Paxil vs Lexapro: A Comparison Guide

Vicky Davis

Reviewed by Vicky Davis, FNP

Written by Geoffrey Whittaker

Published 07/15/2022

Updated 07/16/2022

There’s a large variety of antidepressants on the market, and learning the differences between each of them can be overwhelming. When it comes to Paxil® vs Lexapro®, two popular antidepressants on the market, even though they’re both in the same class of antidepressants, it’s important to understand that they are not identical or interchangeable. In fact, they each have some very specific differences when it comes to effectiveness and side effects. 

If you’re on of these medications, are looking for more information to help you decide which one is right for you or if your healthcare provider has advised you to change from one to the other,  you’re likely scouring the Internet for data to try and figure out what the best medicine for your needs is. 

We’ve assembled a comparative guide to help you do just that.

Let’s start with what these medications have in common. The list is quite long. Both Paxil (generic name paroxetine) and Lexapro (generic name escitalopram) are selective serotonin reuptake inhibitors (SSRIs), and both are approved by the FDA to treat a variety of mood disorders, starting with depression

Both of these medications have been around for some time, and are generally considered safe for daily use and effective for the treatment of a number of mood disorders and other issues when taken as directed.

How Are Lexapro and Paxil Used?

Lexapro is predominantly used for treating anxiety and treatment of depression, specifically major depressive disorder and generalized anxiety disorder. 

It affects your serotonin levels and, taken daily, it can help with addiction, mood disorders and certain behavioral responses. 

In an off-label capacity, it is sometimes used to treat OCD or obsessive-compulsive disorder, panic and post-traumatic stress disorders (PTSD), some symptoms of menopause and social anxiety.

Paxil, meanwhile, has a very similar function. It can also be employed as a treatment for the same listed mental health conditions above, and though its serotonin function is slightly different, it effectively functions the same way that Lexapro does: it increases your levels of serotonin supply over time.

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Side Effects of Lexapro vs Paxil

Lexapro’s common side effects include sexual dysfunction and reduced libido, insomnia, nausea, fatigue, dizziness and a potentially fatal condition called serotonin syndrome. In certain cases, it can cause headaches, seizures and coma.

The adverse effects of Paxil, on the other hand, may include a decrease in dopamine supply, as well as feelings of apathy, dizziness, chest pains and some constipation issues not mentioned with Lexapro.

Dosage Differences of Paxil vs Lexapro

Typically, Lexapro is administered in doses of between 10mg and 30mg per day, and can be taken with or without food. Doses range between 5mg and 20mg when oral tablets are considered, and oral solutions can be tailored starting at mg per mL.

Paxil can be administered in the same ways, but typically is administered in larger doses, starting at 20mg per day and up to 60mg per day for adults.

Truth be told, these medications could be considered nearly identical on paper. Both are dangerous when used alongside monoamine oxidase inhibitors (MAOIs), both aren’t indicated for use among breastfeeding women. 

The dosages might suggest that one or the other is more effective, but what we can tell you is that neither of these medications are “right” or “wrong” for you until you’ve tried one or the other and found it to be difficult to deal with side effects. If Paxil affects your quality of life, it may be the wrong medication. Ditto for Lexapro. 

All antidepressants have side effects and all come with an adjustment period — it will take some time for your brain to adjust to serotonin levels as you’re going on or off this medication.

SSRIs are known to take time to “build up” in your body, so working out the correct dosage regardless of whether it’s Paxil or Lexapro will likely take time — as much as a few weeks. 

And if we’re giving you the most honest and direct medical advice here, your healthcare provider won’t just prescribe a pill and send you on your way — they will likely suggest a holistic approach to improved mental health, involving other treatments.

If you're thinking about making the switch, check out our blog on switching from Paxil to Lexapro.

Treating depression in adults is a hard thing to explain in one sitting, in part because there are so many types of depression, from major depression and clinical depression, to seasonal affective disorder and others. 

And that’s assuming you’re not suffering from another related mood disorder like generalized anxiety disorder, panic disorder, social anxiety disorder or bipolar depression and bipolar disorder, to boot. 

When seeking depression treatment, it’s important for depression patients to understand that generally, all medications available today are considered safe and effective. One just may be more effective or safe for you and your needs. 

Determining that is the responsibility of a healthcare professional, who will likely start your pharmacological treatment with one of several selective serotonin reuptake inhibitors (SSRIs), available today. 

But they may also suggest two other effective treatments be included into your daily life: health improvements and therapy. 

Therapy works. These days, a practice like cognitive behavioral therapy (CBT) might be their go-to suggestion. CBT is a strategy for controlling and overcoming negative throughs and thought patterns that can keep us mired in depression, even when the medication is doing what it’s supposed to. 

If you’re out of shape, eating poorly, smoking too much, drinking too much, taking recreational drugs, neglecting your sleep or otherwise not taking care of yourself, giving your body the attention and support it needs to be healthy may have just as much impact on your mental health as therapy or medication. 

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Choosing the right medication for depression is a difficult challenge without help. If you’re doing your due diligence right now about the right antidepressant for you, it’s probably best to include a healthcare professional in that conversation. 

Making these choices with help is common practice for a reason: professionals have seen more people work through side effects than you have, and they’re likely to have a better understanding based on your unique circumstances of what will and won’t affect you. 

If you’re looking for the right way to treat your depressive disorder, it’s probably time to bring in that expert support. Ready to take the next step? Why not use our online therapy resources and get started today. Unlike the right SSRI for you, the choice to get started is one you can make now, all on your own.

6 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Ng, C. W., How, C. H., & Ng, Y. P. (2017). Managing depression in primary care. Singapore medical journal, 58(8), 459–466.
  2. U.S. Department of Health and Human Services. (n.d.). Perinatal depression. National Institute of Mental Health. Retrieved December 6, 2021, from
  3. Craft, L. L., & Perna, F. M. (2004). The Benefits of Exercise for the Clinically Depressed. Primary care companion to the Journal of clinical psychiatry, 6(3), 104–111.
  4. Landy K, Rosani A, Estevez R. Escitalopram. [Updated 2022 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  5. Shrestha P, Fariba K, Abdijadid S. Paroxetine. [Updated 2020 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
  6. U.S. National Library of Medicine. (n.d.). Citalopram: MedlinePlus Drug Information. MedlinePlus.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Vicky Davis, FNP

Dr. Vicky Davis is a board-certified Family Nurse Practitioner with over 20 years of experience in clinical practice, leadership and education. 

Dr. Davis' expertise include direct patient care and many years working in clinical research to bring evidence-based care to patients and their families. 

She is a Florida native who obtained her master’s degree from the University of Florida and completed her Doctor of Nursing Practice in 2020 from Chamberlain College of Nursing

She is also an active member of the American Academy of Nurse Practitioners.

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