Lexapro vs. Remeron

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

Key Takeaways

  • Lexapro is an SSRI approved for depression and generalized anxiety, while Remeron is a tetracyclic antidepressant approved only for depression.

  • Remeron causes far more sedation, appetite increase, and weight gain, while Lexapro more often causes nausea and sexual side effects.

  • Both carry a boxed warning for suicidal thoughts in children, adolescents, and young adults and cannot be combined with MAOIs.

Lexapro vs. Remeron Drug Summary

Lexapro

Lexapro (escitalopram) is an SSRI antidepressant approved for major depressive disorder and generalized anxiety disorder in adults. It comes as a tablet or oral solution taken once daily, usually starting at 10 mg and moving to 20 mg after two weeks if needed.

Remeron

Remeron (mirtazapine) is a tetracyclic antidepressant approved for major depressive disorder in adults. It is taken once daily, typically at bedtime, starting at 15 mg and titrated up to a maintenance dose of 45 mg, and is available as a standard or dissolving tablet.

Lexapro vs. Remeron Side Effects

Lexapro

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

Remeron

Most common
somnolence (54%)
dry mouth (25%)
increased appetite (17%)
constipation (13%)

Lexapro vs. Remeron Dosage

Lexapro

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily Week 2 onward
Maximum dose 20 mg once daily Same as starting
Dose changes None Fixed dose

Remeron

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 15 mg once daily At the start
Maximum dose 15 mg once daily Same as starting
Dose changes None Fixed dose

Lexapro vs. Remeron Indications

Lexapro

Lexapro is FDA-approved for major depressive disorder in adults and adolescents 12 to 17, and for 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

  • Major depressive disorder in adolescents 12-17

  • Generalized anxiety disorder in adults

  • Not approved for pediatric anxiety disorders

Remeron

Remeron is FDA-approved only for major depressive disorder in adults. It is often prescribed off-label for insomnia, anxiety, or to stimulate appetite in people who are underweight.

  • Major depressive disorder in adults

  • Off-label: insomnia

  • Off-label: anxiety disorders

  • Off-label: appetite or weight stimulation

Lexapro vs. Remeron Pros and Cons

Lexapro

Lexapro is a widely used SSRI with a long safety record and broad availability as a generic. It tends to be less sedating than Remeron during the day but carries a higher chance of nausea and sexual side effects.

Pros

  • Approved for both depression and anxiety

  • Less sedating, easier to take during the day

  • Available as tablet or liquid for flexible dosing

  • Generic version widely covered by insurance

Cons

  • Higher risk of sexual side effects like ejaculation issues

  • Can cause insomnia instead of helping with sleep

  • Costs roughly $440 to $603 per month before insurance

Remeron

Remeron is a sedating antidepressant often chosen for people with depression who also struggle with insomnia or poor appetite. It is less likely to cause sexual side effects than Lexapro but carries a much higher chance of daytime sleepiness and weight gain.

Pros

  • Generic mirtazapine costs as little as $10 to $40 a month

  • Helps with sleep and appetite when depression affects both

  • Available as a dissolving tablet for easy swallowing

  • Lower risk of sexual side effects than SSRIs like Lexapro

Cons

  • Significant sedation, especially at lower doses

  • Often causes increased appetite and weight gain

  • Carries a rare risk of serious neutropenia requiring monitoring

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