Cymbalta Vs Lexapro: Similarities, Differences, & Which to Take

What Is Cymbalta?

Cymbalta, with the active ingredient duloxetine, is an SNRI antidepressant. It is thought to work by affecting chemicals, serotonin and norepinephrine, in your brain that influence mood. There is a risk of suicidal thoughts or actions in children and young adults.

Cymbalta is FDA-approved to treat major depression, chronic musculoskeletal and diabetic neuropathic pain in adults, generalized anxiety disorder in adults and children 7 years and older, and fibromyalgia in adults and children 13 years and older.^{1, 3}

What Is Lexapro?

Lexapro, with the active ingredient escitalopram, is an SSRI antidepressant. It is thought to influence serotonin levels in the brain for extended periods, which may improve symptoms of depression and anxiety. Serotonin is a chemical neurotransmitter responsible for mood regulation, cognition, and other bodily functions.

Lexapro is the first-line FDA-approved antidepressant to treat depression in adults and children 12 years and older and generalized anxiety disorder in adults and children 7 years and older.^{2, 4, 5} It may improve your energy level and feelings of well-being and decrease nervousness.

How Is Cymbalta Different From Lexapro?

Cymbalta and Lexapro are antidepressant drugs to treat major depressive and anxiety disorders. They can help prevent suicidal thoughts or attempts and improve mental and physical health. Both require close monitoring for worsening symptoms and the emergence of suicidal thoughts and behaviors. Both drugs can treat generalized anxiety disorder for adults and children 7 years and older.

Despite the same indications, both drugs act differently. Cymbalta is an SNRI and regulates serotonin and norepinephrine, while Lexapro is an SSRI and regulates serotonin levels. Cymbalta can treat depression in adults 18 years and older, while Lexapro treats major depression in adults and children 7 years and older. Both are medications for depression but are not interchangeable.

The table below summarizes the key differences between Cymbalta versus Lexapro in treating depression and anxiety:^{1, 2}

What Are Cymbalta Vs. Lexapro Used to Treat?

Both are antidepressants and FDA-approved to treat major depression and generalized anxiety disorder. However, Cymbalta is also approved to treat fibromyalgia, diabetic peripheral neuropathy, and long-term musculoskeletal pain. FDA-approved means that the drug has met federal quality standards and is both safe and effective for its intended use, with its benefits outweighing any potential risks.

An off-label means a drug has not been approved by the FDA for a certain use, but a physician may choose to use the medication based on their professional judgment. Off-label use for Cymbalta includes chemotherapy-induced peripheral neuropathy and stress urinary incontinence in men and women.³

The table below compares the medical and mental health conditions Cymbalta and Lexapro are used to treat in certain people:^{1, 2, 3, 4}

Effectiveness of Cymbalta Vs. Lexapro

Both Cymbalta and Lexapro are safe and effective drugs that may provide relief to individuals dealing with mental health conditions. According to a comparative study, Lexapro is superior to Cymbalta in the short-term treatment of depression.⁶

Another study suggests that Lexapro is tolerated better and is as effective as Cymbalta in treating major depression.⁷ Furthermore, some studies suggested that individuals taking Cymbalta may experience more adverse events.⁸

You should talk with your healthcare provider about what medication is the correct choice for you.

Cymbalta & Lexapro Dosages for FDA-Approved Treatment

Drug doses for FDA-approved treatment can vary for each individual. Optimal doses depend on factors like an individual’s age, current health conditions, medical history, and drug response and tolerance.

Typically, a Cymbalta dose is 40 to 60 mg once daily in a single or two divided doses with periodic reassessment to determine the need for a high dose. The dose for older adults with anxiety, who are 65 years of age or older, is recommended to be 30 mg once daily for 2 weeks, then increased to 60 mg once daily. The maximum dose for all people is 120 mg daily, depending on the individual’s tolerance.^{1, 3}

Lexapro dose is 10 mg once daily, and depending on drug response and tolerability, the dose may be increased to a maximum of 20 mg once daily.^{2, 4}  The dose of Lexapro for older adults, who are 65 years of age or older, is recommended to be a maximum of 10 mg once daily.

