Should I switch from lexapro to cymbalta?

This blog post will answer the question, “Should I switch from lexapro to cymbalta?”. We are going to cover the benefits of switching your lexapro and what circumstances lead to the discontinuation of this med in the first place. We will also talk about the therapeutic efficacy and safety of cymbalta. 

Should you switch from lexapro to cymbalta? 

You should switch from lexapro to cymbalta if your mental healthcare professional believes that it’s the better option for you and will deliver desired therapeutic outcomes. 

However, lexapro has a better safety and efficacy profile, but some people can’t tolerate it well and it results in discontinuation of the treatment. Both of these agents are antidepressants. 

Remember, it is not recommended to switch your antidepressant without your doctor’s approval. Switching antidepressants is a normal practice because of variable responses of people to these meds. 

There’s one thing to know here that the new drug will not start working overnight. Your body will take its time to adapt to cymbalta. Just give it a few weeks, be consistent and maintain a healthy lifestyle. 

What is the difference between Lexapro and cymbalta? 

Lexapro, brand name for escitalopram, belongs to the class of selective serotonin reuptake inhibitors (SSRIs). These drugs inhibit the reuptake of serotonin from the synaptic cleft (space between a neuron and its target cell). 

So the neuron here releases serotonin and oftentimes there’s some leftover within the synaptic cleft that is retaken by transporters. 

With lexapro, these transporters are blocked, so the reuptake of neurotransmitter (serotonin) is prevented, which leaves more serotonin within the synaptic cleft to bind to its target cells and produce its effect.

In short, lexapro increases the availability of serotonin in your brain, which is a neurotransmitter (a chemical) released by our brain which is responsible for modulating mood, cognition, reward, learning, memory, and various other psychological processes. 

Cymbalta, on the other hand, is a generic name for duloxetine. It belongs to the class of serotonin norepinephrine reuptake inhibitors (SNRIs), which inhibits the reuptake of both serotonin and norepinephrine. 

Norepinephrine is another excitatory neurotransmitter which is responsible for a lot of physiological functions like contraction of skeletal and cardiac muscles etc. 

What circumstances lead to the discontinuation of lexapro? 

Following circumstances lead to the discontinuation of treatment with lexapro:

Lexapro intolerance

Lexapro is not for everyone. Some people can not seem to tolerate this antidepressant, no matter how properly they take it. Several surveys have revealed that some people start exhibiting the signs of allergic reactions soon after taking their first ever dose. 

These reactions include redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. This response to lexapro requires immediate discontinuation. 

Some side effects start to show up within a few weeks. These include insomnia, tremors, jaw clenching, mental fog, Parkinson’s-like symptoms etc. They can also result in discontinuation of treatment as these symptoms disturb you as long as you keep taking lexapro. 

The rest of the common side effects including nausea, vomiting, diarrhoea, acid reflux, loss of libido etc can be managed and they usually begin to fade away once your body adjusts to the medication. 

Inadequate therapeutic response 

As discussed earlier, lexapro acts differently in different individuals. Experts have revealed that some people get no benefits from lexapro. Even if their side effects begin to go away, they still don’t see as much difference in their condition as they should. 

This indicates that lexapro is indeed not a good choice of antidepressant for everyone. It is absolutely useless to continue using a med that shows no results, whatsoever. Make sure you monitor the effects of your lexapro and report back to your healthcare provider.

Drug interactions 

Your doctor may recommend you to switch using lexapro if your antidepressant is interfering with the effects or metabolism of some other medicines that you are taking along with it, it’s best to switch to another antidepressant that’s safe to use with your other prescribed medications. 

Sometimes this interaction makes an entire class of antidepressants useless and the doctor moves to another class of antidepressants, in order to avoid this complication. 

If your doctor stops lexapro, you might suffer from withdrawal symptoms. It is best to taper off lexapro while slowly increasing the dose of cymbalta. 

This technique maintains the amount of neurotransmitters in your body. If they get too low, you will suffer from withdrawal symptoms. If they get too high, you will be subjected to the symptoms of serotonin syndrome. 

What are the most common side effects associated with cymbalta? 

Common side effects of cymbalta include:

• Drowsiness/fatigue/sleepiness/hypersomnia
• Decreased salivation leading to dry mouth 
• Vertigo 
• Loss of appetite 
• Excessive sweating
• Constipation or diarrhoea 
• Weight gain or loss
• Abdominal pain

Serious side effects include:

• Urinary problems 
• Vision problems 
• Low sodium levels 
• Orthostatic Hypotension. 
• High doses can cause serotonin syndrome, associated with chills, fever, confusion, delirium, cloudiness, convulsions etc. 
• It can cause liver damage associated with abdominal pain, excessive itching, yellowing of eyes and skin etc. 
• Allergic reaction to the drug, which includes breathing issues, skin rashes associated with itching, redness, blisters, blue-purple patches, burning sensation etc. 
• It can cause manic behaviour in some patients, associated with aggressiveness, anger, improper behaviour, chills, sweating, hyperventilation etc. 

Is there any difference between the uses of these two antidepressants? 

Uses	Lexapro	Cymbalta
Approved by FDA	-Major depressive disorder (MDD) -Generalised anxiety disorder (GAD)	-Major depression-Generalised anxiety disorder (GAD) -Fibromyalgia induced pain-Skeletal muscle pain
Off-label	-Obsessive compulsive disorder -Panic attacks -Vasomotor symptoms associated with menopause	-Urinary incontinence -Peripheral Neuropathy associated with Chemotherapy

Conclusion 

In this blog, we discussed whether you should switch from lexapro to cymbalta or not. Both of these agents are antidepressants and you can switch if your mental healthcare professional believes that it’s the better option for you and will give desired therapeutic outcomes.

