Effexor XR vs. Lexapro: Similarities and Differences

Medically reviewed by Femi Aremu, PharmD

Effexor XR (venlafaxine) and Lexapro (escitalopram) are prescription medications used to treat depression and anxiety.

Venlafaxine is classified in a group of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). Immediate-release (IR) venlafaxine is only available in its generic form. It is U.S. Food and Drug Administration- (FDA) approved to treat depression.

Effexor XR is an extended-release (ER) form of this medication. It is also approved to treat depression plus certain types of anxiety disorders.

Lexapro is classified in a group of drugs called selective serotonin reuptake inhibitors (SSRIs) and contains the active ingredient escitalopram.

This medication is FDA-approved to treat depression and generalized anxiety disorder. Unlike Effexor XR, it can be used for children and adolescents of a certain age.

Effexor XR and Lexapro are both popularly prescribed medications. This article will discuss their similarities and differences.

What Is Effexor XR and How Does It Work?

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). The IR generic version is approved to treat major depressive disorder.

Effexor XR, the ER version of venlafaxine, is FDA-approved to treat:

• Depression, or major depressive disorder

• Generalized anxiety disorder (persistent and ongoing worrying and anxiety)

• Social anxiety disorder (anxiety around social interactions)

• Panic disorder (people with this condition have sudden episodes of intense fear or panic attacks)

This medication is often the first choice for treating symptoms of depression and anxiety.

SNRIs work by increasing brain levels of serotonin and norepinephrine, which are neurotransmitters or chemical messengers.

• Serotonin is involved in many body functions, such as mood, sleep, memory, and appetite.

• Norepinephrine (also called noradrenaline) is also involved in many functions, such as energy, attention, and focus.

Increasing levels of these neurotransmitters helps improve symptoms.

Off Label Uses

Some healthcare providers prescribe venlafaxine off-label to children and adolescents. It is considered an off-label use because this medication is not FDA-approved for use in children and adolescents. Some other examples of off-label uses may include:

• Obsessive-compulsive disorder (OCD) in adults.

• Hot flashes due to menopause.

What Is Lexapro and How Does It Work?

Lexapro is an SSRI. It works by increasing levels of serotonin in the brain.

Like venlafaxine, Lexapro is often a first-choice medication for anxiety and depression.

Lexapro is FDA-approved in adults and adolescents 12 years and older to treat depression. It can also be used to treat anxiety in adults and children 7 years and older. This medication is available as:

• A tablet that is taken by mouth (available in both brand name and generic)

• A solution (liquid) that is taken by mouth (available in generic only)

Off-Label Uses

Some healthcare providers prescribe Lexapro off-label for:

• Irritability in children and adolescents 6 years and older with autism

• Panic disorder in adults
  

Dosing Guidelines

Dosing recommendations for Effexor XR, IR venlafaxine, and Lexapro can vary. Always talk to your healthcare provider about the proper dosage guidance for your needs.

Effexor XR vs. Lexapro: How Long Do They Take to Work?

The body absorbs Effexor XR and Lexapro at similar rates, although it is slightly different for the IR version of venlafaxine. Still, all of these medications may start to improve symptoms within a few weeks, although exactly how long it takes to work varies from person to person.

Effexor XR

When you take venlafaxine, it is processed, or metabolized, in the body as venlafaxine, as well as an active metabolite (a modified form of the medicine that has an effect on the body) called O-desmethylvenlafaxine:

• A dose of IR venlafaxine reaches its maximum levels at 2 hours for venlafaxine and 3 hours for O-desmethylvenlafaxine.

• A dose of ER venlafaxine (Effexor XR) reaches its maximum levels at 5.5 hours for venlafaxine and 9 hours for O-desmethylvenlafaxine. It is absorbed slower but to the same extent.

Symptoms like sleep, energy, and appetite may start to improve within the first two weeks. However, it may take up to about eight weeks to notice the full effects of this medication.

Lexapro

A dose of Lexapro reaches its maximum effect within about 5 hours. Like Effexor, symptoms may start to improve within two weeks. However, it can take up to about eight weeks to see the full effects.

Side Effects & Precautions

All antidepressants have a boxed warning, the most serious warning required by the FDA. This includes both Effexor XR and Lexapro.

The warning states that in clinical studies, children, adolescents, and young adults who took antidepressants had an increased risk of suicidal thoughts and behaviors. People of any age who take an antidepressant like Effexor XR or Lexapro should be closely monitored for any changes in mood or behavior or any suicidal thoughts.

