Cymbalta vs. Lexapro: Which Antidepressant Might Be Right for You?

When it comes to treating anxiety and depression, Cymbalta (duloxetine) and Lexapro (escitalopram) are two of the most commonly prescribed medications. Both are effective, but they work in slightly different ways and may be better suited for different patients. At Next Step Psychiatry, we help patients throughout Gwinnett County and the greater Atlanta area find the right medication for their unique situation.

How They Work: SNRI vs. SSRI

The biggest difference between these two medications comes down to brain chemistry:

• Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI). It focuses on one neurotransmitter — serotonin — blocking its reabsorption so more remains available in the brain.
• Cymbalta (duloxetine) is a serotonin-norepinephrine reuptake inhibitor (SNRI). It targets both serotonin and norepinephrine, providing a dual mechanism that can be beneficial for certain patients.

FDA-Approved Uses

Lexapro is also used off-label for panic disorder, OCD, social anxiety, PTSD, and PMDD. Cymbalta has off-label applications for stress urinary incontinence and certain types of neuropathy.

Side Effects Comparison

Both medications share some common side effects: nausea, drowsiness, dizziness, dry mouth, constipation, and sexual dysfunction. However, there are some differences:

• Cymbalta may be more likely to cause increased sweating and blood pressure changes, and carries a rare risk of liver damage
• Lexapro is generally considered to have a slightly milder side-effect profile, which is why it's often tried first

Which One Should You Choose?

There's no universal "better" option — it depends on your specific symptoms, medical history, and treatment goals. For example:

• If you have anxiety or depression with chronic pain or fibromyalgia, Cymbalta's dual mechanism may offer added benefit
• If you're looking for a well-tolerated first-line option for GAD or depression, Lexapro is often a great starting point
• If you've tried one and it didn't work or caused side effects, switching to the other class may help

At Next Step Psychiatry, Dr. Aneel Ursani and Fathima Chowdhury, PA-C take the time to understand each patient's full picture before recommending a medication. We believe in informed, collaborative decision-making.