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Lexapro vs Elavil
Introduction
For patients with major depressive disorder (MDD) or other types of depression, there are certain drugs available that can modify the concentrations of neurotransmitters in the brain related to mood and help stabilize emotional lows and control symptoms. Lexapro and Elavil are two such medications often prescribed for depression. Both impact different neurotransmitters within the brain but have been proven to aid in stabilizing moods for those suffering from depressive disorders.
Lexapro is a selective serotonin reuptake inhibitor (SSRI), which primarily impacts levels of serotonin—a neurotransmitter associated with feelings of wellbeing and happiness—by limiting its reabsorption into neurons, thus increasing its availability within synaptic gaps. On the contrary, Elavil belongs to a class known as tricyclic antidepressants (TCAs). It affects multiple neurotransmitters like norepinephrine and serotonin by blocking their absorption back into nerve cells after they have sent messages along neural pathways.
Lexapro vs Elavil Side By Side
| Attribute | Lexapro | Elavil |
|---|---|---|
| Brand Name | Lexapro | Elavil |
| Contraindications | Should not be taken with or within 5 weeks of taking monoamine oxidase inhibitors (MAOIs). | Should not be taken with or within 5 weeks of taking monoamine oxidase inhibitors (MAOIs). |
| Cost | For brand name, around $350 for 30 tablets (10 mg). For generic (escitalopram), costs can be as low as $0.14/day to about $1/day. | For brand name, less than $20 for 30 tablets (25 mg). For generic (amitriptyline), costs start at just over $0.01/day. |
| Generic Name | Escitalopram | Amitriptyline |
| Most Serious Side Effect | Increased suicidal thoughts or self-harm tendencies, severe skin reactions, low sodium levels, serotonin syndrome. | Allergic reactions, chest pain, sudden numbness or weakness, rapid weight gain, signs of an allergic reaction. |
| Severe Drug Interactions | Monoamine oxidase inhibitors (MAOIs). | Monoamine oxidase inhibitors (MAOIs). |
| Typical Dose | 10-20 mg/day for adults. For children and adolescents aged 12 to 17 years, 5-10 mg/day. | 25-50 mg/day taken orally before bedtime, can be gradually increased. Maximum dosage for most adults is around 150 mg per day. |
What is Lexapro?
Escitalopram (the generic name for Lexapro) is one of the newer drugs in the Selective Serotonin Reuptake Inhibitors (SSRIs) class, designed to improve upon earlier classes of antidepressants such as tricyclic antidepressants (TCAs). Escitalopram was first approved by the FDA in 2002. Lexapro works by increasing levels of free serotonin, a neurotransmitter associated with mood regulation, by preventing it from being reabsorbed into nerve cells in the brain. It is commonly prescribed for treating various types of depression and generalized anxiety disorder.
On the other hand, Amitriptyline (the generic name for Elavil), which belongs to TCAs class that came before SSRIs like Lexapro, affects not just serotonin but also norepinephrine another neurotransmitter involved in mood regulation. This lack of specificity often results in more side effects compared to newer drugs like Lexapro.
What conditions is Lexapro approved to treat?
Lexapro is approved for the treatment of several mood and anxiety disorders:
- Major depressive disorder (MDD), also known as unipolar depression
- Generalized anxiety disorder (GAD)
- Panic disorder
- Obsessive-compulsive disorder (OCD) in combination with cognitive-behavioral therapy
On the other hand, Elavil has been approved to treat:
- Endogenous depression, including both major depressive episodes and mixed episodes of bipolar I or II
- Neurogenic pain particularly neuropathic pain such as postherpetic neuralgia and fibromyalgia
How does Lexapro help with these illnesses?
Lexapro, like Prozac, works to manage depression by increasing the amount of serotonin available in the synapses of the brain. It does this by blocking it from being reabsorbed by neurons allowing levels to be maintained higher for prolonged periods. Serotonin is a neurotransmitter that plays a critical role in mood regulation, cognition, memory, sleep patterns and more. In individuals with depression, serotonin levels are often lower than usual. Hence, Lexapro's ability to increase serotonin helps mitigate depressive symptoms and aids patients in managing their condition.
On the other hand, Elavil targets not only serotonin but also another neurotransmitter called norepinephrine. Like serotonin, norepinephrine affects mood and cognition among other functions. By inhibiting its reuptake along with that of serotonin's reuptake; Elavil can also alleviate depressive symptoms effectively albeit through a slightly different mechanism than Lexapro.
