Cymbalta vs. Lexapro: Which Is Better?

Written by

Jessica Guht

Jessica is a medical writer with an unquenched thirst to discover something new. She believes that medical content should be accessible to everyone and strives to write content that every single person can understand. When Jessica isn’t writing, she can usually be found reading a book with a dog cuddled in her lap. Jessica has a Masters of Engineering degree in Biomedical Engineering.

Medically reviewed by

Amy Dougherty, FNP-BC, AGAC

Amy is a Board Certified Family Health Nurse Practitioner (FNP) with over 15 years of experience working in Hospital Medicine, Urgent Care and Primary Care practices. Amy graduated Thomas Jefferson University with high distinction earning a Bachelor of Science in Nursing in 2008, a Master of Science in Nursing in 2010 and a Post Master's Certificate in Adult Gerontology Acute Care (AGAC) in 2014. She was recognized by the Elite American Nurses Association in 2013 for her dedication, achievements and leadership in the field Nursing. She served as a clinical preceptor for a number of Nurse Practitioner students and enjoys teaching the bright minds of future NPs.

Cymbalta and Lexapro are two prescription medications, both of which are used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). While both Cymbalta and Lexapro are used to treat similar conditions, the two medications have some key differences.

Table of Contents

• What Are the Differences Between Cymbalta and Lexapro?
• What Conditions Are Treated with Cymbalta and Lexapro?
• Which One Is More Effective: Cymbalta or Lexapro?
• Coverage And Cost of Cymbalta and Lexapro
• What Are the Side Effects of Cymbalta and Lexapro?
• Drug Interactions of Cymbalta and Lexapro
• Frequently Asked Questions (FAQs)
• Key Takeaways

What Are the Differences Between Cymbalta and Lexapro?

Cymbalta (a popular brand name for duloxetine) is a prescription medication used to treat both major depressive disorder (MDD) and generalized anxiety disorder (GAD). It is an antidepressant that belongs to a class of drugs known as selective serotonin-norepinephrine reuptake inhibitors (SNRIs). 

Cymbalta inhibits the reuptake of norepinephrine and serotonin, two important neurotransmitters used for communication between the neurons, in the neuron synapses. This increases the availability of neurotransmitters that positively affect mood.  

Lexapro (a popular brand name for escitalopram) is another prescription medication used to treat both major depressive disorder (MDD) and generalized anxiety disorder (GAD). It is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). 

Lexapro differs from Cymbalta as it works to inhibit only serotonin reuptake at the neuron synapse. As a result, more quantity of free serotonin is available in the neuron synapses to utilize. It does not affect norepinephrine reuptake, unlike Cymbalta.

What Conditions Are Treated with Cymbalta and Lexapro?

Since both ‌drugs are so similar, they can both be used as an alternative to each other in certain situations. Both ‌medications are frequently used to treat:

• Major depressive disorder (MDD)
• Generalized anxiety disorder (GAD)

Cymbalta can also ‌treat fibromyalgia, chronic musculoskeletal pain, and neuropathic pain caused by diabetes. Off-label uses include chemotherapy-induced peripheral neuropathy and stress urinary incontinence.

Interestingly, Lexapro is used off-label for a variety of conditions, including binge eating disorder, bulimia nervosa, panic disorder, premature ejaculation, posttraumatic stress disorder, obsessive-compulsive disorder, and premenstrual dysphoric disorder.

Which One Is More Effective: Cymbalta or Lexapro?

Cymbalta and Lexapro appear to be equally effective for the treatment of depression, as shown by a clinical trial. However, a review of extensive data from multiple studies suggests that the higher risk of adverse events with Cymbalta may be the reason ‌ most doctors prefer to prescribe Lexapro to their patients first.

However, it is important to note that Cymbalta and Lexapro do not provide immediate relief from the symptoms of depression or anxiety. Patients must understand this so that they do not stop taking their medication prematurely because they believe it is ineffective. 

Most patients will notice no difference after two weeks, and it may take four to six weeks for the medication to work at its full capacity. 

Coverage And Cost of Cymbalta and Lexapro

The cost of your medication is determined by a number of factors, including the brand and the dosage, as well as your insurance status and the pharmacy it is acquired from.

A 30-milligram Cymbalta prescription can cost nearly $350 per month, while a 20-milligram Lexapro prescription can cost up to $260 per month, this information is backed up by a study that found that Lexapro was associated with significant cost savings compared with Cymbalta.

In terms of coverage, most commercial insurance plans pay at least a portion of the cost of both generic and brand-name Cymbalta and Lexapro.

What Are the Side Effects of Cymbalta and Lexapro?

Cymbalta and Lexapro can cause mild side effects that are very similar to each other. Even though they both have the potential to cause similar side effects, some are more likely with one agent than the other. 

For example, in clinical trials, nausea was reported in only 5% of Lexapro patients compared to 23% of Cymbalta patients.

