Effexor (venlafaxine) and Lexapro (escitalopram) are two commonly prescribed antidepressants used to treat depression and anxiety. Both medications have been on the market for a long time and are prescribed for patients with symptoms of depression. While both can be very effective, they have different mechanisms of action, potential side effects, and drug interactions, including differences in their association with weight gain. Learning as much as you can now will help you navigate the hard times.
Main Differences Between Effexor and Lexapro
While both Effexor and Lexapro are considered antidepressants, they work in the body differently. Effexor, also known as venlafaxine, is an SNRI, or selective serotonin-norepinephrine reuptake inhibitor. SNRIs help the body by increasing the availability of multiple neurotransmitters including norepinephrine, serotonin, and dopamine. Lexapro, also known as escitalopram, is an SSRI, or selective-serotonin reuptake inhibitor. Escitalopram directly affects the availability of serotonin in the body.
Effectiveness
Both Effexor and Lexapro are effective in treating depression. However, effectiveness is based on a broad population. In every population there are those who may experience greater side effects than the rest and this may be a factor of their genetics. If your genetics were tested prior to using these medications, you may find that one is a better choice than the other. Effexor is stopped more frequently than Lexapro due to adverse reactions. When surveyed, 25% of patients reported a negative experience with Effexor use while only 16% of patients reported a negative experience with Lexapro.
Conditions Treated
Effexor and Lexapro are both indicated in the treatment of major depressive disorder and generalized anxiety disorder. Effexor also carries indications for both social phobia and panic disorder. There are some off-label uses of both drugs as well. Off-label use is the utilization of a drug for an indication not approved by the Food and Drug Administration (FDA). Effexor has been used without FDA approval for obsessive-compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), and hot flashes related to menopause.
Effexor:
- Adults: FDA approved to treat major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder, and panic disorder. Off-label treatment includes migraine prophylaxis, post-traumatic stress disorder (PTSD), neuropathic pain, and cataplexy.
- Pediatrics: Has been used off-label to treat major depressive disorder (MDD), generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), and cataplexy.
Lexapro:
- Adults: FDA approved to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD).
- Pediatrics: FDA approved to treat major depressive disorder (MDD). Off-label uses may include social anxiety disorder and autism.
Pros and Cons of Effexor
Benefits of Effexor
- Effexor affects multiple neurotransmitters and may benefit your mental disorder better than an SSRI, or selective serotonin reuptake inhibitor, alone.
- Effexor has the side benefit of helping with chronic pain, including nerve pain.
- Effexor is available to treat numerous different mental health indications.
- Effexor (venlafaxine) is a serotonin-norepinephrine reuptake inhibitor (SNRI) that increases serotonin and norepinephrine levels in the brain by slowing their uptake. Its dual-action mechanism can improve both mood and energy levels.
Side Effects of Effexor
- Common side effects: abnormal dreams, blurred vision, constipation, decreased appetite, diarrhea, dizziness, drowsiness, dry mouth, flu-like syndrome, headache, high cholesterol, insomnia, nausea, sexual dysfunction, sweating, weight loss, yawning
- Severe side effects: suicidal thoughts, increased depression, hypomania/mania, serotonin syndrome, bleeding, severe rash, angle-closure glaucoma, seizures, low sodium, heart irregularities, hepatotoxicity, extrapyramidal symptoms
Drug Interactions of Effexor
There are multiple drug interactions with Effexor.
Read also: Weight Management on Effexor
- Alcohol with Effexor may make you dizzy, drowsy, or have a difficult time concentrating. It is recommended to avoid alcohol while being treated with Effexor.
- Cimetidine: If you have high blood pressure, liver disease, or are becoming elderly it would be best to avoid taking cimetidine while you are being treated with Effexor.
- Clozapine and Effexor can increase clozapine levels making it more likely for you to have an adverse reaction.
- Drug testing: False-positive urine tests for phencyclidine (PCP), and amphetamine have been found while taking Effexor.
- Haloperidol levels may increase while taking Effexor leading to higher risk of adverse reactions.
- Imipramine levels may increase with Effexor.
- Indinavir levels may be reduced, potentially bringing the concentration down to a level that is insufficient for treatment.
- Ketoconazole use can increase the concentrations of Effexor, which may increase the risk of an adverse reaction.
- MAOIs: Increases risk of serotonin syndrome.
- Risperidone metabolism is reduced in the presence of venlafaxine.
- Serotonergic drugs increase the risk of serotonin syndrome. Serotonergic medications include SSRIs, SNRIs, quetiapine, sumatriptan, buspirone, lithium, St. John’s Wort, MDMA (ecstasy), and psilocybin (magic mushrooms) as well as many others.
- Taking Effexor with other medications that affect serotonin levels in the body can increase the risk of serotonin syndrome. Serotonin affects multiple parts of our body including our brains, heart, and digestive system. With serotonin toxicity, you may experience an elevated blood pressure, fast heart rate, fever, shivering, sweating, muscle spasms, confusion, hallucinations, seizures, and coma.
- Warfarin, a blood thinner, with concurrent use of Effexor increases INR, prothrombin time, partial thromboplastin time, increasing your risk of internal bleeding.
- Avoid 5-HTP, ephedra, kava, SAMe, and yohimbe. (These are all available without a prescription.)
Pros and Cons of Lexapro
Benefits of Lexapro
- Lexapro, or escitalopram, is the active metabolite of citalopram. This means that when you take Lexapro, the liver does not have to make it active to work. It may work better for you than citalopram and you may not need as large a dose to notice a benefit.
- Comes as a solution or a tablet and is long acting.
