Lexapro versus cymbalta
Differences, similarities, and which is better for you
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Cymbalta and Lexapro are two prescription drugs most commonly used to treat both major depressive disorder (MDD) and generalized anxiety disorder (GAD). Major depressive disorder is estimated to affect approximately 16 million adults in the United States. It is characterized by a low mood for at least a two-week period. Patients may also exhibit a loss of interest in activities they normally enjoy or low energy. Some patients experience pain without any known cause.
Generalized anxiety disorder is estimated to affect 6.8 million adults in the United States. It is characterized by excessive worry about a variety of issues including money, family, health, and work. It is diagnosed once patients display this worry on more days than not for at least six months.
While Cymbalta and Lexapro are both used to treat these conditions and many others, there are some significant differences between the two medications.
What are the main differences between Cymbalta and Lexapro?
Cymbalta (duloxetine) is a prescription medication indicated in the treatment of both MDD and GAD. Cymbalta belongs to a group of antidepressants known as selective serotonin-norepinephrine reuptake inhibitors (SNRIs). In the neuron synapse, Cymbalta blocks the reuptake of both norepinephrine and serotonin. This leaves the neurotransmitters more readily available to play a positive role on mood and affect. Other SNRIs you may be familiar with are Effexor (venlafaxine) and Pristiq (desvenlafaxine).
Cymbalta is available as a 20 mg, 30 mg, and 60 mg oral capsule.
Lexapro (escitalopram) is also a prescription medication indicated in the treatment of both MDD and GAD. Lexapro belongs to the group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Lexapro works by blocking the reuptake of serotonin at the neuronal membrane transport pump. This action effectively leaves more free serotonin in the neuron synapse. Other SSRIs you may be familiar with include Prozac, Zoloft, Celexa, or Paxil.
Lexapro is available as an oral tablet in strengths of 5 mg, 10 mg, and 20 mg. It is also available as an oral solution in a 5 mg/5 ml concentration.
Conditions treated by Cymbalta and Lexapro
As previously mentioned, Cymbalta and Lexapro are both indicated to treat both major depressive disorder and generalized anxiety disorder. Cymbalta is approved for some unique indications related to neuropathic and musculoskeletal pain. These indications set Cymbalta apart from other antidepressant medications as it is the only one approved in pain-related diagnoses. Lexapro is sometimes used off-label for conditions such as obsessive compulsive disorder, bulimia nervosa, and binge eating.
The following chart provides a list of conditions treated by Cymbalta and Lexapro. It may not include all potential uses, and you should always consult with your healthcare professional to see if one of these drugs is right for you.
Is Cymbalta or Lexapro more effective?
A meta-analysis reviewed studies comparing duloxetine to escitalopram and other common SSRIs. The study found that in terms of the treatment of major depression, duloxetine fails to show a significant advantage in terms of treatment success over SSRIs. However, according to this review, patients are more likely to discontinue duloxetine due to adverse events. A second meta-analysis echoed these findings. It may not be possible to say if Cymbalta or Lexapro are better than the other in terms of treating depression. The increased rate of side effects with Cymbalta would be an important factor to consider when choosing a therapy.
Coverage and cost comparison of Cymbalta vs. Lexapro
Cymbalta is a prescription medication that is typically covered by both commercial and Medicare drug plans. The out-of-pocket price for Cymbalta 60 mg can be more than $300, but with a coupon from SingleCare, you could get the generic for as low as $15 at participating pharmacies.
Lexapro is also a prescription medication that is typically covered by both commercial and Medicare drug plans. The out-of-pocket price for a 30 day supply of Lexapro 10 mg can be as much as $400. SingleCare offers a coupon for generic Lexapro, which can lower the price to $10 or less.
prescription discount card
Common side effects of Cymbalta vs. Lexapro
Cymbalta and Lexapro have the potential to cause similar side effects, though some are more likely with one or the other agent. Nausea, for example, was only reported in 5% of patients taking Lexapro in clinical trials versus 23% of patients taking Cymbalta. While the nausea is not always a long-lasting side effect, it can impact a person’s quality of life. It is more likely to happen in the first few weeks of therapy, and given that these drugs generally take anywhere from two to six weeks to show an impact on depression or anxiety symptoms, nausea could be a reason for early discontinuation before the true benefit of the drug is known.
Perspiration, or sweating, occurs at a similar rate between the two drugs. This side effect may also impact a person’s daily life and self-esteem, and it could be a reason patients choose to discontinue the drug.
