Prozac vs Lexapro: Differences and Similarities

By Craig Sorkin, DNP, APN
Medically reviewed checkmarkMedically reviewed
March 15, 2022

Prozac and Lexapro are both popularly prescribed antidepressants.

They are both approved by the Food and Drug Administration to treat depression, which according to the World Health Organization (WHO) affects 280 million people around the world.

Both Lexapro and Prozac are a type of antidepressant called a selective serotonin reuptake inhibitor, or SSRI.

But they are not the same medication.

One or the other may be right for you and your symptoms.

In this article, I’ll explore ways that Lexapro and Prozac are alike, how they differ, their side effects, and other medications that can interact with each of these antidepressants.

Prozac vs. Lexapro

Prozac, the brand name of fluoxetine, and Lexapro, the brand name for escitalopram, are two types of antidepressants.

They are both selective serotonin reuptake inhibitors, or SSRIs.

These types of antidepressants work to prevent the clearance of serotonin from the brain.

Serotonin is a type of chemical in the brain and body called a neurotransmitter.

Neurotransmitters carry messages for your nervous system.

Usually, when the message is finished being carried, serotonin is reabsorbed by the brain, a process called “reuptake.” 

Serotonin levels in the brain can promote a better mood, feelings of calm, and well-being.

People who clear serotonin too quickly may experience symptoms of depression or anxiety.

SSRIs help slow the process of reuptake, or clearing of serotonin.

This can help balance the amount available in the brain, alleviating depression symptoms.

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Prozac side effects

Side effects of Prozac may include:

Lexapro side effects

Common side effects of Lexapro may include:

  • Nausea
  • Sleepiness
  • Weakness
  • Dizziness
  • Anxiety
  • Trouble sleeping
  • Sexual problems
  • Sweating
  • Shaking
  • Lack of appetite
  • Dry mouth
  • Constipation
  • Infection
  • Yawning

Serious side effects of both

Antidepressants come with the potential for serious side effects and risks.

Serious potential side effects of Lexapro and Prozac include:

  • Suicidal thoughts or actions: Watch out for changes in behavior, mood, actions, thoughts, or feelings (especially if sudden or severe). These can be signs of serious side effects of antidepressants, and typically occur within the first few months of starting a medication or if the dosage is adjusted. If you notice these signs or symptoms, seek emergency medical care immediately.
  • Serotonin syndrome: This life-threatening condition can include symptoms like agitation, hallucinations, coma, or severe changes to mental status. It can also include muscular coordination problems, twitching, racing heartbeat, sudden changes in blood pressure, fever, nausea, vomiting, or diarrhea. If you notice any of these symptoms together, seek emergency medical help. Serotonin syndrome requires care in an emergency room.
  • Severe allergic reactions: If you notice trouble breathing, swelling of the face, tongue, eyes, or mouth, or develop a rash or hives, tell your healthcare provider immediately.
  • Bleeding problems: Antidepressants may increase your risk of bleeding or bruising especially if you take blood-thinning medication, nonsteroidal anti-inflammatories (NSAIDs, including ibuprofen), or aspirin.
  • Manic episodes: If you experience racing thoughts, sudden impulsive behavior, talking much faster or more than usual, or other personality changes, tell your doctor right away.

This list of side effects may not be complete and may not reflect your experience with Lexapro or Prozac.

Your pharmacist or prescribing physician will help you understand the risks, side effects, and warnings that you should be aware of.

Always read your prescription insert and follow the dosing instructions carefully.

Never stop taking antidepressants without consulting your doctor.

Most antidepressant medications require tapering to avoid withdrawal symptoms or other complications, relapses, or recurrence of symptoms.

Costs and availability of each

Lexapro (escitalopram) and Prozac (fluoxetine) are both available in brand names and generics.

Insurance and Medicare typically cover generics and brand names, but generic options are significantly less costly. 

Lexapro is available as a tablet or oral solution, with a typical daily dose of 10-20 mg.

Prozac is available as a tablet, capsule, or oral solution, with a typical daily dose that can range from 20-80 mg.

