Lexapro vs. Cymbalta

See how Lexapro and Cymbalta compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Lexapro is an SSRI approved for depression and anxiety, while Cymbalta is an SNRI also approved for chronic pain conditions like fibromyalgia and diabetic nerve pain.

  • Cymbalta requires a week-long titration up to 30 mg before its maintenance dose, while Lexapro starts right at a 10 mg maintenance dose.

  • Nausea and somnolence are common with both drugs, but Cymbalta's reported rates for these and other side effects run higher than Lexapro's.

Lexapro vs. Cymbalta Drug Summary

Lexapro

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) approved to treat major depressive disorder and generalized anxiety disorder in adults, and depression in adolescents 12 to 17. It is taken as a single daily tablet or oral solution, usually starting at 10 mg.

Cymbalta

Cymbalta (duloxetine) is a serotonin and norepinephrine reuptake inhibitor (SNRI) approved for depression, generalized anxiety disorder, and several chronic pain conditions including diabetic nerve pain and fibromyalgia. It is taken as a delayed-release capsule, starting at 30 mg for one week before increasing, with pain doses sometimes split twice daily.

Lexapro vs. Cymbalta Side Effects

Lexapro

Most common
nausea (up to 15%)
somnolence (up to 6%)
insomnia (up to 9%)
ejaculation disorder (up to 9%)

Cymbalta

Most common
nausea (up to 30%)
somnolence (up to 21%)
headache (up to 18%)
dizziness (up to 17%)

Lexapro vs. Cymbalta Dosage

Lexapro

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily Week 1
Maximum dose 20 mg once daily Week 2 onward
Dose changes 1 increase Every week

Cymbalta

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 30 mg once daily Week 1
Maximum dose 60 mg twice daily If needed
Dose changes 2 increases Every week

Lexapro vs. Cymbalta Indications

Lexapro

Lexapro is FDA-approved to treat major depressive disorder in adults and adolescents ages 12 to 17, as well as generalized anxiety disorder in adults. It is not approved for depression in children under 12 or for anxiety in pediatric patients.

  • Major depressive disorder in adults and teens 12-17

  • Generalized anxiety disorder in adults

  • Not approved for pediatric anxiety

  • Available as tablet or oral solution

Cymbalta

Cymbalta is FDA-approved for major depressive disorder and generalized anxiety disorder, plus three pain-related conditions: diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain. This makes it one of the few SNRIs approved for both psychiatric and chronic pain use.

  • Major depressive disorder

  • Generalized anxiety disorder

  • Diabetic peripheral neuropathic pain

  • Fibromyalgia

Lexapro vs. Cymbalta Pros and Cons

Lexapro

Lexapro's clinical profile centers on psychiatric use only, with a side effect pattern that tends to be milder than Cymbalta's in trials. Generic escitalopram is widely available, which often makes it an affordable pick for insured and uninsured patients alike.

Pros

  • Approved for depression and anxiety, not marketed for pain

  • Lower reported rates of nausea and somnolence than Cymbalta

  • Generic escitalopram is widely available

Cons

  • Not approved for any chronic pain condition

  • Sexual side effects like ejaculation disorder are common

  • Contraindicated with MAOIs and pimozide

Cymbalta

Cymbalta's dual approval for mood and pain conditions makes it a common choice for patients managing both, though its side effect rates run higher across the board. Its titration schedule and organ-related precautions call for more monitoring than a simpler SSRI.

Pros

  • Approved for chronic pain conditions like diabetic neuropathy and fibromyalgia

  • Twice-daily high-dose option available for pain control

  • Broader label covering five separate FDA-approved conditions

Cons

  • Higher reported rates of nausea, somnolence, headache, and dizziness

  • Must be avoided in liver disease, cirrhosis, or severe kidney impairment

  • More complex titration schedule with multiple dose steps

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