However, remember that venlafaxine is not FDA-approved for use in children or adolescents. Lexapro is not approved for use in children under 7 years old.

Like most medications, Effexor XR and Lexapro have other side effects that you might experience while taking them. Some are mild, while others may be more severe.

Effexor XR

Common side effects of Effexor XR include:

• Drowsiness

• Dizziness

• Headache

• Stomach problems such as nausea, vomiting, stomach pain, gas, heartburn, and diarrhea or constipation

• Dry mouth
  

• Altered taste

• Appetite and weight loss

• Numbness and tingling

• Tremor

• Yawning

• Sweating

• Urination problems such as frequent urination or difficulty urinating

• Sexual problems, such as decreased sex drive (libido), impotence (inability to get or keep an erection), and abnormal ejaculation

Serious side effects of Effexor XR may include:

• Anaphylaxis (serious allergic reaction): Get emergency medical help if you have urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat

• Seizures

• Unusual bleeding or bruising; small purple spots on the skin

• Serotonin syndrome

• Low sodium levels

• High blood pressure

• Angle-closure glaucoma (a medical emergency due to a rapid increase in eye pressure)
  

Lexapro

Common side effects of Lexapro include:

• Stomach problems like stomach pain, heartburn, nausea, diarrhea, or constipation

• Sexual problems

• Drowsiness

• Dizziness

• Yawning

• Shaking

• Trouble falling asleep or staying asleep

• Sweating

• Dry mouth
  

• Appetite and weight loss

• Flu-like symptoms, such as a runny nose or sneezing

Serious side effects of Lexapro may include:

• Anaphylaxis

• Unusual or excessive excitement

• Hallucinations

• Fever

• Joint pain

• Serotonin syndrome

• Unusual bleeding or bruising, including nosebleeds

• Low sodium levels

• Angle-closure glaucoma

• Headache

• Unsteadiness

• Difficulty with thinking, concentration, or memory

• Seizures

• Difficult and/or painful urination

Help Is Available

If you are experiencing symptoms of depression, talk to your healthcare provider. If you or someone you know is in suicidal crisis or emotional distress, you can call 988 for the Suicide & Crisis Lifeline. The line is open 24 hours a day, seven days a week in the United States, providing free, confidential support. You can also call 911 and go to the nearest emergency room if you or someone you know is in a suicidal crisis.

Potential for Interaction

Before taking Effexor or Lexapro, tell your healthcare provider about all of the medicines you take, including:

• Prescription medications

• Over-the-counter medicines

• Vitamins

• Other dietary and herbal supplements

Do not start any new medications while taking Effexor XR or Lexapro without approval from your healthcare provider. Some examples of drug interactions are listed below.

Because Effexor XR and Lexapro both affect serotonin, taking these medications with other drugs that affect serotonin levels can lead to a condition called serotonin syndrome, a condition caused by the build-up of serotonin levels. This can range from mild to life-threatening and can cause death if not treated.

Serotonin syndrome symptoms may include:

• Agitation

• Restlessness

• Unusual eye movements

• Stomach problems such as nausea, vomiting, and diarrhea

• Fast heartbeat

• High blood pressure or rapidly changing blood pressure

• Hallucinations (sensing things are there but they are not, such as seeing or hearing things)

• Increased body temperature

• Incoordination

• Overactive reflexes

Examples of drugs that affect serotonin include, but are not limited to:

• Other antidepressants, such as amitriptyline or monoamine oxidase inhibitors (MAOIs)

• Opioid pain medications such as Conzip (tramadol)

• Triptans for migraine, such as Imitrex (sumatriptan)

Antidepressants that affect serotonin also can increase the risk of bleeding. Certain medications can also affect bleeding.

Check with your healthcare provider if you take any blood thinner medication (such as warfarin), aspirin, or any nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin (ibuprofen) or Mobic (meloxicam).

This is not a complete list of drug interactions. Other drug interactions may occur with Effexor XR or Lexapro. Consult your healthcare provider for more information about drug interactions and how they may affect you.

Summary

SNRIs like Effexor XR and SSRIs like Lexapro are commonly prescribed to treat various mental health conditions, such as anxiety and depression, along with other methods like therapy.

These drugs have various similarities and differences. While they are similarly effective, Effexor XR and Lexapro differ in their dosing, the age groups that can take them, and how they work.

You can talk to your healthcare provider for more information about Effexor XR and Lexapro and see which treatment is appropriate.

Read the original article on Verywell Health.