Some of the common side effects include

• Reduced appetite
• Fatigue (lack of energy)
• Digestive issues, such as constipation and nausea
• Dizziness
• Sweating excessively (hyperhidrosis)
• Dry mouth
• Sleepiness or sleeplessness (trouble sleeping)

Cymbalta comes with additional potential side effects of headache and hypertension (Increased blood pressure), which are ‌uncommon for Lexapro.

Lexapro, on the other hand, has been shown to cause sexual side effects like erectile dysfunction in men and loss of libido (sex drive) in both men and women.

Lexapro’s side effects that differ from Cymbalta are

• Agitation or restlessness
• Blurred vision
• Drowsiness
• Fever
• Frequent urination
• Headache
• Indigestion
• Changes in appetite
• Increased sweating 
• Changes in taste
• Tremors (shaking)
•  Weight changes

While the side effects that are exclusive to Cymbalta include 

• Constipation
• Fatigue
• Dizziness
• Increased blood pressure
• Seizures

Drug Interactions of Cymbalta and Lexapro

Drug interactions are important to know because a number of patients who suffer from generalized anxiety disorder or major depressive disorder are also dealing with other mental health disorders like attention deficit disorder that are treated with amphetamines and other drugs that interact. 

Cymbalta and Lexapro are both metabolized by the liver using the cytochrome enzyme system.  

Some common drug interactions for Cymbalta and Lexapro are‌ given below.

1. Amphetamines

Simultaneous administration of Cymbalta and Lexapro with amphetamines can lead to the increased serum concentration of amphetamines because of their decreased metabolism. This can cause a decrease in the effectiveness of amphetamines in treating attention deficit disorders and an increase in their toxicity.

2. Tricyclic Antidepressants

When Cymbalta and Lexapro are combined with tricyclic antidepressants like amitriptyline, the risk of QT prolongation (extended interval between the contraction and relaxation of the heart) and serotonin syndrome increases. These combinations should be avoided in general.

3. Aspirin

Using Cymbalta or Lexapro in conjunction with aspirin may increase the risk of bleeding. If you are elderly or have kidney or liver disease, the interaction is more likely to be dangerous.

If your doctor has prescribed both of these medications, you should seek immediate medical attention if you notice any unusual bleeding or bruising, or if you have other signs and symptoms of bleeding such as dizziness, severe headache, lightheadedness, coughing up, or vomiting fresh or dried blood that looks like coffee grounds, red or black tarry stools, and weakness.

4. Tramadol

The combination of Cymbalta and Lexapro with tramadol (an opioid analgesic) increases the risk of serotonin syndrome, a rare but serious condition characterized by symptoms such as confusion, hallucination, seizures, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, blurred vision, muscle spasm or stiffness, tremors, stomach cramps, nausea, vomiting, and diarrhea. Severe cases can even result in coma or death.

Furthermore, combining these medications can increase the risk of an irregular heart rhythm, which can be serious and potentially fatal, though this is a relatively uncommon side effect. If you have congenital long QT syndrome, any other cardiac diseases, conduction abnormalities, or electrolyte disturbances, you may be more vulnerable.

5. Xanax

When combined with Cymbalta or Lexapro, dizziness, drowsiness, confusion, and difficulty concentrating are some of the common side effects. Certain people, especially the elderly, may also have cognitive, judgment, and motor coordination issues. 

You should avoid or limit your alcohol consumption while taking these medications as it can further aggravate the symptoms. Avoid activities that require mental alertness, such as driving or operating dangerous machinery, until you know how the medications affect you. 

6. Other drugs 

Other drugs that can potentially interact with Cymbalta and Lexapro include:

• Antimigraine agents like Oxitriptan, Eletriptan, and Almotriptan.
• Antiplatelet medications like Edoxaban and Apixaban.
• Antineoplastic medications like Gilteritinib, Dabrafenib, Erdafitinib, Acalabrutinib, and Ibrutinib.
• Antibiotics like Linezolid.

All SSRIs and SNRIs, including Cymbalta and Lexapro, have been linked to serotonin syndrome. Taking two serotonergic drugs at the same time can lead to this condition. It is caused by abnormally high serotonin levels that cause agitation, dizziness, and an increased heart rate. 

Rarely, Cymbalta has also been linked to fatal liver failure, characterized by abdominal pain, elevated liver enzymes, and jaundice. Alcohol can further increase the risk so it should be avoided when taking Cymbalta. 

Frequently Asked Questions (FAQs)

Key Takeaways

• While Cymbalta and Lexapro are similar drugs used to treat depression and anxiety, they differ from each other in the way they act and also in the side effects they cause. 
• Lexapro is as effective and more tolerable than Cymbalta. 
• Both these drugs also differ from each other in their off-label uses. While Cymbalta can be used off-label for chemotherapy-induced peripheral neuropathy and stress urinary incontinence, Lexapro can be used for conditions like Bulimia nervosa, panic disorder, posttraumatic stress disorder, binge eating disorder, and premature ejaculation. 
• A 30-milligram Cymbalta prescription costs nearly $350 per month, whereas a 20-milligram Lexapro prescription costs up to $260 per month, which means that Lexapro is associated with significant cost savings when compared to Cymbalta.

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