*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.
There are several Lexapro alternatives available to treat certain mental health conditions. Lexapro, with the active ingredient escitalopram, is a commonly prescribed antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs). Lexapro is FDA-approved to treat major depressive disorder and generalized anxiety disorder in adults and adolescents.1 Some of the most common alternatives to Lexapro are other types of antidepressants, natural remedies, and over-the-counter treatments.2, 3
If you’re considering a Lexapro alternative, online psychiatry platforms such as Talkiatry and Brightside can connect you with a provider quickly. These platforms can provide an assessment and may offer you a prescription for a Lexapro 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.
Reasons to Consider a Lexapro Alternative
While Lexapro (escitalopram) is a commonly prescribed and effective medication for treating depression and anxiety, there are cases where individuals may consider alternative medications or treatment options. Some individuals may experience side effects with Lexapro, such as nausea, insomnia, or sexual dysfunction.
Each person responds uniquely to antidepressants, and switching between medications can sometimes lead to improved outcomes. Patients may also be taking medications that interact with Lexapro, leading to potential toxicity or reduced effectiveness. Alternatives to Lexapro may be valuable for individuals who may have allergic reactions to Lexapro.
Insurance coverage, costs, and personal preference are additional key factors to consider. Some patients may find the cost of Lexapro a burden. Patients should communicate with their prescriber and pharmacist to identify alternative options to Lexapro that align with the individual’s preferences.
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.
Other SSRIs as Lexapro Alternatives
Prozac (fluoxetine) and Paxil (paroxetine) are alternative selective serotonin reuptake inhibitors (SSRIs) to Lexapro. All SSRIs may have side effects. These side effects can range from nausea, vomiting, dizziness, and decreased sexual desire to suicidal thoughts or serotonin syndrome (shivering, diarrhea, fever, seizures).
While all three SSRIs share the common mechanism of increasing serotonin levels in the brain, there are some differences in how they work and associated side effects. Prozac is available in a form that has a longer half-life, making it suitable for individuals who struggle with remembering to take their medication every day. Paxil is known for its effectiveness in reducing anxiety, making it a preferred choice for individuals who also have anxiety.4, 5
Comparing SSRIs Efficacy & Side Effects
Among SSRIs, Celexa (citalopram) is well-tolerated, with a lower likelihood of weight gain and insomnia. Celexa carries a higher risk of heart complications, especially at higher doses. Lexapro is less likely to cause nausea but may lead to more headaches in patients. Prozac causes less weight gain and stomach upset, and there may be fewer sexual side effects. However, Prozac has an increased risk of bleeding and possible sleep disturbances.
Zoloft (sertraline) is associated with a higher rate of diarrhea in addition to an increased risk of bleeding. Individual responses to these medications vary, underscoring the need for personalized treatment decisions in consultation with healthcare providers.5, 6, 7
The table below compares antidepressant alternatives to Lexapro:*
Medication Form & Dosage | Common side effects | Special Considerations | |
Lexapro (Escitalopram) | Tablets: 5 milligram (mg), 10mg, 20mg |
| Health conditions your doctor should know about:
|
Zoloft (Sertraline) | Tablets: 25mg, 50mg, 100mg Oral solution: 20mg/milliliter (mL) |
|
Health conditions your doctor should know about
|
Prozac (Fluoxetine) | Capsule: 10 mg, 20 mg, 40 mg, 60 mg |
|
Health conditions your doctor should know about
|
Paxil (Paroxetine) | Immediate-release tablet: 10 mg, 20 mg, 30 mg, 40 mg Oral suspension: 10 mg/5 mL Extended-release tablet (Paxil CR): 12.5 mg, 25 mg, 37.5 mg |
| Health conditions your doctor should know about:
|
*All medications can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your prescriber and pharmacist about any questions you have and understand the potential side effects and benefits of any medication.
Popular Choices for Online Psychiatry
Talkiatry – Safe, virtual mental health care from doctors who take insurance. Most psychiatry visits cost patients $30 or less* Take a short assessment.
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*Includes copayment, deductible, coinsurance, and $0 Visits. Excludes no shows. **On average. Actual appointment times vary by state and individual patient.