The following list is not intended to be a complete list of adverse events. Please consult a pharmacist, doctor, or another medical professional for a complete list of possible side effects.
Source: Cymbalta (DailyMed) Lexapro (DailyMed)
Drug interactions of Cymbalta vs. Lexapro
Cymbalta and Lexapro are each metabolized by the cytochrome enzyme system in the liver. Cymbalta is a major substrate for CYP1A2, and a moderate inhibitor of CYP2D6. It is important to note that some patients may suffer from attention disorders in addition to depression and anxiety disorders. Many patients with attention disorders are treated with amphetamines. Cymbalta can increase the serum concentration of amphetamines through its inhibition of CYP2D6. Patients taking this combination should be monitored closely.
Lexapro is a major substrate of CYP2C19 and CYP3A4, and a weak inhibitor of CYP2D6.
The use of Lexapro with tricyclic antidepressants, such as amitriptyline, may increase the risk of QT prolongation and serotonin syndrome. In general, this combination should be avoided.
The following list is not intended to be a complete list of drug interactions. It is best to consult your provider or pharmacist for a complete list.
Warnings of Cymbalta and Lexapro
Cymbalta and Lexapro will not produce an immediate remission of symptoms of either depression disorder or anxiety disorder. It will take a minimum of two weeks to notice any change in most post patients, and up to four to six weeks to realize the full effect of the medication. It is important patients understand this so they do not prematurely discontinue their medication with the belief that it is not working.
Patients with MDD may experience a worsening of depression or suicidal thoughts whether or not they are taking antidepressant medications. These conditions may worsen until remission is achieved. Cymbalta and Lexapro therapy may increase suicidal ideation and thoughts among teens and young adults, especially in the early stages of treatment before any type of remission is achieved. These patients must be monitored closely if this treatment is deemed medically necessary. A therapy change may be necessary if symptoms suddenly arise or get worse.
There have been reports of liver failure, sometimes fatal, with Cymbalta. These cases may present with abdominal pain and elevated liver enzymes with or without jaundice. The consumption of alcohol may increase this risk, and therefore this combination should be avoided.
Serotonin syndrome has been reported with all SSRIs and SNRIs, including Cymbalta and Lexapro. This is a condition related to abnormally high levels of serotonin and can result in the patient feeling agitated, dizzy, and having an increased heart rate. This can be brought on by the use of two serotonergic drugs together. It is important to refer to the manufacturer’s information on drug interactions when prescribing these drugs.
Frequently asked questions about Cymbalta vs. Lexapro
What is Cymbalta?
Cymbalta is a prescription antidepressant medication used in the treatment of major depression, generalized anxiety disorder, and various neuropathic and musculoskeletal pain disorders. Cymbalta is available as an oral capsule in 20 mg, 30 mg, and 60 mg strengths.
What is Lexapro?
Lexapro is a prescription antidepressant medication used in the treatment of major depression and generalized anxiety disorder. Lexapro is available as an oral tablet in 5 mg, 10 mg, and 20 mg strengths. It is also available as an oral solution.
Are Cymbalta and Lexapro the same?
While both Cymbalta and Lexapro treat depression and anxiety, they are not the same. Cymbalta blocks the reuptake of both serotonin and norepinephrine in the neuronal synapse, while Lexapro blocks serotonin reuptake only. Cymbalta carries additional indications for pain disorders.
Is Cymbalta or Lexapro better?
Cymbalta and Lexapro appear to be similarly effective in treating depression. Large meta-analyses of multiple studies indicate that the higher rate of adverse events with Cymbalta may be a reason to try Lexapro first in most patients.
Can I use Cymbalta or Lexapro while pregnant?
The Food and Drug Administration (FDA) considers both Cymbalta and Lexapro pregnancy category C, meaning there have not been adequate human studies to determine safety. With Cymbalta, non-teratogenic effects have been observed in newborns following the administration of Cymbalta while pregnant. These include respiratory distress, feeding difficulty, and tremors. With Lexapro use, animal studies have shown teratogenic effects to the fetus, including cardiovascular effects, and it has been determined that it crosses the human placenta. For these reasons, the use of Cymbalta or Lexapro in pregnancy must be weighed against potential harm to the fetus.
Can I use Cymbalta or Lexapro with alcohol?
