Lexapro Vs. Seroquel: Drug Comparison

Lexapro^® (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression by increasing available serotonin levels in the brain, which helps improve mood and reduce anxiety. Its FDA-approved indications include the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. Off-label uses may include treating panic disorder, obsessive-compulsive disorder (OCD), and social anxiety disorder. Lexapro is available in tablet and oral solution forms, taken once daily. Common side effects include nausea, insomnia, and sexual dysfunction, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the initial stages of treatment.

Seroquel^® (quetiapine) is an atypical antipsychotic medication used to treat mental health conditions by altering the actions of neurotransmitters like serotonin and dopamine in the brain. Its FDA-approved indications include the treatment of schizophrenia, bipolar disorder (both manic and depressive episodes), and as an adjunct therapy for major depressive disorder (MDD). Off-label uses may include the treatment of anxiety disorders and insomnia. Seroquel is available in tablet form, including both immediate-release and extended-release formulations. Common side effects include drowsiness, dizziness, and weight gain, and it carries a boxed warning for an increased risk of death in elderly patients with dementia-related psychosis as well as for the potential risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

Selective serotonin reuptake inhibitor (SSRI)

Atypical antipsychotic

Lexapro (escitalopram) is indicated for the:

• Treatment of major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older

• Treatment of generalized anxiety disorder (GAD) in adults and pediatric patients 7 years and older

Seroquel (quetiapine) is indicated for the treatment of:

• Schizophrenia

• Bipolar I disorder manic episodes

• Bipolar disorder, depressive episodes

• Typically taken orally once daily

• Comes in 5 mg, 10 mg (scored), and 20 mg (scored) tablets

• Typically taken orally once or twice daily

• Comes in 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, and 400 mg tablets

Most commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) are:

• Insomnia

• Ejaculation disorder (primarily ejaculatory delay),

• Nausea

• Sweating increased

• Fatigue and sleepiness

• Decreased libido

• Inability to orgasm

Most common adverse reactions (incidence ≥5% and twice placebo):

Adults

• Sleepiness

• Dry mouth

• Dizziness

• Constipation

• Weakness

• Abdominal pain

• Positional low blood pressure

• Inflammation of the throat

• Weight gain

• Lethargy

• ALT increased, dyspepsia

• Indigestion

Children and adolescents:

• Sleepiness

• Dizziness

• Fatigue

• Increased appetite

• Nausea

• Vomiting

• Dry mouth

• Fast heartbeat

• Weight increased

• Do not use MAOIs intended to treat psychiatric disorders with Lexapro or within 14 days of stopping treatment with Lexapro. Do not use Lexapro within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Lexapro in a patient who is being treated with linezolid or intravenous methylene blue

• Concomitant use of pimozide

• Known hypersensitivity to escitalopram or citalopram or any of the inactive ingredients

• Drug interactions: SSRIs, SNRIs, tryptophan, drugs that affect hemostasis (NSAIDs, aspirin, warfarin)

• Known hypersensitivity to Seroquel or any components in the formulation

• Drug interactions: strong CYP3A4 inhibitors, strong CYP3A4 inducers

• Serotonin syndrome

• Discontinuation syndrome

• Seizures

• Activation of mania/hypomania

• Low blood sodium: Can occur in association with syndrome of inappropriate antidiuretic hormone secretion

• Increased risk of bleeding

• Interference with cognitive and motor performance

• Angle closure glaucoma

• Use in patients with concomitant illness

• Sexual dysfunction

• Pregnancy: SSRI use, particularly later in pregnancy, may increase the risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulties, hypotonia, tremor, irritability) in the neonate

• Cerebrovascular adverse reactions

• Neuroleptic malignant syndrome (NMS)

• Metabolic changes

• Dyslipidemia

• Weight gain

• Tardive dyskinesia

• Low blood pressure

• Increased blood pressure in children and adolescents

• Leukopenia, neutropenia and agranulocytosis

• Cataracts

• Anticholinergic (antimuscarinic) effects

• Pregnancy: May cause extrapyramidal and/or withdrawal symptoms in neonates with third trimester exposure

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. Lexapro is not approved for use in pediatric patients less than 7 years of age.

WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS; and SUICIDAL THOUGHTS AND BEHAVIORS

Increased Mortality in Elderly Patients with Dementia-Related Psychosis

• Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Seroquel is not approved for elderly patients with dementia-related psychosis.

Suicidal Thoughts and Behaviors

• Increased risk of suicidal thoughts and behavior in children, adolescents and young adults taking antidepressants

• Monitor for worsening and emergence of suicidal thoughts and behaviors.

*This information is from the label for brand name Lexapro^®. See the Full Prescribing Information for more complete information. Escitalopram, the active ingredient in Lexapro, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient escitalopram.

*This information is from the label for brand name Seroquel^®. See the Full Prescribing Information for more complete information. Quetiapine, the active ingredient in Seroquel, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient quetiapine.