*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Wellbutrin, Zoloft, Paxil, Effexor XR, and Cymbalta are common Lexapro alternatives. Depending on the condition, anti-anxiety medications and non-medication treatments may also be considered instead of Zoloft.2 Your healthcare provider can help you consider your options and safely change medications, if necessary.1
If you’re considering a Zoloft alternative, we have thoroughly reviewed platforms like Brightside, Talkiatry, and Circle Medical. These platforms can prescribe antidepressants and may offer you a prescription for a Zoloft alternative if they determine a medication may help your symptoms.
Boxed Warning: Escitalopram (Lexapro) - Risk of suicidal thoughts and behaviors in certain people
Escitalopram, the active ingredient in Lexapro, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Escitalopram can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of your age, you should talk with your doctor about serious risks with escitalopram and any other medications before starting treatment.
Key Takeaways
Lexapro is prescribed to treat depression, anxiety, and other mental health conditions, but may not be right for everyone. Lexapro alternatives may be necessary for some to consider.
Several types of antidepressants can be used as Lexapro alternatives, including other SSRIs, SNRIs, MAOIs, and TCAs. Some may find natural and over-the-counter treatments helpful.
If you are considering an alternative to Lexapro, a good place to start is with an evaluation from a medical provider. Many online psychiatry platforms, such as Talkiatry and Brightside Health, offer assessments and can help you find the right medication for you.
Reasons to Consider a Lexapro Alternative
Some looking for depression and anxiety treatments need to consider alternatives to Lexapro. While Lexapro is a safe and effective medication for many, it may not be a good fit for everyone. Each person responds uniquely to antidepressants, and switching to a different medication can sometimes lead to better symptom relief.
Some individuals may experience uncomfortable side effects with Lexapro, such as nausea, insomnia, or sexual dysfunction. Some may be taking medications that interact with Lexapro, leading to potential toxicity or reduced effectiveness. Those who have allergic reactions to ingredients in Lexapro will need to avoid it, considering other medications or non-medication treatments instead.
Insurance coverage, costs, and personal preference are additional key factors to consider. Some patients may find the cost of Lexapro a burden. If you are considering Lexapro alternatives, communicate with your prescriber and pharmacist to identify the treatments that may be a good fit for you.
Would You Like to Be Evaluated for Depression? Virtual psychiatry for depression. Talkiatry offers personalized care with medication and additional support. They take insurance, too. Get started with a short assessment.
What Medications Are Alternatives to Lexapro?
Lexapro is a commonly prescribed medication for treating depression and anxiety, but Lexapro alternatives may be necessary for some needing treatment. Several types of antidepressants are available and can help depressive and anxiety symptoms. Benzodiazepines, beta blockers, or buspirone each work differently to manage various anxiety symptoms. Every Lexapro alternative medication carries risk and the potential for side effects.
Some of the most common Lexapro alternatives include:
- SSRIs: Zoloft, Paxil, Prozac, Celexa
- SNRIs: Effexor XR, Pristiq, Cymbalta
- Atypical antidepressants: Wellbutrin, Remeron, Trazodone, Trintellix
- TCAs and MAOIs: Elavil, Norpramin, Emsam, Marplan
- Anti-anxiety medications: Benzodiazepines (Xanax, Ativan), beta blockers, buspirone
Other SSRIs
Selective serotonin reuptake inhibitor (SSRI) medications all treat depression and anxiety effectively. And because they often occur with other mental health conditions, other SSRIs can be good alternatives to Lexapro. While all SSRIs affect serotonin levels in the brain, there are some differences with how they work and associated side effects. Common side effects for SSRIs include nausea, diarrhea, dry mouth, increased sweating, sleep changes, sexual dysfunction
SSRIs have many FDA-approved and non-FDA-approved (off-label) uses. Because depression and anxiety often occur with other mental health conditions, SSRIs are often considered as treatments. And because each person has a unique response to medication, some may find that one SSRI works better than others they try.
Here are some SSRIs prescribed as Lexapro alternatives:
- Zoloft (sertraline): Some studies suggest that Zoloft may be associated with less drowsiness and fewer serious side effects than other SSRIs. Common side effects include nausea, loss of appetite, diarrhea, and anxiety
- Paxil (paroxetine): Paxil’s side effect of drowsiness may be helpful for those having trouble with sleep. People are often prescribed Paxil for anxiety since it has been shown has been FDA-approved to treat three different anxiety disorders. Common side effects include sexual dysfunction, diarrhea, dry mouth, and sweating.