What is Elavil?
Elavil, the brand name for amitriptyline, is a tricyclic antidepressant (TCA) that works by increasing the levels of certain chemicals in the brain. It was first approved by the FDA in 1961. Unlike Lexapro, which is a selective serotonin reuptake inhibitor (SSRI), Elavil also affects norepinephrine and to a lesser degree dopamine neurotransmission. This means it doesn't act solely on serotonin like Lexapro does. A consequence of this broader effect is that Elavil's side-effect profile differs from SSRIs such as Lexapro; for example, it can cause anticholinergic effects like dry mouth or blurred vision and may lead to weight gain or sedation more frequently than most SSRIs do. However, its effects on norepinephrine can be beneficial for treating depression especially in patients who have not responded well to typical SSRI drugs like Lexapro.
What conditions is Elavil approved to treat?
Elavil, also known as Amitriptyline, is approved for the treatment of:
- Major depressive disorder (MDD)
- Neuropathic pain
- Migraine prophylaxis
It's essential to note that Elavil is a tricyclic antidepressant and it's often chosen when newer medications are not effective. Despite its potential side effects such as dry mouth and sedation, it has proven beneficial in managing these conditions effectively.
How does Elavil help with these illnesses?
Amitriptyline, marketed under the brand name Elavil, is a tricyclic antidepressant that works by increasing the levels of certain chemicals in the brain that help improve mood. It affects numerous neurotransmitter systems in the brain including serotonin and norepinephrine. As with low levels of serotonin, reduced amounts of norepinephrine have been linked to depression. Elavil boosts these neurotransmitters which helps alleviate symptoms associated with depression. Its action on other receptors such as muscarinic and histamine receptors may account for its side effects profile which includes drowsiness and dry mouth among others.
Elavil can be prescribed when patients do not respond well to more "typical" selective serotonin reuptake inhibitors (SSRIs) like Lexapro or it might be used in combination with them for treatment-resistant cases.
How effective are both Lexapro and Elavil?
Escitalopram (Lexapro) and amitriptyline (Elavil) both have long-standing histories of successful use in treating depression, though they were initially approved by the FDA several decades apart. They act on different neurotransmitter systems and therefore may be prescribed under distinct circumstances. The comparative effectiveness of escitalopram and amitriptyline was directly studied in a double-blind clinical trial in 2004; the two drugs demonstrated comparable efficacy in managing depressive symptoms but presented different safety profiles, with Lexapro exhibiting fewer side effects.
A 2018 review showed that escitalopram is effective at alleviating depressive symptoms within the first week or two of treatment, has a favorable side effect profile compared to many other antidepressants including tricyclics like Elavil, and is generally well-tolerated across various patient populations such as elderly individuals or those with co-existing medical conditions. The same study reports that escitalopram has become one of the most commonly prescribed SSRIs globally due to its relative potency and tolerability profile. Optimal dosing for maximum efficacy typically ranges from 10-20mg per day.
On the other hand, while amitriptyline also proves effective against depression symptoms more so than placebo treatments according to a 2011 meta-analysis review, it's usually considered a secondary line of treatment due to its potential for significant side effects such as dry mouth, constipation and urinary retention which are linked to its anticholinergic actions. Despite this fact, Elavil remains an important option especially when dealing with patients who suffer from comorbidities like nerve pain or migraine prophylaxis where it exhibits additional beneficial effects.
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At what dose is Lexapro typically prescribed?
Oral dosages of Lexapro typically range from 10-20 mg/day, but studies suggest that 10 mg/day is enough for treating generalized anxiety disorder in most adults. For major depressive disorder, adults are usually started on a daily dose of 10mg which may be increased to a maximum of 20mg per day if required. Children and adolescents aged between 12 to 17 years old with depression may start at lower doses around the range of 5 -10 mg/day based on doctor's advice. In either population, dosage can be gradually increased after about a week if there is no significant improvement observed. The maximum dosage that should not be exceeded in any case is generally considered to be about 20 mg/day.
On the other hand, Elavil (amitriptyline) dosing often starts at low doses like 25-50mg taken orally once daily or divided into smaller doses throughout the day (usually before bed). This can then slowly increase by your healthcare provider's recommendations based on response and tolerance up until about a general maximum dose limit around150-200mg per day for most patients suffering from various forms of depression.