- Lexapro is one of the few antidepressants with FDA approval for children and is approved for the treatment of major depressive disorder.
- Lexapro, on the other hand, is in the class of drugs known as selective serotonin reuptake inhibitors (SSRIs).
Side Effects of Lexapro
- Common side effects: abnormal dreams, constipation, decreased appetite, diarrhea, dizziness, drowsiness, dry mouth, flu-like syndrome, headache, insomnia, nausea, sexual disfunction, sweating, vomiting, yawning
- Severe side effects: suicidal thoughts, increased depression, mania, serotonin syndrome, bleeding, severe rash, seizure, low sodium, priapism, extrapyramidal symptoms
Drug Interactions of Lexapro
- Alcohol is not recommended with Lexapro due to possible increased dizziness, drowsiness, and reduced concentration.
- Blood clotting agents: All SSRIs, including Lexapro, increase the risk of bleeding.
- Carbamazepine may alter the clearance of Lexapro increasing the side effects of Lexapro.
- Cimetidine may increase the levels of Lexapro in the blood, potentially increasing the risk for adverse reactions.
- CNS drugs: Any medication or drug that affects your central nervous system may be impacted negatively when taken with another central nervous system medication. Monitor for increased side effects and discontinue medications that are no longer needed.
- Ketoconazole taken while using Lexapro will reduce the concentration of ketoconazole potentially making ketoconazole less effective.
- Lithium can increase the serotonergic effects of escitalopram which can lead to serotonin syndrome.
- MAOIs increase the risk of serotonin toxicity.
- Pimozide and Celexa, citalopram, may increase the QTc of the heart which could lead to a heart attack or heart failure. Escitalopram (or Lexapro) is the active metabolite of Celexa.
- Serotonergic drugs increase the risk of serotonin syndrome. Taking more than one medication that affects serotonin levels greatly increases your risk of serotonin syndrome. This is an additive effect. You may be on one or two medications that affect serotonin levels and tolerate them well, but when you add a third or increase a dose the levels may reach a point of serotonin toxicity.
- Sumatriptan use with Lexapro may lead to weakness, hyperreflexia, and incoordination. Monitor carefully if you need to use sumatriptan to treat a migraine.
- Triptans increase the risk of serotonin syndrome.
Weight Gain: What the Studies Suggest
Weight gain is a key reason that some people decide to stop antidepressants, even if they're otherwise working well," says Dr. Roy Perlis, associate chief of psychiatric research at Massachusetts General Hospital. Antidepressants are a group of medications commonly used to treat chronic mental health conditions, particularly major depression. Reports have suggested that certain antidepressants can sometimes have weight gain as a side effect.
A study recently published in the Annals of Internal Medicine examined weight changes related to several common antidepressants. Through their research, which included 183,118 participants, the study authors found that people taking bupropion (brand name Wellbutrin) were the least likely to experience weight gain, while participants taking escitalopram (Lexapro, Cipralex), paroxetine (Paxil, Seroxat), and duloxetine (Cymbalta) were the most likely to experience weight gain.
Researchers found that at the 6-month point, compared to sertraline, bupropion was associated with less weight gain. In contrast, escitalopram, duloxetine, paroxetine, venlafaxine (Effexor), and citalopram were associated with more weight gain.
Researchers also estimated that escitalopram, paroxetine, and duloxetine each had an associated 10-15% higher risk of gaining 5% of baseline weight or more. Bupropion had an associated 15% reduced risk of gaining 5% of baseline weight or more.
After 2 years, duloxetine and venlafaxine were associated with less weight gain than sertraline.
Read also: Effexor's Impact on Weight
Important Considerations Regarding Weight Gain Studies
- The study points out average weight gain. Many people taking antidepressants won't gain any weight and others could gain more.
- The study was observational, meaning it cannot prove that antidepressants cause weight changes, only that they were linked with them.
- Only about one in three participants was still taking their initially prescribed medication six months after the study started.
- The researchers lacked certain data that could have impacted the results. For example, they did not have data on medication dispensing.
- Participants also had low medication adherence. The study authors also noted they had incomplete data on adherence and weight measures across time points.
- The research did not look at dose-response effects either.
- Almost 80% of participants were white, and 65% were female, which could influence the generalizability of the results.
Dosage and Half-Life
Generalized anxiety disorder (GAD) & depression: The starting dose is 75 mg/day, divided into 2-3 doses. Panic disorder: The starting dose is 37.5 mg/day, taken once daily (morning or evening).
A medication’s half-life refers to how long it takes for the body to eliminate half of the drug from the bloodstream. Lexapro has a longer half-life than Effexor. Lexapro’s half-life is around 27 - 33 hours, whereas Effexor’s immediate-release version has a half-life of about 5 hours, and the extended-release version, Effexor XR, has a half-life of approximately 11 hours.
General Information
Effexor and Lexapro are both prescription-only medications used in the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD). Symptoms of depression may include low mood for at least a two-week period and loss of interest in normal activities. Generalized anxiety disorder is characterized by excessive worry about a variety of issues including money, health, family, and work occurring more days than not for the past six months. Both MDD and GAD affect millions of Americans, and adequate treatment is important for quality of life. Treatment of depression or anxiety may include increased physical activity, meditation, or psychotherapy.
The effects of Effexor and Lexapro are not immediate. It may take between two and six weeks to see any effect from the drugs. Patients with depression may experience a worsening of symptoms or suicidal thoughts whether or not they are taking antidepressant medications. These conditions may worsen until remission is achieved. Effexor 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.
Effexor and Lexapro should not be stopped suddenly or without your prescriber’s knowledge.