Conditions treated by both

Lexapro and Prozac are both approved by the Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD), the most common type of depression-related diagnosis.

MDD is sometimes referred to as being clinically depressed, and is characterized by a persistently low mood, loss of interest in usual activities, and impairment in the functioning of everyday life.

It may be associated with changes in appetite, energy levels, ability to sleep (or suddenly sleeping a lot more), as well as poor concentration and low self-esteem.

In rarer cases, it can include thoughts of self-harm or suicide.

Lexapro is also approved to treat generalized anxiety disorder (GAD).

Prozac is also approved to treat obsessive-compulsive disorder (OCD), panic disorder, bulimia, binge eating disorder, premenstrual dysphoric disorder (PMDD), bipolar depression, and treatment-resistant depression when paired with other medications.

Lexapro and Prozac may both be used off-label for social anxiety disorder, and post-traumatic stress disorder (PTSD).

Interactions with Prozac and Lexapro

Antidepressants like Prozac and Lexapro have many potential food and drug interactions.

Interactions may also occur with herbal supplements, vitamins, and minerals.

Always tell your prescribing physician of everything that you take, even occasionally, such as over-the-counter medications, multivitamins, other supplements, alcohol, or illicit drugs.

Interactions that may occur with Prozac and Lexapro include:

  • Alcohol
  • MAOIs (monoamine oxidase inhibitors)
  • Linezolid
  • Pimozide
  • Triptans
  • Tricyclics
  • Lithium
  • SSRIs
  • SNRIs
  • Amphetamines
  • Anticonvulsants
  • Antipsychotics
  • Tramadol
  • Tryptophan
  • St. John’s wort

This is not a complete list of potential interactions.

Consuming alcohol, illicit drugs, or other substances with Prozac or Lexapro can change the way that your body metabolizes the drug, resulting in serious side effects or severe reactions.

Always tell your doctor what you are taking, and do not start taking new medications, supplements, or OTC medications without consulting your doctor first if you are taking SSRIs or other antidepressants.

Which is Better?

The antidepressant that works best for you depends on several factors, including your genetic profile, your age, your weight, your other health conditions, other medications you take, your symptoms, and more.

Your doctor will do their best to prescribe a medication that has the highest potential for alleviating your symptoms without causing excessive side effects.

Occasionally, there is a trial and error period with these types of medication.

While your provider is knowledgeable about your condition and the medications used to treat them, everyone has a different metabolism, and may experience different effects or side effects from medications.

Studies that have compared Lexapro and Prozac have found that, like many other SSRIs, they work about the same.

Most antidepressants take a few weeks to build up in your system and start addressing symptoms, so it’s not always possible to tell how well one is working until you have tried it for a few months.

Always tell your healthcare provider if you feel that your symptoms are worse or you do not notice any improvements.

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When to See a Doctor

If you are noticing signs of depression, such as changes in mood, feeling frequently feeling sad or tired, or having reduced motivation for daily life, talk to your doctor.

Depression does not always make you feel sad, but may interfere with your ability to function well, or may increase feelings of agitation, anger, or frustration.

There are many treatment options available for depression.

Your doctor will consider your symptoms and other health factors and suggest a course of treatment, which may include medications, lifestyle changes, talk therapy, and more.

If you have questions about whether or not you are depressed, having a conversation with your healthcare provider can help give you context and a plan of action.

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

Which is better, Prozac or Lexapro?
Prozac and Lexapro are in the same drug class and have similar therapeutic potential. But one may work better for you than the other—your genetic makeup and other health factors may determine which will be best for you. Your doctor will prescribe the most effective medication for you based on your symptoms and other health needs.
How does Prozac differ from Lexapro?
Prozac and Lexapro are both in the same drug class, called selective serotonin reuptake inhibitors, or SSRIs. While they work similarly, they are FDA-approved to treat some different conditions and have different off-label uses. Their costs vary widely, although they are both available as generics. In regards to treatment, both work about the same, and have similar results according to studies comparing them.

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.

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.