At what dose is Elavil typically prescribed?
Elavil treatment typically begins at a low dosage, such as 25-50 mg/day taken orally before bedtime. Depending on how the patient reacts to the medication and their specific medical condition, this dose can be gradually increased. The maximum dosage for most adults is around 150 mg per day divided into two or three smaller doses throughout the day. This level of dosing may be tested if there's no response to initial treatment after several weeks. Please remember that Elavil usage should always begin under close supervision from your healthcare professional due to its potential side effects.
What are the most common side effects for Lexapro?
Common side effects of Lexapro include:
- Nausea
- Sleepiness or drowsiness
- Dry mouth
- Insomnia (trouble sleeping)
- Increased sweating, often with hot flashes
- Decreased libido (sex drive)
- Diarrhea
- Ejaculation disorder in men
While Elavil also shares some similar side effects such as dry mouth and constipation, it has other unique ones including:
- Weight gain
- Blurred vision
- Changes in sexual desire or ability
- Increased sensitivity to sunlight.
Both drugs can cause nervousness and tremors. However, the presence and severity of these adverse reactions can vary between individuals. If you experience any disturbing symptoms while taking either medication, promptly seek medical advice.
Are there any potential serious side effects for Lexapro?
While both Lexapro and Elavil are used to treat depression, there are differences in their potential side effects. For example:
- Increased suicidal thoughts or self-harm tendencies can occur with either medication, especially during the initial stages of treatment or when dosage is changed
- Allergic reactions and severe skin reactions such as hives, difficulty breathing, swelling on your face or throat, fever, sore throat, burning eyes, skin pain; a red or purple skin rash that spreads (especially in the face or upper body) causing blistering and peeling may also occur.
- Blurred vision might be experienced more frequently with Elavil than Lexapro due to its anticholinergic effect.
- Rapid heartbeats and palpitations which could cause sudden dizziness might be experienced more often with Lexapro.
- Both medications can cause low sodium levels - symptoms include headache confusion slurred speech severe weakness vomiting loss of coordination unsteady feeling. -Nervous system reactions like stiff muscles high fever sweating confusion rapid uneven heartbeat tremors fainting could happen while taking these drugs but it's rarer -In rare cases serotonin syndrome may occur causing symptoms like agitation hallucinations fever sweating shivering fast heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea.
If you experience any of these symptoms contact your healthcare provider immediately.
What are the most common side effects for Elavil?
Elavil, also known as Amitriptyline, can have an array of side effects including:
- Dry mouth and throat discomfort
- Blurred vision or difficulty focusing
- Constipation and potential stomach pain or upset
- A rapid heartbeat that may cause concern
- Issues with sleep, such as insomnia
- Feelings of nervousness or anxiety accompanied by sweating
- Possible tremors in some individuals
- Confusion or agitation which could escalate to hostility in some cases
- Rashes on the skin, unexplained weight loss
- Increased frequency of urination
-Dizziness and headaches are common. Additionally, you might experience muscle soreness or joint pain.
Remember to always consult a healthcare professional before starting any new medication regimen.
Are there any potential serious side effects for Elavil?
While Elavil is often highly effective, it can also result in significant side effects. These may include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Chest pain or pressure, pain spreading to your jaw or shoulder, nausea and sweating
- Sudden numbness or weakness (especially on one side of the body), slurred speech
- Rapid weight gain with no obvious cause
- A lightheaded feeling like you might pass out
- New or worsening symptoms of depression - thoughts about suicide or dying; new behavior changes being more depressed or having severe anxiety and panic attacks
- Abnormal heartbeats (too fast/slow/uneven) If any of these occur while taking Elavil, seek immediate medical attention.
Contraindications for Lexapro and Elavil?
Both Lexapro and Elavil, like many other antidepressant medications, may inadvertently worsen symptoms of depression in some individuals. If you notice your depression intensifying or an increase in suicidal ideas, thoughts, or behavior after starting either medication, it's crucial to seek medical attention immediately.
Neither Lexapro nor Elavil should be taken if you are currently taking monoamine oxidase inhibitors (MAOIs), or have been using them recently. Always be transparent with your physician about any medications you're taking; MAOIs will need roughly 5 weeks to exit your system fully before starting a new regimen with Lexapro or Elavil to prevent harmful interactions.