- Prozac (fluoxetine): Prozac is available in a form that stays in the body longer, making it suitable for individuals who struggle with remembering to take their medication every day. Common side effects from Prozac include sexual dysfunction, loss of appetite, dry mouth, and indigestion.
- Celexa (citalopram): Celexa is well-tolerated with a lower likelihood of weight gain and insomnia. Common side effects include nausea, dry mouth, drowsiness, and delayed ejaculation.
SNRIs
Serotonin norepinephrine reuptake inhibitors (SNRIs) are safe and effective treatments for depression and anxiety disorders. They work by taking action on two different chemicals in the brain, serotonin and norepinephrine. Common side effects of SNRIs include anxiety, dry mouth, nausea, constipation, fatigue, sexual dysfunction.
SNRIs are a smaller drug class and are not used to treat the wide variety of disorders that SSRIs are. But because SNRIs and SSRIs are both effective at improving mood and anxiety, they are commonly used as alternatives for each other.
- Effexor XR (venlafaxine): Because of its extended-release formula, some Effexor side effects may not be as likely to occur when starting the medication than with other antidepressants. Common side effects of Effexor include nausea, dry mouth, sexual dysfunction, and sleepiness.
- Pristiq (desvenlafaxine): Pristiq’s active ingredient is closely related to Effexor’s. But because of the way it is formulated, the side effects of Pristiq, including insomnia, nausea, and fatigue, may not be as likely to occur.
- Cymbalta (duloxetine): Along with its antidepressant properties, Cymbalta is FDA-approved for managing chronic pain conditions like fibromyalgia and diabetic peripheral neuropathy. Common side effects include nausea, dry mouth, fatigue, and loss of appetite.
Atypical Antidepressants
Atypical antidepressants are unique compared to traditional antidepressants. These medications may be prescribed when SSRIs or SNRIs prove ineffective or are unsuitable due to side effects.
- Remeron (mirtazapine): Remeron targets serotonin, norepinephrine, and histamine in the brain, providing additional sedative effects that other antidepressants may not. Common side effects include sleepiness, increased appetite, weight gain, and constipation.
- Wellbutrin (bupropion): Wellbutrin primarily affects norepinephrine and dopamine levels. Also, the risk of sexual side effects with Wellbutrin is lower than for other antidepressants. Common side effects include trouble sleeping, dry mouth, constipation, and nausea.
- Trazodone: Trazodone is a versatile antidepressant that can be used off-label to treat insomnia, anxiety disorders, and PTSD. Common side effects include dizziness, sleepiness, diarrhea, and weight loss.
- Trintellix (vortioxetine): Trintellix is a newer antidepressant on the market. Because it works differently than other antidepressants it may provide relief for those who have not found other treatments helpful enough. Common side effects include nausea, constipation, and vomiting.
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TCAs & MAOIs
Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are older classes of antidepressants that can be considered as Lexapro alternatives when other antidepressants are ineffective. However, TCA and MAOI use requires careful monitoring and consideration of potential side effects and lifestyle adjustments.
TCAs
TCAs, like amitriptyline and nortriptyline, work by increasing the levels of serotonin and norepinephrine in the brain. However, they often come with a more significant side effect profile, including sedation, constipation, dry mouth, and potential heart complications.
MAOIs
MAOIs, such as phenelzine and tranylcypromine, improve depression symptoms by affecting the activity of the enzyme monoamine oxidase in the brain. While effective, MAOIs have notable dietary restrictions. This is due to the risk of a hypertensive crisis (extremely high blood pressure) when consuming foods rich in tyramine, found in aged cheeses and cured meats. Common side effects of MAOIs include headache, drowsiness, fatigue, weight gain, insomnia, nausea, sexual dysfunction
Anti-anxiety Medications
Several anti-anxiety medications can be prescribed as an alternative to Lexapro for anxiety symptoms.
Benzodiazepines
Benzodiazepines aren’t the first choice for treating anxiety symptoms due to the risk of dependence and sedation. But they are FDA-approved for treating anxiety symptoms and can be effective for short-term relief.
Long-acting benzodiazepines can take longer to work but their effects last longer. Short-acting benzodiazepines stay in the body for a shorter period of time, but also kick in quickly. Common side effects include drowsiness, dizziness, problems with coordination, and changes in sex drive.
