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Paxil vs Lexapro: Which one should I take?

Paxil vs Lexapro: Which one should I take?

Paxil and Lexapro are both SSRIs and first-choice treatments for depression and anxiety. Which works best for ultimately depends on how your body reacts to the medication, since everyone is different.

Reviewed by:
Michael Roman, MD
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May 5, 2024
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In this article

If you're struggling with depression or anxiety, your psychiatrist might prescribe you medication to help ease your symptoms. Two common medications psychixatrists prescribe are Paxil (paroxetine) and Lexapro (escitalopram).

In this article we’ll compare and contrast these antidepressants and explore their side effects, interactions, and more. While it can be helpful to gather information about a medication you might take and do research on your own, it’s important to remember that a psychiatrist is your best guide. They're the experts who can explain the nuances of each medication and help you figure out which one might be best for you. So, don't hesitate to get their professional advice.  

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Similarities between Paxil and Lexapro

Paxil and Lexapro belong to the same class of medication and are commonly prescribed for treating depression and anxiety. Studies show that they have similar levels of effectiveness, too.  Let’s take a look at some of their similarities.  

They're both SSRIs

Paxil and Lexapro are both SSRIs (selective serotonin reuptake inhibitors), a type of antidepressant that affects the levels of serotonin available in your brain. Serotonin is a neurotransmitter that plays a crucial role in regulating mood, emotions, and overall mental well-being. Your brain naturally produces these neurotransmitters. SSRIs like Paxil and Lexapro block the serotonin from being reabsorbed by your brain so more of it is available to you. This can ultimately help improve your mood and reduce symptoms of depression, anxiety, and other related conditions.  

SSRIs like Paxil and Lexapro are a primary choice for doctors when it comes to treatment of depression and other mental health conditions. To learn more in-depth about how they work, you can check out: SSRIs vs SNRIs

They treat the same conditions

Paxil is used to treat:

Lexapro is used to treat:

The *denotes an off-label use, meaning the medication has been prescribed for something other than its FDA-approved purpose, and it's still a valid use of the medication if it is supported by enough scientific research and data

They may not work for everyone

Just like with any other medication, Paxil and Lexapro won't be a perfect fit for everyone. It's important to take into account certain factors, such as pre-existing medical conditions, that could make Paxil or Lexapro unsuitable for you. Before prescribing you medication your psychiatrist will ask about your health history to make sure using it is right for you. You should let your doctor know about any of the following:  

  • Heart problems
  • Bleeding problems
  • Seizures
  • Glaucoma
  • Low sodium levels in your blood
  • Bone problems
  • Kidney or liver problems

Differences between Paxil and Lexapro

While Paxil and Lexapro share certain similarities, they also have a few distinct differences. A mental health professional like a psychiatrist will take these variations into account when deciding which one to prescribe to you.  

They have different common side effects

Lexapro and Paxil, along with other SSRIs, share common side effects such as nausea, headache, and sleep disturbance. These are usually mild and in some cases even go away. Between Paxil and Lexapro there may be differences in how intense and how often a specific side effect occurs. (And remember, everyone experiences side effects differently.)

The chart below outlines the most common possible side effects as observed during clinical trials. When you talk with your doctor about medication options, they’ll discuss possible side effects  and help you minimize them. If you’re worried about a particular side one, you should also let your doctor know.  

Lexapro side effects:

  • Nausea
  • Insomnia
  • Ejauclation delay
  • Diarrhea
  • Drowsiness
  • Dry mouth
  • Dizziness
  • Fatigue

Paxil side effects:

  • Nausea
  • Drowsiness
  • Headache
  • Dry mouth
  • Weakness
  • Constipation
  • Dizziness
  • Problems with ejaculation  

Related article: Paxil vs Prozac

They have different dosages

If you’re prescribed Paxil or Lexapro, your doctor will instruct you to take them by mouth, usually once a day.

Lexapro dosages range from 10 mg to 20 mg per day.  