Make sure you don’t switch your antidepressant, stop using it or change your dose without your doctor’s approval. Antidepressants should not be messed with or else they will leave you with severe consequences. 

Lexapro is most commonly switched when it is not tolerated well and it produces a number of side effects. The discontinuation can also be a result of drug interactions of lexapro with any other prescription medication. 

FAQs: should i switch from lexapro to cymbalta

Does Cymbalta work better than Lexapro? 

Cymbalta and lexapro may provide a similar amount of relief from the symptoms associated with various mental health conditions. They both belong to different classes of antidepressants. Lexapro (Escitalopram) is a selective serotonin reuptake inhibitor (SSRI) and cymbalta (Duloxetine) is a serotonin-norepinephrine reuptake inhibitor (SNRI). 

The only difference between their mechanism of action is that lexapro only inhibits the reuptake of serotonin, whereas cymbalta inhibits the reuptake of serotonin as well as norepinephrine. 

How do you switch from lexapro to cymbalta?

The best switching strategy for replacing lexapro with cymbalta is cross tapering. Your doctor will taper off lexapro while starting cymbalta from the lowest effective dose. 

Gradually the dose of lexapro is decreased, while the dose of cymbalta increases until the former drug is stopped completely. It is not recommended to stop using lexapro abruptly. 

Which is better for depression: Lexapro or Cymbalta?

Both lexapro and cymbalta are approved by the Food and Drug Administration (FDA) for the treatment of mild to severe episodes of depression. It totally depends on how your body reacts to these meds. Some people can not tolerate lexapro well. 

In fact, they can’t seem to tolerate any SSRI well, which is why the doctor shifts them from these meds to another class of antidepressants, like SNRIs. However, a large number of the population remains satisfied with the use of lexapro. 

Can you take Lexapro and Cymbalta at the same time?

It is not recommended to take more than one antidepressant at the same time to avoid excessive activity of excitatory neurotransmitters in your brain, which can give rise to serotonin syndrome. 

This syndrome is associated with disturbing symptoms including chills, fever, excessive sweating, restlessness and fatigue, headache, which often feels like your head is pounding, changes in blood pressure, nausea, vomiting, diarrhoea, bradycardia, tremors and muscle twitching etc. 

What’s the difference between Lexapro and Cymbalta?

Lexapro and cymbalta belong to the different classes of antidepressants. Lexapro (Escitalopram) is a selective serotonin reuptake inhibitor (SSRI) and cymbalta (Duloxetine) is a serotonin-norepinephrine reuptake inhibitor (SNRI). 

The only difference between their mechanism of action is that lexapro only inhibits the reuptake of serotonin, whereas cymbalta inhibits the reuptake of serotonin as well as norepinephrine.

Does your brain go back to normal after antidepressants?

Your brain does go back to normal after you stop using antidepressants, but it takes time and this time taken depends on the duration of your antidepressant therapy. It could take up to 10 months to go back to your normal serotonin levels, after long-term antidepressant therapy.

Can you switch from one antidepressant to another?

Yes, you can switch from one antidepressant to another by following one of the following switching strategies:

• Direct switch: You stop one antidepressant and directly switch to another.
• Cross taper: You taper off one antidepressant while gradually increasing the dose of the next one, over a few weeks period.
• Taper and switch right away: You gradually taper off your current drug. As soon as you have completely stopped the first drug, you start taking the next one. 
• Taper and switch, after washing out the first drug completely: You gradually taper off the first drug and wait a couple of weeks, usually 1-6 weeks, for your body to completely wash out the drug from your system, even traces.

References 

• Alan G Wade et al. Pharmacoeconomics. (2008) – Escitalopram and duloxetine in major depressive disorder: a pharmacoeconomic comparison using UK cost data https://pubmed.ncbi.nlm.nih.gov/18850765/#:~:text=In%20the%20primary%20CEA%2C%20escitalopram,30.7%20days%20vs%2062.2%20days). 
• Arif Khan et al. Clin Drug Investig. (2007) – Double-blind comparison of escitalopram and duloxetine in the acute treatment of major depressive disorder https://pubmed.ncbi.nlm.nih.gov/17563128/ 
• Andrew A Nierenberg et al. Curr Med Res Opin. (2007) – Duloxetine versus escitalopram and placebo in the treatment of patients with major depressive disorder: onset of antidepressant action, a non-inferiority study https://pubmed.ncbi.nlm.nih.gov/17288694/. 
• Antidepressant switching guidelines (1998) https://www.nps.org.au/assets/Products/Guidelines-switching-antidepressants_A3.pdf 
• Nicholas Keks, Director and Adjunct professor, Judy Hope, Deputy director and Senior lecturer, and Simone Keogh, Psychiatrist and senior fellow – Switching and stopping antidepressants https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919171/
• K. Outhoff – Switching antidepressants : review https://journals.co.za/doi/10.10520/EJC170556
• Strategies and Solutions for Switching Antidepressant Medications https://www.psychiatrictimes.com/view/strategies-and-solutions-switching-antidepressant-medications
• Duloxetine – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-91490-2114/duloxetine-oral/duloxetine-sprinkle-capsule-oral/details
• Escitalopram (Oral Route) https://www.mayoclinic.org/drugs-supplements/escitalopram-oral-route/side-effects/drg-20063707