Buspirone
Buspirone is another medication used to treat symptoms of anxiety. Unlike benzodiazepines, another class of anti-anxiety medications, buspirone does not have sedative effects and is considered non-addictive.3 Common side effects include dizziness, nausea, headache, and lightheadedness.
Beta Blockers
Beta-blockers are a group of medications that help to reduce symptoms of high blood pressure. They are helpful for anxiety symptoms because they cause the heart to beat more slowly and create a decrease in blood pressure.4 With fewer physical symptoms of anxiety, a person could experience increased feelings of calm. Common side effects include dizziness, sleepiness, fatigue, diarrhea, and constipation.
How to Get a Prescription for a Lexapro Alternative
To get a prescription for a Lexapro alternative in person, start with an evaluation for your symptoms. Your primary care provider, who may be a physician, nurse practitioner, or physician assistant, can help you get the process started. They may make a referral to a psychiatrist or specialist to determine if a prescription Lexapro alternatives should be included in your treatment plan.
To get an online prescription for a Lexapro alternative, you will also start by getting evaluated by an online psychiatric provider. We have thoroughly reviewed platforms like Talkiatry or Circle Medical that prescribe non-controlled substances such as antidepressants and some anti-anxiety medications.
Benzodiazepines are controlled substances that may be used to treat anxiety symptoms. To get prescribed benzodiazepines, you must do your evaluation with an online psychiatry provider that can and will prescribe controlled substances.
We have thoroughly evaluated online providers like Talkiatry that can and will prescribe benzodiazepines and found them each to be a good place to get started with an evaluation. If your provider feels a benzodiazepine is a good fit for your anxiety symptoms, they may offer you a benzodiazepine prescription online.
Would You Like to Be Evaluated for Depression? Virtual psychiatry for depression. Talkiatry offers personalized care with medication and additional support. They take insurance, too. Get started with a short assessment.
Non-medication Alternatives for Lexapro
Some with depression or anxiety may consider non-medication alternatives to Lexapro. Over-the-counter treatments, lifestyle changes, and psychotherapy are non-medication alternatives for treating depression and anxiety. These options vary in effectiveness and research support.
Discuss these alternatives with your primary provider to understand which may be most helpful to you. Before taking an over-the-counter treatment or supplement, consult with your primary provider as they can interact with other substances and medications.
Over-the-counter Lexapro Alternatives
Currently, there are no over-the-counter Lexapro alternatives available FDA-approved to treat depression and anxiety. Many over-the-counter and natural products claim to help with the treatment of depression and anxiety symptoms. However, quality studies are limited and have yet to show whether such supplements improve depression and anxiety symptoms. However, some individuals may find them helpful for their symptoms.
- St. John’s Wort: St. John’s wort is an herbal supplement derived from the Hypericum perforatum plant. The evidence regarding its effectiveness for depression symptoms is mixed, with some studies showing positive outcomes and others report inconsistent results. St. John’s Wort interacts with many medications, potentially reducing their effectiveness or causing adverse effects.5
- Vitamin B: Low levels of certain B vitamins, particularly B6, B9 (folate), and B12, have been associated with depression symptoms. These vitamins play a crucial role in mood regulation. Some studies suggest that supplementation may be beneficial, particularly in cases where a deficiency is present, but results vary and further research is needed.5
- Omega-3 Fatty Acids: Commonly found in fish oil, omega-3 fatty acids have been studied for their potential role in mental health, including their impact on depression. While the evidence is not entirely consistent, some studies have indicated that omega-3 fatty acid supplementation may be beneficial in reducing symptoms of depression, especially in individuals with major depressive disorder.5
Some can also interact with other medications you may be taking. Check with reputable sources and your healthcare providers before taking any supplements.
Lifestyle Changes
Making positive lifestyle changes can improve your mental wellbeing. Healthy activities and routines can enhance the effects of therapy and/or medication. And for some with mild symptoms, lifestyle changes alone may be enough to improve quality of life.
Important lifestyle changes for managing depression and anxiety include:
- Following a healthy diet: Maintaining a healthy and balanced diet can play a supportive role in managing and preventing depression.
- Getting regular exercise: Regular exercise has been demonstrated to positively impact mental health, potentially alleviating symptoms of depression. The benefits extend to improvements in sleep, increased energy levels, and a sense of accomplishment.
- Following a sleep schedule: Maintaining a healthy sleeping schedule can play a crucial role in managing and preventing depression. Sleep disturbances are common symptoms of depression, and improving sleep hygiene can greatly impact mood and overall well-being.