SNRIs as Alternatives to Lexapro
Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) represent another class of antidepressants and are characterized by their action on two different chemicals in the brain. Effexor (venlafaxine) and Cymbalta (duloxetine) are notable examples within this class. SNRIs inhibit the reuptake of both serotonin and norepinephrine, enhancing the availability of these chemicals in the brain.
SNRIs provide additional benefits, especially for individuals with both depression and anxiety. Effexor XR, available in an extended-release formulation, may be prescribed for a range of mood disorders, including generalized anxiety disorder. Cymbalta, in addition to its antidepressant properties, is FDA-approved for managing chronic pain conditions like fibromyalgia and diabetic peripheral neuropathy. While SNRIs share some side effects with SSRIs, such as nausea and sexual dysfunction.8
Atypical Antidepressants as Alternatives to Lexapro
Atypical antidepressants, like Wellbutrin SR and XL (bupropion) and Remeron (mirtazapine), are unique compared to traditional antidepressants. Wellbutrin primarily affects norepinephrine and dopamine levels, making it a suitable option for individuals concerned about sexual side effects often associated with SSRIs. Remeron targets serotonin, norepinephrine, and histamine in the brain, providing additional sedative effects that other antidepressants may not.
These atypical antidepressants may be prescribed when SSRIs or SNRIs prove ineffective or are unsuitable due to side effects. The unique profiles of Wellbutrin and Remeron make them valuable alternatives, especially for patients seeking alternatives with distinct mechanisms of action.
TCAs & MAOIs as Alternatives to Lexapro
Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are older classes of antidepressants that are considered when other antidepressants are ineffective. 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, dry mouth, and potential heart complications.
MAOIs, such as phenelzine and tranylcypromine, block the activity of the enzyme monoamine oxidase, increasing the levels of certain chemicals 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. TCA and MAOI use requires careful monitoring and consideration of potential side effects and lifestyle adjustments.
How to Get a Prescription for Lexapro Alternative Medications
Antidepressants are prescription-only medications designed to treat various mood disorders, such as depression and anxiety. When considering how to get antidepressants, only authorized prescribers such as psychiatrists, primary care physicians, nurse practitioners, and physician assistants can prescribe these medications. The decision to prescribe antidepressants is typically based on a thorough evaluation of an individual’s mental health, medical history, and current symptoms.
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.
To determine whether antidepressants may be a suitable and helpful treatment, a healthcare provider may conduct a comprehensive examination, which can include a detailed discussion of the patient’s symptoms, their duration, and any contributing factors. Additionally, a mental health assessment may involve questions about sleep patterns, appetite changes, energy levels, and overall daily functioning.
In some cases, healthcare providers may request laboratory tests or refer individuals to mental health specialists for further evaluation. The goal is to ensure a thorough understanding of the individual’s mental health status and to make informed decisions about the most appropriate course of treatment, which may include antidepressant medications, psychotherapy, or a combination of both.
Over-the-Counter Lexapro Alternatives
Over-the-counter alternatives that may offer some relief for mild symptoms include herbal supplements, lifestyle modifications, and relaxation techniques. St. John’s Wort, Vitamin B, and Omega-3 fatty acids are some examples. It is crucial to note that while these over-the-counter options may be suitable for some individuals with milder symptoms, they are not equivalent to prescription medications like Lexapro and may not be as effective for more severe cases.
It’s always advisable to consult with a healthcare professional before starting any new treatment, even over-the-counter remedies, to ensure safety and effectiveness and to discuss potential interactions with existing medications or health conditions.9
Over-the-counter Lexapro alternatives include:
St. John’s Wort
St. John’s wort is an herbal supplement derived from the Hypericum perforatum plant and has been traditionally used to alleviate symptoms of depression and anxiety. The evidence regarding its effectiveness is mixed, with some studies showing positive outcomes for mild to moderate depression while others report inconsistent results. St. John’s Wort interacts with many medications, potentially reducing their effectiveness or causing adverse effects, making it crucial for individuals to consult with their prescriber or pharmacist before considering it as a potential alternative to prescription antidepressants.
