Paxil vs. Lexapro_ How Do They Compare_

Paxil vs. Lexapro: Which One Is Right for You?

Estimated Read Time: 10 minutes

Paxil (paroxetine) and Lexapro (escitalopram) are both commonly prescribed selective serotonin reuptake inhibitors (SSRIs). While they are similar in how they treat mental health conditions, they differ in their applications, tolerability, and side effects. Choosing between them depends on individual health factors and treatment goals, so working closely with your healthcare provider is essential.

Key Differences Between Paxil and Lexapro

Who Can Take These Medications?

Paxil is generally prescribed for adults only, while Lexapro is approved for a broader age range — from age 7 and up for generalized anxiety disorder and age 12 and older for major depression.

Approved and Off-Label Uses

Paxil

FDA-Approved Uses:

• Major Depressive Disorder (MDD)

• Obsessive-Compulsive Disorder (OCD)

• Panic Disorder

• Generalized Anxiety Disorder (GAD)

• Social Anxiety Disorder

• Post-Traumatic Stress Disorder (PTSD)

• Premenstrual Dysphoric Disorder (PMDD)

Off-Label Uses:

• GAD in children 7+

• OCD in children 7+

• Social anxiety disorder in children 8+

Lexapro

FDA-Approved Uses:

• MDD in adults and adolescents (12+)

• GAD in adults and children (7+)

Off-Label Uses:

• Social anxiety disorder

• Autism-related irritability in children 6+

• Panic disorder and other anxiety conditions

Effectiveness Comparison

For Major Depressive Disorder (MDD)

Both medications have proven effective in treating MDD. However, studies have shown Lexapro may be slightly more effective in people with severe depression, especially when compared directly to Paxil.

For Generalized Anxiety Disorder (GAD)

Lexapro has demonstrated superior outcomes in managing GAD symptoms, showing greater symptom reduction and better tolerability than Paxil in clinical trials.

How Long Before You Feel the Effects?

Both medications typically take several weeks to begin improving symptoms. It’s important to be patient and maintain regular contact with your healthcare provider during this adjustment period.

Common Side Effects

While Paxil and Lexapro share many of the same side effects, their intensity and frequency can vary:

Shared Side Effects

• Nausea

• Fatigue

• Sexual dysfunction

• Constipation

• Sweating

Unique to Paxil

• Weight gain

• Low blood pressure upon standing

• Higher risk of withdrawal symptoms

Unique to Lexapro

• Possible weight loss

• Low sodium levels (especially in older adults)

• Rare changes in heart rhythm

Risks of Stopping the Medication

Paxil

Stopping Paxil suddenly may trigger intense withdrawal symptoms such as:

• Nausea

• Mood swings

• Tremors

• Dizziness

• Anxiety

Doctors typically recommend tapering off the dosage slowly.

Lexapro

Lexapro also requires gradual discontinuation to avoid:

• Fatigue

• Irritability

• Trouble sleeping

• Headaches

Always consult your provider before stopping either medication.

Safety and Interactions

Potential Serious Risks

• Serotonin Syndrome: A dangerous condition caused by excess serotonin. Seek help immediately for symptoms like confusion, hallucinations, tremors, or agitation.

• Suicidal Thoughts: Antidepressants may increase suicidal ideation, especially in young adults and adolescents.

• Bleeding Risk: Both drugs can increase the chance of bleeding when taken with NSAIDs (like ibuprofen or aspirin), anticoagulants (like warfarin), or antiplatelet medications.

Paxil Drug Interactions

• MAOIs (e.g., phenelzine, selegiline)

• Pimozide, thioridazine

• Tamoxifen

• Drugs with high plasma protein binding, including warfarin

• Other serotonin-increasing medications (SSRIs, SNRIs, tricyclics)

Lexapro Drug Interactions

• MAOIs (avoid within 14 days)

• Pimozide

• Sumatriptan

• Warfarin

• Tegretol (carbamazepine)

• Other serotonergic drugs

Which Medication Should You Choose?

Several factors can guide the decision between Paxil and Lexapro:

• Diagnosis: Paxil treats a wider range of mental health conditions, while Lexapro is mainly used for MDD and GAD.

• Age Group: Lexapro is suitable for children and adolescents; Paxil is typically for adults.

• Current Medications: If you’re on drugs that interact with one SSRI, the other might be a safer alternative.

• Side Effect Tolerance: Lexapro tends to be better tolerated with fewer side effects and lower withdrawal risk.

• Insurance Coverage: Coverage may vary depending on your health plan and available generics.

Frequently Asked Questions

What are Paxil and Lexapro used to treat?
Paxil: MDD, OCD, PTSD, GAD, PMDD, social and panic disorders.
Lexapro: MDD and GAD (including in children), with off-label uses in anxiety and autism-related irritability.

Is one more effective than the other?
Lexapro may have a slight edge in tolerability and effectiveness for GAD and severe depression, but both are effective SSRIs.

Can I switch between Paxil and Lexapro?
Only under medical supervision. Sudden changes can lead to serious withdrawal effects.

How long should I stay on these medications?
Duration varies based on the individual, condition severity, and response. Discuss long-term plans with your healthcare provider.

Expert Tips

• Stay consistent with your medication timing each day.

• Don’t stop abruptly—always taper under a doctor’s guidance.

• Monitor your mood and side effects; share changes with your provider.

• Lifestyle factors like sleep, diet, and therapy can support medication effectiveness.

Key Takeaways

• Both Paxil and Lexapro are SSRIs but differ in side effects, approved uses, and age suitability.

• Lexapro is generally better tolerated and has fewer withdrawal risks.

• Always involve a healthcare provider when starting, switching, or stopping medication.

Stay Informed

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