- Avoiding substance use: Avoiding alcohol and smoking is essential for managing and preventing depression. Substance abuse can worsen symptoms of depression, interfere with treatment, and contribute to a cycle of negative mental and physical health issues.
- Staying socially connected: Staying connected socially can reduce loneliness and boost feelings of inclusion and self worth. Communicating and spending time with others provides opportunities to have fun, be helpful to others, and get emotional support when needed.
How to Get Therapy Online & In Person
Therapy is a research-backed treatment approach for anxiety, depression, and many other mental health conditions. While therapy and medication are often used together, it can be an alternative to Lexapro or other psychiatric medications.
Start by finding a therapist with the experience and training to treat your condition. For in-person treatment, your primary care provider or insurance company can provide a referral, or you may get one from family or friends. To find an online therapist, an online therapist directory is a great starting point. Many online psychiatry platforms, such as Talkiatry and Brightside Health, also offer therapy services.
What to Consider When Switching Antidepressants
As with any medication, antidepressants should be taken as prescribed. This helps prevent problems that can develop when the medications are taken incorrectly. If the antidepressant medication you are taking does not work for you, do not stop taking it without consulting your prescriber. Stopping your medication abruptly puts you at risk of antidepressant withdrawal symptoms, which can lead to uncomfortable and potentially dangerous side effects.
Also, switching to a different medication can worsen your depression or anxiety symptoms since both substances trigger individual side effects. If the drug does not work for you or leads to intolerable side effects, talk to your doctor to ensure safe tapering before switching to a different antidepressant. When choosing a switching strategy, your prescriber will consider several factors, including your symptoms and side effects.
Before switching your antidepressant, your prescriber will consider the following:
- Your current symptoms
- Your current diagnosis
- Your current medications side effects
- How well you can function in daily life
- Your treatment goals
- Whether you have pre-existing medical conditions
- How sensitive are you to the side effects of medication
- Whether you are at risk of life-threatening complications
Questions to Ask Your Provider
When considering a new Lexapro alternative medication, consult your doctor and pharmacist to better understand what treatment may be the best fit for you. Prepare for your appointment by creating a list of questions addressing issues such as side effects, effectiveness, other medications you take, and more.
Questions to ask your provider about Lexapro alternatives include:
- Is it safe to take this medication with my other medications?
- Am I at risk for side effects from antidepressants or supplements if I am already taking other medications, such as anti-anxiety medication?
- What medication should I consider for fewer side effects?
- Will my symptoms get better without medication?
- What lifestyle changes do you recommend I make?
- What therapy recommendations do you have for my symptoms?
- How long will it take for this medication to reach full effectiveness?
- How long should I use this treatment or medication?
- What are the pros and cons that I should consider for Lexapro alternatives?
- Based on your clinical judgment, do you think I should consider this particular alternative treatment?
- Will my insurance cover this medication?
- Which of these medications are safe in pregnancy?
- What should I expect when I start this Lexapro alternative?
Prescriber’s Tips
Your prescriber will share important information about your Lexapro prescription. They will explain how to take and store your medication, what to avoid when taking it, and what to do about side effects. Follow these tips for safe and effective use of Lexapro.
- Take your medication as prescribed, do not change your dose or stop taking it unless your prescriber tells you to. Keeping a consistent dosing schedule reduces the chance of unwanted side effects. When taking antidepressants, this approach can prevent withdrawal symptoms such as dizziness, brain zaps, and flu-like symptoms.1
- Take your medication at the same time each day. Doing so can help you remember to take it, making it as effective as possible. Your healthcare provider can help determine the optimal timing based on your sleep patterns and initial medication response.
- Tell your prescriber right away if you or your child have any worsening mental health symptoms. Antidepressants have a boxed warning for increased risk of suicidal thoughts and behaviors in children under age 18 and young adults.
- Some antidepressants and anti-anxiety medications can cause drowsiness and may affect your decision making. Talk to your doctor about how taking one of these medications may affect your ability to drive, operate heavy machinery, or do other dangerous activities safely.
- Ask your doctor whether it is safe to drink alcohol while taking your medication.
- Tell your prescriber about all medications and supplements you take, including over-the-counter treatments. Many over-the-counter medications and supplements can interact with prescription medications. This is because they are processed by the same gut enzymes, cytochrome P450 (CYPs). These interactions can lead to unwanted side effects or reduce the effectiveness of your prescription medication.6
Frequently Asked Questions
Does the Generic Version of Lexapro Work the Same as the Brand Name?