Alcohol can increase the toxic effects of both Cymbalta and Lexapro. Drinking alcohol while taking these drugs can cause significant psychomotor impairment, and for this reason, patients are advised to avoid alcohol if taking Cymbalta or Lexapro. As previously discussed, alcohol consumption while on Cymbalta increases the likelihood of hepatic failure.
Does Cymbalta help with anxiety?
Cymbalta is approved in the treatment of generalized anxiety disorder. Patients should be educated that the drug will not provide immediate remission of anxiety symptoms, and some patients may need additional medication for acute anxiety episodes.
Does Cymbalta make you happy?
Cymbalta works by increasing available norepinephrine and serotonin. These neurotransmitters play a significant role in mood or affect. Patients who take Cymbalta may report feeling “happier” or less depressed, especially after four to six weeks of treatment.
Does Cymbalta change your personality?
Cymbalta will affect mood by increasing available norepinephrine and serotonin. For most patients, this induces a positive change in their mental health. If you notice a negative change in yourself or someone you care for while taking Cymbalta, including suicidal thoughts or ideations, seek help immediately.
Cymbalta vs. Lexapro: Similarities, Differences, & Side Effects
About 13.2% of adults in the U.S. take antidepressants.
Of the many types of antidepressants available, Cymbalta and Lexapro are commonly prescribed for the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD).
You may be experiencing adverse reactions with your current medication and considering your other options.
Although these two drugs have a similar mechanism of action—both affect the levels of serotonin in the brain—there are some differences.
In this article, we’ll discuss the differences and similarities between Cymbalta and Lexapro, the conditions they treat, and their effectiveness.
We’ll also compare the coverage and the cost of the medication, the common side effects, and the possible drug interactions of Cymbalta and Lexapro.
Take our free assessment and learn about your options.
What Are the Differences & Similarities Between Cymbalta and Lexapro?
Cymbalta and Lexapro are prescription drug antidepressants used to treat major depression and generalized anxiety disorder.
Cymbalta, the brand name for duloxetine, is a serotonin-norepinephrine reuptake inhibitor (SNRI).
This class of antidepressants works by preventing the reuptake (reabsorption) of two neurotransmitters in the brain called serotonin and norepinephrine.
The resulting increased levels of these chemical messengers helps to relieve symptoms of major depressive disorder and generalized anxiety disorder.
The FDA has also approved Cymbalta for the treatment of some pain conditions.
Lexapro, the brand name for escitalopram, is a selective serotonin reuptake inhibitor (SSRI).
It works by preventing the reuptake of serotonin in the brain, thereby increasing the levels of available serotonin.
Since serotonin is a neurotransmitter responsible for mood, sleep, and other bodily functions, increased amounts in the brain help ease symptoms of major depressive disorder and generalized anxiety disorder.
The table below provides an overview of how the two antidepressant medications compare:
|Drug class||Serotonin-norepinephrine reuptake inhibitors (SNRI)||Selective serotonin reuptake inhibitors (SSRI)|
|Standard dosage||60 milligrams (mg) once daily||10 mg once daily|
|Dosage strengths available||20 mg, 30 mg, and 60 mg||5 mg, 10 mg, and 20 mg|
|Dosage forms||Oral capsule||Oral tablet and oral solution|
|Recommended age group||7 years and older (generalized anxiety disorder)||12 years and older (major depressive disorder)|
What Conditions Are Treated with Cymbalta and Lexapro?
Both Cymbalta and Lexapro are prescription medications for the treatment of major depressive disorder and generalized anxiety disorder.
Cymbalta is also approved for treating some pain-related conditions, including fibromyalgia, diabetic peripheral neuropathic pain, and chronic musculoskeletal pain.
Cymbalta is the only antidepressant approved to treat neuropathic pain.
Lexapro is prescribed off-label for the treatment of conditions such as panic disorder, premenstrual dysphoric disorder, and obsessive-compulsive disorder.
When a doctor or healthcare provider prescribes a drug off-label, they prescribe it for a condition that the FDA has not approved.
Off-label prescription is not illegal, but your doctor should explain how the drug may help your condition.