Cymbalta Forms & Strengths

Cymbalta is available as delayed-release capsules. The whole capsule is swallowed without chewing or crushing, regardless of meals.¹ If swallowing is difficult, capsules may be opened and contents sprinkled on apple juice or sauce to swallow the drug mixture immediately after mixing.³

Its doses may be tailored according to an individual’s age, tolerance, disorder type, and severity of symptoms. Initial effects may be observed within 2 weeks of treatment, with continued improvements through 4 to 6 weeks.⁹

Cymbalta is available in the following forms and strengths:

• 20 milligram (mg) oral capsules
• 30 mg oral capsules
• 60 mg oral capsules

Cymbalta is also available as a generic known as duloxetine. Talk with your healthcare provider or your pharmacist if you are interested in taking the generic medication, as forms and strengths of the medication may vary.

You can take Cymbalta with food if you have an upset stomach. Follow your doctor’s instructions carefully and regularly take the drug to achieve the best results. Never crush, or divide extended-release tablets, as this can alter the drug’s effects.

Lexapro Forms & Strengths

Lexapro is available in 2 forms, an oral solution at a concentration of 1 mg/mL and tablets ranging from 5 to 20 mg strengths. It is usually taken once daily, with or without food. The right form and strength for an individual are determined by the disorder being treated, the individual’s age, tolerance, and the severity of symptoms. Initial effects may be observed within 2 weeks of treatment, with continued improvements through 4 to 6 weeks.¹⁰

Lexapro is available in the following forms and strengths:

• 5 milligram (mg) oral tablet
• 10 mg oral tablet
• 20 mg oral tablet

Lexaprois also available as a generic known as escitalopram. Talk with your healthcare provider or your pharmacist if you are interested in taking the generic medication, as forms and strengths of the medication may vary.

You can take Lexapro with food if you have an upset stomach. Follow your doctor’s instructions carefully and regularly take the drug to achieve the best results.

Side Effects of Lexapro Vs. Cymbalta

Sometimes, people may experience side effects when taking both drugs. However, these side effects may subside or become better tolerated as your body adjusts to the change in neurotransmitters, especially serotonin. If the side effects persist or worsen, talk to your doctor about potentially adjusting the dosage.

Commonly experienced side effects are often mild, though some may require medical attention. This is not a comprehensive list of possible side effects. Talk with your prescriber and pharmacist about any potential side effects from either medication.

The table below compares the most common side effects of Cymbalta and Lexapro:^{1, 2, 3, 4}*

*All medications, including Cymbalta and Lexapro, have a risk of side effects, including serious side effects. This is not a complete list of side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Warnings & Precautions for Cymbalta & Lexapro

Cymbalta and Lexapro both come with warnings and precautions to be aware of. While the benefits of taking these medications may outweigh the risks, Cymbalta and Lexapro may not be a suitable treatment for some. If you experience any of the following serious symptoms or conditions, seek immediate medical care.

Risks to consider when taking Cymbalta and Lexapro include:^{1, 2, 3, 4}

• Interactions with alcohol: Antidepressants and alcohol may interact to cause liver injury or may provoke pre-existing liver disease. Avoid them in individuals with substantial alcohol use or evidence of chronic liver disease due to the risk of abdominal pain, jaundice, and liver failure.
• Allergic reactions: Although rare, severe allergic reactions may occur using antidepressants. Therefore, discontinue their use immediately if any signs of hypersensitivity appear, like blisters, peeling rash, mucosal erosions, or sudden swelling of the lips, mouth, throat, or tongue. If you experience difficulty breathing, confusion, drowsiness, or dizziness, seek immediate medical attention.
• Serotonin syndrome: Combining Cymbalta or Lexapro with other antidepressants increases the risk of serotonin syndrome, including symptoms like confusion, hallucination, seizure, unstable blood pressure, rapid heart rate, fever, excessive sweating, shivering, incoordination, and blurred vision.
• Suicidal thoughts and behaviors: Antidepressants are associated with an increased risk of suicidal thoughts and behaviors during the early phases of treatment. Your doctor may monitor you for suicidality and worsening changes in behavior during the initial months of treatment or at times of dose changes.
• Increased risk of bleeding: Antidepressants have the potential to increase bleeding events ranging from abdominal bleeding, postpartum hemorrhage in mothers, bruising, hematomas, nosebleeds, and bleeding underneath the skin (petechiae) to life-threatening hemorrhages.
• Activation of mania or hypomania: Antidepressants have the potential to increase the mixed or manic events in individuals with major depression.
• Hyponatremia: Antidepressant-induced syndrome of inappropriate secretion of antidiuretic hormone (SIADH) causes hyponatremia, producing headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls.
• Angle-closure glaucoma: Antidepressant drugs may trigger an angle-closure attack in individuals with narrow angles, causing eye pain, swelling, redness, widened pupils, and vision changes (seeing rainbows around lights at night, blurred vision), which can rapidly lead to permanent blindness if not treated.¹¹
• Sexual dysfunction: Antidepressants have been associated with sexual disorders like ejaculatory delay or failure, decreased libido, absent orgasm, and erectile dysfunction in men and women. Your prescriber may ask about sexual function before considering either of these medications.

