Venlafaxine (Effexor) vs Escitalopram (Lexapro)

Based on "Essential Psychopharmacology"
written by Stephen M. Stahl, MD, PhD

Venlafaxine vs. Escitalopram (Lexapro)

Major depressive disorder

Escitalopram is at least as effective as venlafaxine XR and significantly better tolerated 8. Escitalopram has a faster onset of antidepressant effects 9.

Results of double-blind comparison of escitalopram and venlafaxine ER for major depressive disorder 8. Venlafaxine Escitalopram
225 mg/day
20 mg/day
Mean changes from baseline to endpoint in MADRS total score
Remission rates at endpoint
Response rates
Treatment-emergent adverse events
Discontinuation due to adverse events

Generalized anxiety disorder (GAD)

Venlafaxine XR seems to be more effective than escitalopram for the treatment of GAD 10.

Results of randomized placebo-controlled trial of escitalopram and venlafaxine XR for GAD 10. Venlafaxine Escitalopram
75-225 mg/day
10-20 mg/day
Mean change from baseline at week 8 in HAMA total score
Mean change from baseline at week 8 using Last Observation Carried Forward approach
Discontinuation due to adverse events

Side effects

Escitalopram appears to be significantly better tolerated than venlafaxine XR 8.

Withdrawal symptoms

Venlafaxine is associated with significantly higher rate of discontinuation symptoms than escitalopram 8, 9.

Escitalopram provides a more cost-effective first-line treatment of depression than generic venlafaxine XR 4.


Venlafaxine vs. Mirtazapine (Remeron)

Major depressive disorder

Mirtazapine and venlafaxine are similarly effective for the treatment of overall symptoms of depression, and both antidepressants may be useful for somatic (bodily) symptoms of depression 12. Mirtazapine appears to have higher response and remission rates than venlafaxine 1.

Mirtazapine orally disintegrating tablets (ODT) have a faster onset of antidepressant efficacy than venlafaxine XR 3.

Side effects

Mirtazapine is associated with significantly fewer dropouts due to adverse events 1.

Venlafaxine vs. Trazodone (Desyrel)

Major depressive disorder

Venlafaxine can produce more improvement in the cognitive disturbance and retardation factors on the Hamilton Rating Scale for Depression. Trazodone is more effective against the sleep disturbance factor 6. Trazodone efficiency in comparison to venlafaxine is faster, so trazodone is characterized by potentially quicker beginning of activity in patients with depression disorders 5.

Side effects

Venlafaxine is most likely to cause nausea, whereas trazodone is associated with the most dizziness and somnolence 6. Libido decrease is common side effect with venlafaxine treatment 5.

Further reading
  • 1. Guelfi JD, Ansseau M, Timmerman L, Kørsgaard S; Mirtazapine-Venlafaxine Study Group. Mirtazapine versus venlafaxine in hospitalized severely depressed patients with melancholic features. J Clin Psychopharmacol. 2001 Aug;21(4):425-31. PubMed
  • 3. Benkert O, Szegedi A, Philipp M, Kohnen R, Heinrich C, Heukels A, van der Vegte-Senden M, Baker RA, Simmons JH, Schutte AJ. Mirtazapine orally disintegrating tablets versus venlafaxine extended release: a double-blind, randomized multicenter trial comparing the onset of antidepressant response in patients with major depressive disorder. J Clin Psychopharmacol. 2006 Feb;26(1):75-8. PubMed
  • 4. Nordström G, Danchenko N, Despiegel N, Marteau F. Cost-effectiveness evaluation in Sweden of escitalopram compared with venlafaxine extended-release as first-line treatment in major depressive disorder. Value Health. 2012 Mar-Apr;15(2):231-9. PubMed
  • 5. Florkowski A, Gruszczynski W, Galecki P, Zboralski K, Kolodziejska I, Mikolajczyk I. Trazodone and venlafaxine in treatment of depressive disorders. Pol Merkur Lekarski. 2005 May;18(107):556-9. PubMed
  • 6. Cunningham LA, Borison RL, Carman JS, Chouinard G, Crowder JE, Diamond BI, Fischer DE, Hearst E. A comparison of venlafaxine, trazodone, and placebo in major depression. J Clin Psychopharmacol. 1994 Apr;14(2):99-106. PubMed
  • 8. Bielski RJ, Ventura D, Chang CC. A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder. J Clin Psychiatry. 2004 Sep;65(9):1190-6. PubMed
  • 9. Montgomery SA, Huusom AK, Bothmer J. A randomised study comparing escitalopram with venlafaxine XR in primary care patients with major depressive disorder. Neuropsychobiology. 2004;50(1):57-64. PubMed
  • 10. Bose A, Korotzer A, Gommoll C, Li D. Randomized placebo-controlled trial of escitalopram and venlafaxine XR in the treatment of generalized anxiety disorder. Depress Anxiety. 2008;25(10):854-61. PubMed
  • 12. Kang EH, Lee IS, Chung SK, Lee SY, Kim EJ, Hong JP, Oh KS, Woo JM, Kim S, Park JE, Yu BH. Mirtazapine versus venlafaxine for the treatment of somatic symptoms associated with major depressive disorder: a randomized, open-labeled trial. Psychiatry Res. 2009 Sep 30;169(2):118-23. PubMed

Published: March 31, 2008
Last updated: February 25, 2017


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