Lexapro vs. Prozac

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

Key Takeaways

  • Lexapro and Prozac are both SSRIs for major depressive disorder, but Prozac also treats OCD, panic disorder, and bulimia nervosa.

  • Lexapro uses a simple two-dose schedule, while Prozac requires titration and offers a once-weekly maintenance capsule.

  • Both carry a boxed warning for increased suicidal thoughts in young people and cannot be combined with MAOIs.

Lexapro vs. Prozac Drug Summary

Lexapro

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder and generalized anxiety disorder. It's taken once daily, usually starting at 10 mg and increasing to 20 mg after two weeks if needed.

Prozac

Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) approved for depression, OCD, panic disorder, and several other conditions. It's taken once daily during titration, then can switch to a once-weekly capsule for long-term maintenance.

Lexapro vs. Prozac Side Effects

Lexapro

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

Prozac

Most common
nausea (up to 21%)
insomnia (up to 33%)
somnolence (up to 12%)
anxiety/nervousness (up to 15%)

Lexapro vs. Prozac Dosage

Lexapro

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily At the start
Maximum dose 20 mg once daily Week 2 onward
Dose changes 1 increase As tolerated

Prozac

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily At the start
Maximum dose 90 mg once weekly If needed
Dose changes 2 increases As tolerated

Lexapro vs. Prozac Indications

Lexapro

Escitalopram is FDA-approved for major depressive disorder in adults and adolescents ages 12 to 17, and for generalized anxiety disorder in adults. It is not approved for younger children with depression or for anxiety disorders in pediatric patients.

  • Major depressive disorder (adults and adolescents 12-17)

  • Generalized anxiety disorder (adults)

  • Not approved for MDD in children under 12

  • Not approved for GAD in pediatric patients

Prozac

Fluoxetine is FDA-approved for major depressive disorder, obsessive-compulsive disorder, bulimia nervosa, and panic disorder, and in combination with olanzapine for bipolar I depression and treatment-resistant depression. It is sometimes used off-label for PMDD, binge eating disorder, and social anxiety disorder.

  • Major depressive disorder

  • Obsessive-compulsive disorder (OCD)

  • Bulimia nervosa and panic disorder

  • Bipolar I and treatment-resistant depression (with olanzapine)

Lexapro vs. Prozac Pros and Cons

Lexapro

Lexapro has a simple two-step dosing schedule and is FDA-approved specifically for depression and generalized anxiety disorder. Its side effect profile tends to be milder for gastrointestinal and sleep-related symptoms, though sexual side effects are common. Generic escitalopram is widely available and typically well covered by insurance.

Pros

  • Simple once-daily dosing with only one dose increase

  • Lower rates of insomnia and anxiety than Prozac

  • Specifically FDA-approved for generalized anxiety disorder

  • Generic escitalopram is widely stocked and affordable

Cons

  • Narrower range of FDA-approved uses (no OCD, panic, or bulimia)

  • Not approved for children under 12 with depression

  • Ejaculation disorder is a notably common side effect (up to 9%)

Prozac

Prozac covers a wider range of FDA-approved conditions, including OCD, panic disorder, and bulimia, and offers a once-weekly dosing option after stabilization. Its long-acting metabolite means missed doses cause fewer withdrawal symptoms, though it also takes longer to clear from the body. Generic fluoxetine is inexpensive and has been available for decades.

Pros

  • Broader FDA-approved uses, including OCD, panic disorder, and bulimia

  • Long half-life means missed doses are less likely to cause withdrawal

  • Only SSRI with an FDA-approved once-weekly dosing option

  • Only SSRI approved with olanzapine for treatment-resistant depression

Cons

  • Higher rates of insomnia and anxiety/nervousness than Lexapro

  • Long half-life can complicate switching to other antidepressants or MAOIs

  • Not approved for generalized anxiety disorder as monotherapy

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