Lexapro vs. Prozac

• Lexapro (escitalopram) and Prozac (fluoxetine) are selective serotonin reuptake inhibitor (SSRI) antidepressants used to treat depression.
• Lexapro is also used to treat generalized anxiety disorder.
• Prozac is also used to treat bulimia, obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder (PMDD). Prozac is also prescribed in combination with Zyprexa (olanzapine) to treat resistant depression and depression associated with bipolar disorder.
• Lexapro is the brand name for escitalopram.
• Prozac is the brand name for fluoxetine.
• Side effects of Lexapro and Prozac that are similar include difficulty sleeping (insomnia), drowsiness, headache, nausea, and sexual difficulties (decreased sexual ability or desire, ejaculatory delay).
• Side effects of Lexapro that are different from Prozac include agitation or restlessness, blurred vision, diarrhea, dry mouth, fever, frequent urination, indigestion, changes in appetite, increased sweating, changes in taste, tremor (shaking), flu-like symptoms, neck and shoulder pain, and weight changes.
• Side effects of Prozac that are different from Lexapro include anxiety, loss of appetite, serious skin rashes, vasculitis, increased blood pressure, and seizures.
• Withdrawal reactions may occur if you suddenly stop taking Lexapro or Prozac.

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat depression and generalized anxiety disorder. Chemically, Lexapro is similar to Celexa (citalopram). Other SSRIs include Prozac (fluoxetine), (Paxil) paroxetine, and Zoloft (sertraline). SSRIs work by affecting neurotransmitters in the brain. Neurotransmitters are made and released by nerves and travel to other nearby nerves where they attach to receptors on the nerves. Not all of the neurotransmitters released bind to receptors and, instead, are taken up by the nerves that produced them. This is referred to as "reuptake." Researchers believe that an imbalance of neurotransmitters is the cause of depression. Lexapro prevents the reuptake of serotonin (a neurotransmitter), which results in more serotonin in the brain to attach to receptors.

Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) antidepressant used primarily for treating depression. It is also used to treat bulimia, obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder (PMDD). Prozac is also prescribed in combination with Zyprexa (olanzapine) to treat resistant depression and depression associated with bipolar disorder. Prozac works by preventing the reuptake of one neurotransmitter, serotonin, by nerve cells after it has been released. Since uptake is an important mechanism for removing released neurotransmitters and terminating their actions on adjacent nerves, the reduced uptake caused by Prozac increases free serotonin that stimulates nerve cells in the brain.

WARNING: Side Effects Warning

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

• Dizziness
• Tingling
• Tiredness
• Vivid dreams
• Irritability
• Poor mood

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

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)
• 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 start 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

Prozac

Prozac, as with most antidepressants, can cause:

• Nausea
• Headaches
• Anxiety
• Insomnia
• Drowsiness
• Loss of appetite

Prozac has been implicated in serious skin rashes and vasculitis (inflammation of small blood vessels).

Increased blood pressure can occur, and blood pressure should be monitored.

Seizures have been reported as has sexual dysfunction.

Some patients may experience withdrawal reactions upon stopping Prozac. Symptoms of withdrawal include anxiety, nausea, nervousness, and insomnia. The dose of Prozac should be gradually reduced when therapy is discontinued.

Prozac and other antidepressants have been associated with angle closure attacks in people with narrow angle glaucoma.

Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Prozac or any other antidepressant in a child or adolescent must balance this risk of suicide with the clinical need. Patients who start therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

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.

Prozac

Depression in adults is treated with 20-80 mg of fluoxetine daily. The recommended dose for treating depression in children is 10-20 mg daily. After 13 weeks of daily administration, 90 mg once weekly may be effective in some patients.

Lexapro

All SSRIs, including Lexapro, should not be combined with drugs in the monoamine oxidase inhibitor (MAOI) 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 MAOI. Conversely, at least 14 days should elapse after discontinuing an MAOI 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 reuptake 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.

Prozac

Taking Prozac with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxant, or medicine for anxiety, depression, or seizures.

Many drugs can interact with Prozac. Tell your doctor about all your current medicines and any you start or stop using, especially:

• Any other antidepressant
• St. John's wort
• Tryptophan (sometimes called L-tryptophan)
• A blood thinner -- warfarin (Coumadin, Jantoven)
• Medicine to treat anxiety, mood disorders, thought disorders, or mental illness -- amitriptyline, buspirone, desipramine, lithium, nortriptyline, and many others
• Medicine to treat ADHD or narcolepsy -- Adderall, Concerta, Ritalin, Vyvanse, Zenzedi, and others
• Migraine headache medicine -- rizatriptan, sumatriptan, zolmitriptan
• Narcotic pain medicine -- fentanyl, oxycodone, hydrocodone, and others

Taking monoamine oxidase inhibitors (MAOIs) with Prozac may cause a serious (possibly fatal) drug interaction. Avoid taking MAOIs (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with Prozac. Most MAOIs should also not be taken for 2 weeks before and at least 5 weeks after treatment with Prozac. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including other SSRIs such as citalopram/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Many drugs besides Prozac may affect the heart rhythm (QT prolongation), including pimozide and thioridazine, among others. Aspirin can increase the risk of bleeding when used with Prozac. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81 to 325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products), because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

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 doctor, the expected benefits to the 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 doctor, the expected benefits to the patient outweigh the possible hazards to the child.

Prozac

Prozac should only be used during pregnancy if the potential benefit justifies the potential risks to the fetus

Prozac is excreted in breast milk. Therefore, use of Prozac while nursing is not recommended.