Paxil dosages come in immediate-release and controlled release forms and dosages range from:

  • 20 mg to 60 mg for immediate release
  • 25 mg to 62.5 mg for controlled release  

These FDA-approved doses are the recommended amounts a person should take, but the actual right dose for you depends on factors like the intensity of your symptoms and treatment goals. If you're prescribed either of these antidepressants, your starting dosage may also be different than the one you end up taking long-term. The bottom line is that your doctor is there to help.  

Paxil and Lexapro drug interactions

When you take SSRIs alongside other vitamins, or supplements, it can affect how they work in your body.  This is known as a medication interaction and it may increase the risk of experiencing side effects or decrease the effectiveness of medication, among other things. To prevent any potential interactions, your doctor will ask you what medications you're currently on.

The most important thing is that Paxil and Lexapro should not be taken with any medications that can increase your serotonin levels, including tryptophan, linezolid, lithium, tramadol, fentanyl St. John's Wort, MAOIs, and other SSRIs. That means you shouldn’t take Paxil and Lexapro at the same time and should also avoid taking them alongside other antidepressants like Celexa (citalopram) or Zoloft (sertraline). The reason is that when you have too much serotonin in your body, it can lead to a potentially dangerous condition known as serotonin syndrome. Your doctor will try and help you minimize the risk. Although serotonin syndrome can be potentially dangerous, most cases are treatable if the symptoms are caught early enough

Lexapro interactions

  • Drugs that can increase the risk of bleeding (anticoagulants), like aspirin, NSAIDs, aspirin, and warfarin  
  • Migraine medications like almotriptan, eletriptan, rizatriptan, sumatriptan, and zolmitriptan

Paxil interactions

  • Drugs that can increase your risk of bleeding (anticoagulants), like aspirin, NSAIDs and warfarin
  • HIV medications like fosamprenavir and ritonavir
  • Drugs metabolized by CYP2D6, like tamoxifen, codeine, tramadol
  • Dextromethorphan, found in many cough medications
  • Migraine medications like almotriptan, eletriptan, rizatriptan, sumatriptan, and zolmitriptan
  • Seizure medications, like phenobarbital, phenytoin, and metoprolol
  • Medications for irregular heartbeat like flecainide or propafenone
  • Diuretics, or “water pills”

How much do they cost?

The cost of medications can vary depending on several factors, including the specific pharmacy, your insurance coverage, and whether you opt for the generic or brand-name version. The generic version is usually cheaper, and you might be able to use manufacturer coupons for certain medications. You should check with your insurance provider and local pharmacies to get more accurate pricing information for Paxil and Lexapro. You can also let your doctor know if one is more expensive than the other so they can take it into account when deciding what you should take.  

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Should I take Paxil or Lexapro?

Paxil and Lexapro are both preferred treatments for anxiety and depression. Choosing between them can be an important decision, but it’s not one you need to make alone. Shared decision making is a big part of finding a treatment plan you’re comfortable with. Your doctor will help figure out what’s best for you—whether it’s Paxil, Lexapro, or something else—by considering your specific symptoms and medical history, and weighing the possible side effects of each medication.

If you have depression or anxiety and are wondering what treatment options are available, including prescription medications, consider Talkiatry. We’re a national psychiatry practice that treats mental health conditions like anxiety and depression. You can take this quick online assessment to get matched with a psychiatrist and schedule your first virtual visit.


Here are more answers to more questions you might have when comparing Paxil and Lexapro.  

Does Paxil or Lexapro make you gain weight?

Weight gain is a potential side effect associated with both Paxil and Lexapro. However, it's important to note that not everyone will experience weight gain while taking these medications and some people may even lose weight. If you have concerns about weight changes, let your healthcare provider know. They can provide personalized guidance and monitor your progress. You can also check out this article on antidepressants and weight loss to learn more about the complexities of medication and their potential impact on your weight.

Is Paxil stronger than Lexapro?

Paxil and Lexapro are both effective medications used to treat various mental health conditions. However, the concept of "strength" in this context can be subjective since your body and brain can respond differently than someone else’s. What works well for one person may not be the same for another.  

