Lexapro vs. Ativan

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

What's the Difference Between Lexapro and Ativan?

What Are Lexapro and Ativan?

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) antidepressant used for treating depression and generalized anxiety disorder. Other SSRIs include citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). Lexapro prevents the reuptake of the neurotransmitter serotonin, which results in more serotonin in the brain to attach to receptors. An imbalance of neurotransmitters is believed to be the cause of depression.

Ativan (lorazepam) is a benzodiazepine drug used for treating anxiety. Ativan is also used to treat insomnia and panic attacks, used along with other medications to prevent nausea and vomiting from chemotherapy, administered before anesthesia for sedation, used for prevention and treatment of alcohol withdrawal, and used to treat seizures. Other benzodiazepines include diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and flurazepam (Dalmane).

What Are the Side Effects of Lexapro and Ativan?

Lexapro

Common side effects associated with Lexapro include:

  • agitation or restlessness,
  • blurred vision,
  • diarrhea,
  • difficulty sleeping,
  • drowsiness,
  • dry mouth,
  • fever,
  • frequent urination,
  • headache,
  • indigestion,
  • nausea,
  • increased or decreased appetite,
  • increased sweating,
  • sexual difficulties (decreased sexual ability or desire, ejaculatory delay),
  • taste alterations, tremor (shaking), and
  • weight changes.

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Lexapro or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults beyond 24 years of age. There was a reduction in risk of suicidality with antidepressants compared with placebo in adults 65 years of age and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients who are started on therapy with antidepressants should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.

Other side effects include influenza-like symptoms and pain in neck or shoulders.

Although changes in sexual desire, sexual performance, and sexual satisfaction often occur as a result of depression itself, they also may be a consequence of the drugs used to treat depression. In particular, about one in 11 men given Lexapro report difficulties ejaculating.

Possible serious side effects of Lexapro include:

  • Serotonin syndrome
  • Suicidal thinking and behavior
  • Abnormal bleeding
  • Seizures
  • Manic episodes
  • Confusion
  • High fever
  • Slurred speech
  • Muscle rigidity
  • Low sodium
  • Angle closure glaucoma.

WARNING

Some patients experience withdrawal reactions upon stopping SSRI therapy. Symptoms may include

  • dizziness,
  • tingling,
  • tiredness,
  • vivid dreams,
  • irritability, or
  • poor mood.

In order to avoid these symptoms, the dose of SSRI can be slowly reduced instead of abruptly stopped.

Ativan

The most common side effects associated with Ativan are:

  • Sedation
  • Dizziness
  • Weakness
  • Unsteadiness

Other side effects include:

  • A feeling of depression
  • Amnesia
  • Loss of orientation
  • Headache
  • Sleep disturbance

Possible serious side effects include:

  • Extrapyramidal symptoms
  • Respiratory depression
  • Suicidal ideation/attempt
  • Seizures
  • Depression

WARNING

Like all benzodiazepines, Ativan can cause physical dependence. Suddenly stopping therapy after a few months of daily therapy may be associated with a feeling of loss of self-worth, agitation, and insomnia. If Ativan is taken continuously for longer than a few months, stopping therapy suddenly may produce seizures, tremors, muscle cramping, vomiting, and sweating.

What Is the Dosage of Lexapro vs. Ativan?

Lexapro

  • The usual starting dose of Lexapro for treating depression in adults or adolescents is 10 mg once daily in the morning or evening. The dose may be increased to 20 mg once daily after 3 weeks.
  • Benefit may not be seen until treatment has been given for up to 4 weeks. A daily dose of 20 mg may not be more effective than 10 mg daily for treatment of depression.
  • The dose for treating generalized anxiety disorder is 10 mg once daily.
  • Lexapro can be taken with or without food.

Ativan

  • The dose of Ativan is tailored to the patient's needs.
  • The usual dose for treating anxiety is 2-6 mg orally every 8 to 12 hours as needed.
  • Insomnia is treated with 2-4 mg given at bedtime.

What Drugs Interact with Lexapro and Ativan?

Lexapro

  • All SSRIs, including Lexapro, should not be combined with drugs in the monoamine oxidase (MAO) inhibitor class of antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl) and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase such as linezolid (Zyvox) and intravenous methylene blue. Such combinations may lead to confusion, high blood pressure, high fevers, tremor or muscle rigidity, and increased activity. At least 14 days should elapse after discontinuing Lexapro before starting an MAO inhibitor. Conversely, at least 14 days should elapse after discontinuing an MAO inhibitor before starting Lexapro.
  • Similar reactions occur when SSRIs are combined with other drugs that increase serotonin in the brain, for example tryptophan, St. John's wort, meperidine (Demerol), lithium (Lithobid, Eskalith), triptans (for example, sumatriptan [Imitrex, Alsuma]), and tramadol (Ultram)
  • Use of selective serotonin inhibitors may increase the risk of gastrointestinal bleeding in patients taking warfarin (Jantoven, Coumadin), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and other drugs that cause bleeding.

Ativan

  • Ativan and all benzodiazepines accentuate the effects of other drugs that slow the brain's processes such as alcohol, barbiturates, narcotics, and tranquilizers, and the combination of Ativan and these drugs may lead to excessive sedation. There have been cases of marked sedation when Ativan was given to patients taking the tranquilizer loxapine (Loxitane); it is unclear if there is a drug interaction, but caution should be used if Ativan and loxapine are used together.

Are Lexapro and Ativan Safe to Take While Pregnant or Breastfeeding?

Lexapro

  • The safety of Lexapro during pregnancy and breastfeeding has not been established. Therefore, Lexapro should not be used during pregnancy unless, in the opinion of the physician, the expected benefits to a patient outweigh unknown hazards to the fetus.
  • Lexapro is excreted in human milk. Lexapro should not be given to nursing mothers unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the child.

Ativan

  • Ativan and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Ativan is best avoided if at all possible in the first trimester and probably throughout pregnancy.
  • Ativan is excreted in human milk and should be avoided during pregnancy.

Summary

Lexapro (escitalopram) and Ativan (lorazepam) are used to treat anxiety. Lexapro is also used to treat depression. Ativan is also used to treat insomnia and panic attacks, used along with other medications to prevent nausea and vomiting from chemotherapy, administered before anesthesia for sedation, used for prevention and treatment of alcohol withdrawal, and used to treat seizures. Lexapro and Ativan belong to different drug classes.

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Medically Reviewed on 2/21/2018
References
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