Lexapro vs. Trintellix

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

Key Takeaways

  • Lexapro is an SSRI approved for both depression and generalized anxiety disorder, while Trintellix is a serotonin modulator approved only for depression.

  • Both carry a boxed warning for increased suicidal thoughts in children, adolescents, and young adults, and nausea is a top side effect for each, though Trintellix's rate can run higher.

  • Lexapro has a generic version available, while Trintellix remains brand-only with no generic option.

Lexapro vs. Trintellix Drug Summary

Lexapro

Lexapro (escitalopram) is an SSRI approved for major depressive disorder in adults and adolescents ages 12 to 17, as well as generalized anxiety disorder in adults. It's taken once daily as a tablet or oral solution, usually starting at 10 mg and increasing to 20 mg after two weeks if needed.

Trintellix

Trintellix (vortioxetine) is a serotonin modulator approved for major depressive disorder in adults only. It's taken once daily as a tablet, typically starting at 10 mg and increasing to 20 mg as tolerated, or reduced to 5 mg if side effects occur.

Lexapro vs. Trintellix Side Effects

Lexapro

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

Trintellix

Most common
nausea (20% to 32%)
constipation (3% to 6%)
vomiting (3% to 6%)
dizziness (3% to 5%)

Lexapro vs. Trintellix 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

Trintellix

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily At the start
Maximum dose 5 mg once daily If needed
Dose changes 2 increases As tolerated

Lexapro vs. Trintellix Indications

Lexapro

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

  • Major depressive disorder, adults

  • Major depressive disorder, adolescents 12-17

  • Generalized anxiety disorder, adults

Trintellix

Trintellix is FDA-approved only for major depressive disorder in adults, with no approved use in children, adolescents, or for anxiety disorders.

  • Major depressive disorder, adults

  • Not approved for children or adolescents

  • Not approved for anxiety disorders

Lexapro vs. Trintellix Pros and Cons

Lexapro

Lexapro has decades of clinical use, a generic option, and FDA approval for both depression and anxiety. Its main tradeoffs are a relatively high rate of sexual side effects and insomnia.

Pros

  • Generic version available at much lower cost

  • Longer track record, FDA approved since 2002

  • Also approved for generalized anxiety disorder

Cons

  • Ejaculation disorder in up to 9% of patients

  • Insomnia in up to 9% of patients

  • Not approved for anxiety in pediatric patients

Trintellix

Trintellix works through a different mechanism than SSRIs and tends to cause less sexual dysfunction and weight gain. It's only approved for depression, has no generic version, and its main tradeoff is a higher rate of nausea.

Pros

  • Lower rates of sexual dysfunction than many SSRIs

  • Lower rates of weight gain than many SSRIs

  • Distinct mechanism may help those who haven't responded to SSRIs

Cons

  • No generic version, brand-only medication

  • Only approved for depression, not anxiety

  • Not approved for children or adolescents

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