How much do Lexapro and Elavil cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Lexapro (10 mg) averages around $350, which works out to about $11.66 per day.
- Conversely, the price for 30 tablets of Elavil (25 mg) is typically less than $20, working out to approximately $0.67 per day.
Thus, if you're taking standard doses, then brand-name Elavil is much less expensive on a daily treatment basis compared with Lexapro. However, cost should not be your only consideration in determining which drug is best suited for you.
In terms of generic versions – escitalopram (Lexapro) and amitriptyline (Elavil), the costs are significantly lower:
- Escitalopram can be bought in packs from 5 up to 500 tablets (10 mg), with approximate costs ranging from as little as $0.14/day (if buying larger quantities upfront) but not exceeding about $1/day.
- Amitriptyline comes in packs from 15 up to several hundred tablets too (25mg). Costs start at an incredibly low rate – just over a penny per day ($0.01/day) when buying more substantial amounts ahead and may stretch upwards slightly based on smaller pack sizes or individual store pricing policies.
Popularity of Lexapro and Elavil
Escitalopram, also known by its brand name Lexapro, was prescribed to about 27.7 million people in the US in 2019. Escitalopram accounted for just over 16% of SSRI prescriptions and just under 10% of overall antidepressant prescriptions in the country. This drug is often used for treating depression and generalized anxiety disorder.
On the other hand, Amitriptyline, commonly referred to by its brand name Elavil, was prescribed to approximately 6 million Americans in that same year. While it only constitutes around 3% of total antidepressant prescriptions within the United States, it remains one of the most commonly prescribed tricyclic antidepressants (TCAs). It's important to note that while both drugs are effective at managing mental health conditions such as depression or anxiety disorders, they belong to different classes: escitalopram is a selective serotonin reuptake inhibitor (SSRI), whereas amitriptyline is a TCA.
Conclusion
Both Lexapro (escitalopram) and Elavil (amitriptyline) are well-established in the treatment of depression, supported by numerous clinical trials and meta-analyses suggesting their effectiveness exceeds that of placebos. Occasionally, these medications might be used together, but this requires careful evaluation by a healthcare provider since they can interact negatively with each other. They work differently: Lexapro primarily increases serotonin levels, while Elavil affects multiple neurotransmitters including norepinephrine and serotonin.
Lexapro is often considered a first-line option for treating depression due to its safety profile and efficacy. Meanwhile, because of its side effects such as anticholinergic effects and potential sedative properties, Elavil may be favored as an adjunctive therapy or when SSRI antidepressants like Lexapro aren't effective or suitable.
Both drugs have generic forms available which provide cost savings especially for patients who must pay out-of-pocket. Both Lexapro and Elavil could take some time before the full benefits are experienced.
The side effect profiles between the two drugs vary; both are generally well-tolerated but differ in specifics. For instance, sexual dysfunction is less common with Elavil than it is with SSRIs like Lexapro. On initiating either drug therapy, patients should closely monitor any mood changes or worsening depressive symptoms - if observed they should immediately seek medical attention.
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Refrences
- Aronson, S., & Delgado, P. (2004). Escitalopram. Drugs of Today. Portico.http://doi.org/10.1358/dot.2004.40.2.799424
- Scharfetter, C. (1965). Vergiftung mit einem Antidepressivum. Archiv f�r Psychiatrie und Nervenkrankheiten Vereinigt mit Zeitschrift f�r die Gesamte Neurologie und Psychiatrie. Springer Science and Business Media LLC.http://doi.org/10.1007/bf00343771
- McClure, E. W., & Daniels, R. N. (2021, January 13). Classics in Chemical Neuroscience: Amitriptyline. ACS Chemical Neuroscience. American Chemical Society (ACS).http://doi.org/10.1021/acschemneuro.0c00467
- Goodman, W. K., Bose, A., & Wang, Q. (2005, August). Treatment of generalized anxiety disorder with escitalopram: Pooled results from double-blind, placebo-controlled trials. Journal of Affective Disorders. Elsevier BV.http://doi.org/10.1016/j.jad.2004.11.011
- Barak, Y. (2008, January). Co-prescription of antidepressants with other psychotropics: Distinct profile of escitalopram. International Journal of Psychiatry in Clinical Practice. Informa UK Limited.http://doi.org/10.1080/13651500701419701