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 to better understand the relationship and determine the most effective approaches for using vitamin B supplements in the context of depression treatment. Individuals considering supplementation should consult with their prescriber or pharmacist to assess their specific needs and potential benefits.
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.
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.
The Role of Therapy & Lifestyle Changes in Managing Depression
The combination of psychotherapy and lifestyle adjustments may not only alleviate symptoms but can also empower individuals to actively participate in their mental health journey.
Effective therapy options for depression include:10, 11
Psychodynamic Therapy
Psychodynamic therapy focuses on how the unconscious mind influences present thoughts and behaviors, representing a specific approach within psychotherapy. Unlike shorter-term therapies, psychodynamic therapy is typically more long-term and aims for profound insight and personal growth. Although less focused on immediate symptom relief than some other therapeutic approaches, psychodynamic therapy can be valuable for individuals seeking a deeper understanding of themselves and the factors shaping their emotional and behavioral patterns.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is a structured and goal-oriented therapeutic approach that targets negative thought patterns and behaviors contributing to depressive symptoms. Our thoughts influence our emotions and behaviors, so by identifying and challenging distorted thought patterns, individuals can modify their emotional responses.
Dialectical Behavior Therapy (DBT)
Dialectical behavioral therapy (DBT) combines CBT with mindfulness strategies. DBT was developed initially for borderline personality disorder. DBT has shown effectiveness in treating depression, especially when there are difficulties managing intense emotions. DBT focuses on building skills in tolerating distress, emotion regulation, interactions with others, and mindfulness, providing individuals with practical tools to cope with challenging emotions and improve overall emotional well-being.
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is for severe depression that has not responded to other forms of therapy. It is particularly considered when depression is accompanied by features such as catatonia (purposeless overactivity), psychotic symptoms, or intense suicidality. The decision to undergo ECT is based on a careful assessment of the individual’s overall health, psychiatric condition, and the potential risks and benefits of the treatment
Interpersonal Therapy (IPT)
Interpersonal therapy (IPT) focuses on addressing communication issues and improving relationships. The aim of therapy is to help individuals resolve these relationship conflicts, which may help improve symptoms.
Important lifestyle changes for managing depression include:12, 13
- Diet: Maintaining a healthy and balanced diet can play a supportive role in managing and preventing depression.
- 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, all of which can be advantageous for individuals grappling with depression
- Healthy sleeping schedule: Establishing and 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 exacerbate symptoms of depression, interfere with treatment, and contribute to a cycle of negative mental and physical health outcomes.
- Mindfulness-based therapies: Involve practicing present-moment awareness and positive thinking. This therapeutic approach has shown effectiveness in reducing symptoms of stress, anxiety, and depression, emphasizing the development of a mindful attitude toward thoughts and emotions.
Questions to Ask Your Healthcare Team About Lexapro Alternatives
Questions to ask your care team about Lexapro alternatives include:
- Is it safe to take antidepressants 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 antidepressants 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 depression?
- How long will it take for this medication to reach full effectiveness?
- How long should I use Lexapro alternatives?
- What are the pros and cons that I should consider for Lexapro alternatives?
- Based on your clinical judgment, do you think I should be on these alternatives?
- Will my insurance cover this depression medication?
- Which depression medications are safe in pregnancy?
- What should I expect when I start this Lexapro alternative?
In My Experience
Additional Resources
To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.
Virtual Psychiatry
Circle Medical – Anxiety and Depression Treatment. Meet with an online doctor today! All prescriptions are based on necessity determined by a medical professional. Diagnosis and prescription over video. Insurance accepted. No membership or hidden fees. Same day appointments. Visit Circle Medical
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Therapy for Anxiety & Medication Management
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Best Online Psychiatry Services
Online psychiatry, sometimes called telepsychiatry, platforms offer medication management by phone, video, or secure messaging for a variety of mental health conditions. In some cases, online psychiatry may be more affordable than seeing an in-person provider. Mental health treatment has expanded to include many online psychiatry and therapy services. With so many choices, it can feel overwhelming to find the one that is right for you.