Escitalopram is a generic version of brand name Lexapro with the same uses and risks as Lexapro.
Why Might I Need to Consider a Lexapro Alternative?
Lexapro alternatives may be needed for people who have taken Lexapro but did not respond well enough, had an allergic reaction, or had intolerable side effects. Lexapro can also interact with other substances and medications.
What Lexapro Alternatives Have the Least Sexual Side Effects?
Wellbutrin, Remeron, Viibryd, and Trintellix are among the antidepressants least likely to cause sexual side effects. Also, buspirone reportedly has fewer sexual side effects than antidepressants.
Do I Need to Consider a Lexapro Alternative If I’m Pregnant or Breastfeeding?
It’s possible. The impact of antidepressants, benzodiazepines, and anti-anxiety medications are unclear on pregnancy and breastfeeding. Patients and prescribers need to weigh the risks and benefits of these medications for each situation.
What If I Switch to a Lexapro Alternative & It Still Doesn’t Work for Me?
Some people try more than one medication before they find one that works for them. Consult your prescriber about which medications may work for you and how to safely make a change, if needed.
What Can I Expect If I Need to Stop Taking Lexapro, & How Can I Minimize Withdrawal Effects?
After about 3 days of not taking Lexapro, most of the medication will have left your body. If you experience symptoms this would be the most likely time for symptoms to start.7 It is not uncommon for prescribers to recommend tapering for several weeks. Frequent check-ins with your doctor may be recommended.
How Long Does It Take to Switch Antidepressants?
The switching process can take several weeks. This provides the time needed to minimize potential withdrawal symptoms and determine how effective the medication switch is.
How Long Should I Take Lexapro Before I Consider an Alternative?
It may depend on the reason for considering a Lexapro alternative. Seek immediate medical care if you experience symptoms of a medication interaction, serious side effect, or an allergic reaction. When evaluating side effects and symptom improvement, it may take a few weeks to observe changes and make a determination.
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Lexapro- escitalopram tablet, film coated, Lexapro- escitalopram solution. (October 1, 2023). Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Mischoulon D. (2009). Update and critique of natural remedies as antidepressant treatments. Obstetrics and gynecology clinics of North America, 36(4), 789–x. Retrieved from https://doi.org/10.1016/j.ogc.2009.10.005
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Tyler K. Wilson; Jayson Tripp (2023). Buspirone. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK531477/
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Shahrokhi, M., & Gupta, V. (2023). Propranolol. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557801/
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Mischoulon D. (2009). Update and critique of natural remedies as antidepressant treatments. Obstetrics and gynecology clinics of North America, 36(4), 789–x. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2786903/
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Marken, P. A., & Munro, J. S. (2000). Selecting a Selective Serotonin Reuptake Inhibitor: Clinically Important Distinguishing Features. Primary Care Companion to the Journal of Clinical Psychiatry. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181142/
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Warner, C et al. (2006). Antidepressant Continuation Syndrome. American Academy of Family Physicians. Retrieved from https://www.aafp.org/pubs/afp/issues/2006/0801/p449.html
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: No Change
Reviewer: No Change
Primary Changes: Revised and retitled “Other SSRIs as Lexapro Alternatives” section, removed header “Comparing SSRIs Efficacy & Side Effects”. Retitled and revised “SNRIs as Alternatives to Lexapro” to “SNRIs”. Retitled and revised “Atypical Antidepressants as Alternatives to Lexapro” to “Atypical Antidepressants”. Retitled and revised “TCAs & MAOIs as Alternatives to Lexapro” to “TCAs & MAOIs”. Added new sections “Key Takeaways”, “What to Consider When Switching Antidepressants”, “Anti-anxiety Medications”, “Non-medication Alternatives for Lexapro”. “How to Get a Prescription for Lexapro Alternatives”. Retitled and condensed “The Role of Therapy & Lifestyle Changes in Managing Depression” and all included subsections to “How to Get Therapy Online & In Person”. Retitled “Questions to Ask Your Health Team” to “Questions to Ask Your Provider”. Retitled and expanded “In My Experience” section to “Prescriber’s Tips”. Removed “For Further Reading”. Added FAQs.
Author: Pamela Wiltfang, PharmD, MPH
Medical Reviewer: Dena Westphalen, PharmD
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