What is there besides Paxil and Lexapro?

Other SSRIs besides Paxil and Lexapro include Zoloft (sertraline) and Prozac (fluoxetine); while SNRIs include Effexor (venlafaxine). There are also atypical antidepressants like Wellbutrin and Mirtazapine. Older classes of antidepressants like TCAs (tricyclic antidepressants) and MAOIs are not as frequently prescribed. Learn more about Lexapro vs Zoloft.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

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Frequently asked questions

Does Talkiatry take my insurance?

We're in network with major insurers, including:

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Call the number on your insurance card and ask about your plan’s coverage for outpatient psychiatric services.

How does Talkiatry compare to face-to-face treatment?

For most patients, Talkiatry treatment is just as effective as in-person psychiatry (American Psychiatric Association, 2021), and much more convenient. That said, we don’t currently provide treatment for schizophrenia, primary eating disorder treatment, or Medication Assisted Treatment for substance use disorders.

What kind of treatment does Talkiatry provide?

At Talkiatry, we specialize in psychiatry, meaning the diagnosis and treatment of mental health conditions. Your psychiatrist will meet with you virtually on a schedule you set together, devise a treatment plan tailored to your specific needs and preferences, and work with you to adjust your plan as you meet your goals.

If your treatment plan includes medication, your psychiatrist will prescribe and manage it. If needed, your psychiatrist can also refer you to a Talkiatry therapist.

What's the difference between a therapist and psychiatrist?

Psychiatrists are doctors who have specialized training in diagnosing and treating complex mental health conditions through medication management. If you are experiencing symptoms of a mental health condition such as depression, anxiety, bipolar disorder, PTSD, or similar, a psychiatrist may be a good place to start.  

Other signs that you should see a psychiatrist include:  

  • Your primary care doctor or another doctor thinks you may benefit from the services of a psychiatrist and provides a referral    
  • You are interested in taking medication to treat a mental health condition  
  • Your symptoms are severe enough to regularly interfere with your everyday life

The term “therapist” can apply to a range of professionals including social workers, mental health counselors, psychologists, professional counselors, marriage and family therapists, and psychoanalysts. Working with a therapist generally involves regular talk therapy sessions where you discuss your feelings, problem-solving strategies, and coping mechanisms to help with your condition.

Who can prescribe medication?

All our psychiatrists (and all psychiatrists in general) are medical doctors with additional training in mental health. They can prescribe any medication they think can help their patients. In order to find out which medications might be appropriate, they need to conduct a full evaluation. At Talkiatry, first visits are generally scheduled for 60 minutes or more to give your psychiatrist time to learn about you, work on a treatment plan, and discuss any medications that might be included.

Michael Roman, MD

Dr. Michael Roman is currently a Staff Psychiatrist at Talkiatry. He completed his adult psychiatry residency training at the University of Pennsylvania. Dr. Roman is a board-certified Adult Psychiatrist and a diplomate of the American Board of Psychiatry and Neurology (ABPN).

Dr. Roman’s clinical practice centers primarily around medication management and psychopharmacological treatment approaches. He also specializes in a variety of psychotherapeutic modalities which he utilizes in conjunction with medication management in order to provide patients with the best possible treatment outcomes.

Dr. Roman’s curiosity for the studies of the human mind began with pursuing a bachelor’s degree in psychobiology at the University of California, Los Angeles (UCLA). He was intrigued by the way our mind, body, emotions, and behavior were intertwined to comprise our everyday life experiences. His interest in the intricacy of the human mind was deepened in medical school, and he received his medical degree from the David Geffen School of Medicine at UCLA. He completed his adult psychiatry residency training at the University of Pennsylvania.

Dr. Roman treats a wide spectrum of patients, but his primary clinical focus is treating mood disorders, ADHD, anxiety disorders, and PTSD. Dr. Roman also specializes in treating substance use disorders and possesses clinical expertise in implementing high quality motivational interviewing and motivational enhancing therapy.

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