This is not a comprehensive list of the warnings and precautions of either Cymbalta or Lexapro. Talk with your healthcare professional to learn about all of the possible risks of any medication they are recommending for you.

Potential Drug Interactions With Cymbalta & Lexapro

Cymbalta and Lexapro can interact with other substances in ways that change their effects, increase the risk for side effects, or become unsafe. Review all other medications, over-the-counter treatments, and substances you use with your prescriber. Do not stop taking or change the drug dose unless directed by your prescriber.

Disclaimer: Taking certain medications, herbs, or supplements alongside Cymbalta and Lexapro can change how these medications work in your body or increase the risk of serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Medications and substances that have harmful interactions with Cymbalta and Lexapro include:^{1, 2}

Costs & Insurance Coverage

Most insurance plans cover prescription antidepressants such as Lexapro and Cymbalta. However, some may only cover certain doses or the generic, not the brand version. Available insurance plans include the Affordable Care Act, children’s health insurance program (CHIP), Medicaid programs (low-income), and medicare advantage (MA) or Part D (prescription drug coverage) for older adults.^{12, 13} Prescription drug costs depend on benefit phase, network, different pricing levels (tier; generic, brand-name, or mail-order prescriptions), pharmacy, and extra help.

Typically, generic medications are cheaper than the brand-name versions. Escitalopram generic for Lexapro (20 mg 30 tablets) costs $9.79, while duloxetine generic for Cymbalta (20 mg for 30 tablets) costs $15.¹⁴ Both drugs are moderately priced. People can save money on prescriptions by using discounted generic drug programs in local pharmacies, copay coupons, or patient assistance programs.

Medicare and Social Security have a program called ‘Extra Help’ for people with limited income and resources to save money on prescription costs. You may pay a maximum of $4.15 for each generic covered drug ($4.50 in 2024) and $10.35 for each brand-name covered drug ($11.20 in 2024) if eligible.¹³

Which Is Right for You: Cymbalta or Lexapro?

It may take 4 to 6 weeks for Cymbalta or Lexapro to take effect, though some might notice them working sooner. The best medication for your situation will depend on factors like age, additional health conditions, the condition being treated, and your unique response to the medication.  While Lexapro may be more effective in terms of drug interactions, side effects, and cost, Cymbalta has a broader range of FDA-approved uses, which may be more beneficial for someone with pain and multiple problems.

Each drug has potential advantages that may help in choosing the best one for your condition. Your doctor can provide guidance based on your individual needs. If you are unable to see a doctor in person or have concerns about the recommended drug, consider online psychiatry services. They can help you weigh the benefits and risks of each drug and provide different perspectives that will assist you in making an informed decision.

How to Get a Prescription for Cymbalta & Lexapro

To get a prescription for Cymbalta or Lexapro, start by consulting with a licensed prescriber. These include family physicians, internists, geriatricians, nurse practitioners, physician assistants, and psychiatrists.¹⁵ They will ask about your symptoms, medical history, and may do a physical examination before recommending a treatment. They can also help you understand how these antidepressants may make you feel. As a team, they work together to help you treat your condition and improve your symptoms.

Questions to Ask Your Health Team About Cymbalta & Lexapro

You may have questions for your healthcare provider about the potential benefits of Cymbalta or Lexapro. Be sure to also discuss potential side effects, risks, and how to take your medication.

Questions to ask your prescriber about Cymbalta and Lexapro include:

• Is it safe to take Cymbalta or Lexapro with my other medications?
• Will my insurance cover Cymbalta or Lexapro?
• Which one has the best results as a treatment for depression and/or anxiety?
• Does my medical history increase my risk of side effects for either?
• How long can I expect side effects to last?
• How often should I see you for checkups while taking Cymbalta or Lexapro?
• What should I do if I am unsure whether antidepressants are right for me?
• Can Cymbalta and Lexapro be taken together?
• Are Cymbalta and Lexapro the same?
• What if I am allergic to these drugs?
• Can I use Cymbalta or Lexapro with alcohol?
• Is it safe to use Cymbalta or Lexapro while pregnant or nursing?