Below is a summary of the conditions that Cymbalta and Lexapro are used to treat:
|Major depressive disorder (MDD)||Yes||Yes|
|Generalized anxiety disorder (GAD)||Yes||Yes|
|Irritable bowel syndrome (IBS)||Yes||Yes|
|Chronic musculoskeletal pain||Yes||No|
|Diabetic peripheral neuropathic pain (DPNP)||Yes||No|
|Obsessive-compulsive disorder (OCD)||No||Off-label|
|Premenstrual dysphoric disorder||No||Off-label|
|Posttraumatic stress disorder||No||Off-label|
|Social anxiety disorder||No||Off-label|
|Vasomotor symptoms of menopause||No||Off-label|
|Chemotherapy-induced peripheral neuropathy||Off-label||No|
|Stress urinary incontinence||Off-label||No|
This list is not conclusive.
Consult your doctor to know which medication is suitable for you.
Effectiveness of Cymbalta and Lexapro
A comparative study of escitalopram (Lexapro) and duloxetine (Cymbalta) found that escitalopram was superior to duloxetine for short-term treatment of depression.
The researchers also concluded that escitalopram is as effective as and more tolerable than duloxetine for long-term treatment.
Due to adverse reactions, the withdrawal rate of patients on duloxetine was 8% higher than that of patients on escitalopram.
Another study showed similar results: Escitalopram was better tolerated and at least as effective as duloxetine for treating major depressive disorder.
This is not to say that Lexapro is better than Cymbalta for treating depression, but rather that people were more likely to discontinue Cymbalta due to common adverse reactions.
Coverage & Cost of Cymbalta and Lexapro
Medicare and commercial insurance plans usually cover at least some of the cost of both generic versions and brand-name Cymbalta and Lexapro.
The exact cost of your medication varies depending on the brand and dosage, as well as your insurance and pharmacy.
A month’s supply of 30-milligram Cymbalta can cost almost $390, while a month of 20-milligram Lexapro can cost up to $260.
You may be able to save money using coupon codes with participating pharmacies.
Common Side Effects of Cymbalta and Lexapro
Cymbalta and Lexapro share similar side effects, although some are more pronounced using one drug than the other.
The table below covers the possible side effects, though this list is not exhaustive.
Most symptoms do not last past the first few weeks of starting either medication.
If you experience any of these symptoms, speak with your doctor.
They can help you manage them and, depending on how severe they are, may suggest switching to another antidepressant.
Take our free assessment and learn about your options.
Drug Interactions & Warnings
Cymbalta and Lexapro can have unpleasant reactions with other drugs.
Before starting either medication, inform your doctor of the other medicines you’re using, including vitamins and supplements.
Cymbalta and Lexapro should not be used within 14 days of using any monoamine oxidase inhibitors (MAOIs).
This class of antidepressants includes:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam)
- Tranylcypromine (Parnate)
- Linezolid (Zyvox)
- Intravenous methylene blue
Cymbalta and Lexapro also interact with other serotonergic medications such as:
- Tricyclic antidepressants
- St. John’s wort
Lastly, using Cymbalta and Lexapro with aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), warfarin, and other anticoagulants increases bleeding risk, including life-threatening hemorrhages.
Cymbalta or Lexapro also have side effects of their own.
People taking either medication for major depressive disorder or other psychiatric disorders are at risk for increased suicidal thoughts and behavior.
If you have any concerning thoughts, seek care immediately.
How K Health Can Help
Your choice of an antidepressant can affect the quality of your life. You need to consult a doctor to know which treatment plan will be best for you.
Think you might need a prescription for Cymbalta (duloxetine) or a prescription for Lexapro (escitalopram)?
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 for depression, Cymbalta or Lexapro?
Studies show that duloxetine (Cymbalta) and escitalopram (Lexapro) are equally effective at treating major depressive disorder long term. However, a randomized controlled trial reported that escitalopram was better tolerated. Your doctor can discuss all of the pros and cons with you when prescribing the right antidepressant for you.
Is Cymbalta a good replacement for Lexapro?
Since Cymbalta and Lexapro have similar efficacy in the treatment of depression, it can be a suitable replacement. One concern is that Cymbalta tends to be less tolerated, so people may be more likely to discontinue the medication. Also, Lexapro is prescribed off-label for some conditions that Cymbalta cannot be used for. Your doctor or healthcare provider can provide you with more information about whether it is a good choice for you.
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.
Antidepressant Use Among Adults: United States, 2015–2018. (2020).
A Comparative Study of the Efficacy of Acute and Continuation Treatment With Escitalopram Versus Duloxetine in Patients With Major Depressive Disorder. (2007).
Cymbalta Prices, Coupons and Patient Assistance Programs. (n.d.).
Double-Blind Comparison of Escitalopram and Duloxetine in the Acute Treatment of Major Depressive Disorder. (2007).
