free assessment, which will tell you in minutes if treatment could be a good fit. If yes, we’ll connect you right to a clinician who can prescribe medication and have it shipped right to your door.

Frequently Asked Questions

Which is better than Paxil for depression?
Some studies show that Lexapro (escitalopram) may be more effective at treating depression and anxiety. However, it’s important to keep in mind that Lexapro does not work for everyone and finding the right medication for your symptoms may take some time. If the first medication doesn’t work, there are many alternatives that you can try.
Is Paxil the strongest SSRI?
Paxil is the more potent inhibitor of the reuptake of serotonin. Partly because of its potency, the potential for withdrawal syndrome and side effects such as weight gain may be slightly higher with Paxil than with other SSRIs.

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.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

Nena Luster DNP, MBA, FNP-BC

Nena Luster is a board certified Family Nurse Practitioner with over 14 years of experience including emergency medicine, urgent care, and family practice. 

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