Paxil vs. Lexapro: A Psychiatrist's Guide to Choosing the Right SSRI

If you're struggling with depression or anxiety, your psychiatrist may recommend medication to help ease your symptoms. Two commonly prescribed options are Paxil (paroxetine) and Lexapro (escitalopram)—both selective serotonin reuptake inhibitors (SSRIs) that have proven effective for many patients.

At Next Step Psychiatry in Lilburn, GA, our board-certified psychiatrists help patients understand their medication options so they can make informed decisions about their mental health care. Here's what you need to know about these two medications.

How Paxil and Lexapro Work

Both Paxil and Lexapro belong to the SSRI class of antidepressants. They work by blocking the reabsorption (reuptake) of serotonin in the brain, making more of this "feel-good" neurotransmitter available. Increased serotonin levels can help improve mood, reduce anxiety, and ease other symptoms of depression.

Conditions They Treat

Paxil is FDA-approved for:

• Major depressive disorder (MDD)
• Generalized anxiety disorder (GAD)
• Social anxiety disorder
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Premenstrual dysphoric disorder (PMDD)

Lexapro is FDA-approved for:

• Major depressive disorder (MDD)
• Generalized anxiety disorder (GAD)

Lexapro is also used off-label for social anxiety, panic disorder, PTSD, and OCD.

Key Differences to Consider

Side Effect Profiles

While both medications share common SSRI side effects like nausea, headache, and sleep changes, there are some differences:

• Lexapro may cause more insomnia, diarrhea, and drowsiness
• Paxil may cause more dry mouth, constipation, and weakness
• Paxil is sometimes associated with more weight gain than Lexapro
• Both can cause sexual side effects

Dosing

Lexapro dosages typically range from 10-20mg daily. Paxil comes in immediate-release (20-60mg) and controlled-release (25-62.5mg) formulations, offering more flexibility for some patients.

Drug Interactions

Both medications should never be combined with MAOIs or other serotonin-affecting drugs due to the risk of serotonin syndrome. Your psychiatrist will review your complete medication list before prescribing.

Which One Should You Take?

The "best" medication depends on your individual circumstances—your symptoms, medical history, other medications, and how your body responds. What works perfectly for one person may not work as well for another.

This is why working with a qualified psychiatrist is so important. At Next Step Psychiatry, we take the time to understand your unique situation and help you find the most effective treatment with the fewest side effects.

Frequently Asked Questions

Does Paxil or Lexapro cause weight gain?

Both medications can potentially cause weight changes, though Paxil is sometimes associated with slightly more weight gain. Not everyone experiences this side effect, and your psychiatrist can help monitor and manage any changes.

Is one medication stronger than the other?

"Strength" isn't the right way to compare these medications. Both are equally effective for treating depression and anxiety—the difference lies in how your individual body responds to each one.

What if neither medication works for me?

There are many other antidepressant options available, including other SSRIs like Zoloft and Prozac, SNRIs like Effexor and Cymbalta, and atypical antidepressants. Our psychiatrists will work with you to find the right solution.