Lexapro Prices, Coupons and Patient Assistance Programs. (n.d.).
The Use of Antidepressants in the Treatment of Irritable Bowel Syndrome and Other Functional GI Disorders. (n.d.).
Home >> Drug Vs. Friend >> Cymbalta vs Prozac: Differences, Similarities & Which is Best for You
Drug Vs. Friend
Drug Overview and Key Differences | Conditions of treatment | Efficiency | Insurance coverage and cost comparison | Side effects | Drug Interactions | Warnings | FAQ
If you or your loved one is experiencing depression, anxiety or other mental health conditions, you are not alone. More than 16 million American adults have major depressive disorder (also called MDD or depression), and nearly 7 million adults have generalized anxiety disorder (GAD).
Cymbalta (duloxetine) and Prozac (fluoxetine) are two popular antidepressants prescribed for depression and several other conditions. Both prescription drugs are approved by the US Food and Drug Administration (FDA). The use of drugs with cymbalta or Prozac is often combined with psychotherapy by a psychologist or psychiatrist. nine0005
Cymbalta belongs to a group of medicines called SNRIs (serotonin-norepinephrine reuptake inhibitors). They work by increasing the levels of serotonin and norepinephrine in the brain.
Prozac belongs to a group of drugs called SSRIs (Selective Serotonin Reuptake Inhibitors). SSRIs work by increasing serotonin levels in the brain.
What are the main differences between Cymbalta and Prozac?
Cymbalta (duloxetine) is an SNRI medication. It is available in both branded and generic. Cymbalta is only available in capsule form. Dosage varies, but a typical dose is 60 mg per day. Cymbalta is used in adults, but under certain conditions it can be used at a younger age (see Table).
Prozac (fluoxetine) is an SSRI medication. It is available in both branded and generic. Prozac comes in the form of tablets, capsules, and oral solution. Although dosage varies, a typical dose is 20 mg once a day. Prozac can be used in adults for all of the indications listed in the table below. Prozac can also be used in children older than 8 years for depression or older than 7 years for OCD. nine0041
Diseases Treated by Cymbalta and Prozac
Cymbalta is indicated for major depressive disorder, diabetic peripheral neuropathic pain and chronic musculoskeletal pain in adults. It can also be used for generalized anxiety disorder in adults and children 7 years of age and older, and fibromyalgia in adults and adolescents 13 years of age and older. Cymbalta is not approved for use in children with depression, diabetic peripheral neuropathic pain, or chronic musculoskeletal pain. nine0005
Prozac is indicated for major depression and obsessive-compulsive disorder (OCD) in children, adolescents and adults. Prozac can also treat bulimia nervosa, premenstrual dysphoric disorder, and panic disorder. Prozac is not approved for use in children under 7 years of age.
Symbiax is a combination drug containing fluoxetine, an ingredient in Prozac, and another medicine called olanzapine. Symbiax may treat depressive episodes associated with bipolar I disorder or treatment-resistant depression. nine0041
Cymbalta or Prozac more effective? nine0025
One study looked at many studies comparing Cymbalta, Prozac, and another drug called Effexor with placebo. Cymbalta and Prozac were found to be similar in efficacy and safety in patients with depression.
Diagnosis is an important factor in deciding which remedy is more appropriate. For example, if depression is the indication, Prozac or Cymbalta may be a suitable option. However, if the diagnosis is OCD, Prozac is more appropriate because it is indicated for the treatment of OCD, while Cymbalt is not. And if the diagnosis is fibromyalgia, Cymbalta is more appropriate because it is indicated for fibromyalgia, and Prozac is not. nine0005
Your doctor can determine which drug is best for you based on your diagnosis, medical history and other medical conditions, and any medications you may be taking that may interact with Cymbalta or Prozac.
Cymbalta and Prozac coverage and cost comparison
Most Medicare Part D and prescription plans cover Cymbalta or Prozac - choosing the generic form will result in significant cost savings. Branded items have a much higher surcharge or may not be covered at all. nine0005
Cymbalta out of pocket costs about $126 for 30 60mg capsules. A free SingleCare card helps you save money on the versatile Cymbalta by dropping the price down to $15.
Prozac's out-of-pocket cost is about $21 for a 30-milligram generic capsule. You can save on generic Prozac with the SingleCare card, which can bring the cost of a generic to about $4.
Contact your health plan for the latest information about Cymbalta or Prozac coverage. nine0005