Lexapro (escitalopram) vs Trintellix (vortioxetine)
Lexapro and Trintellix, compared on what the public record actually supports: side effects by rate from each FDA label, what the largest trial comparison found, who takes each one, who pays, what the labels warn, and what the litigation record holds. Sources on every number.
the short answer
- is Lexapro or Trintellix more effective? in the largest comparison of antidepressant trials (522 trials, 116,477 people, Lancet 2018), both beat placebo on response at about 8 weeks: escitalopram odds ratio 1.68 (95% CrI 1.50 to 1.87), vortioxetine 1.66 (1.45 to 1.92). the authors called the differences between drugs mostly modest, with wide intervals.
- which has fewer side effects? the labels say their trials “cannot be directly compared”, because each drug was tested in different people under different rules. what each label prints: Lexapro (escitalopram): 6% stopped for an adverse reaction vs 2% on placebo (Lexapro label, Revised:4/2024 (as printed in the SPL)). Trintellix (vortioxetine): 5%, 6%, 8%, and 8% (5, 10, 15, and 20 mg/day) stopped for an adverse reaction vs 4% on placebo (Trintellix label, SPL effective 2025-03-05). the reactions both labels list, side by side, are in the table below. in the 2018 network, all-cause dropout against placebo was 0.90 for escitalopram and 1.01 for vortioxetine.
- which should i take? not a question this page answers. the odds ratios are averages across thousands of strangers; your history, other medications and what you can live with are not in them. the questions for your prescriber below are built from what is on this page.
What this page will not do is rank them. These drugs are in different classes and were tested for partly different things, so a single-axis ranking would be a category error. Which one fits you turns on your history, your other medications, and side-effect trade-offs — a prescriber conversation. This page arms that conversation; here are the questions worth taking into it →
what the 522-trial comparison found for escitalopram and vortioxetine
the 2018 Lancet network meta-analysis pooled 522 trials comprising 116 477 participants, the median duration of the acute treatment was 8 weeks (iqr 6–8), and compared 21 antidepressants against placebo and against each other on two outcomes: response (at least a 50% fall on the depression scale) and all-cause dropout, its stand-in for acceptability. odds ratios are against placebo. an odds ratio above 1 on response favours the drug; below 1 on dropout means fewer people stopped than on placebo.
| drug | response vs placebo, OR (95% CrI) | dropout vs placebo, OR (95% CrI) |
|---|---|---|
| Lexapro (escitalopram) | 1.68 (1.50 to 1.87) | 0.90 (0.80 to 1.02) |
| Trintellix (vortioxetine) | 1.66 (1.45 to 1.92) | 1.01 (0.86 to 1.19) |
- escitalopram: among the drugs that were more effective than other antidepressants in head-to-head trials; among the more tolerable (fewer dropouts) in head-to-head trials.
- vortioxetine: among the drugs that were more effective than other antidepressants in head-to-head trials; among the more tolerable (fewer dropouts) in head-to-head trials.
the other direction, in the authors' words. “the certainty of evidence was moderate to very low”; “The random-effects summary SMD for all antidepressants was 0·30 (95% CrI 0·26–0·34)”, a modest average effect; “positive results need to be taken with great caution, because the trials in this network meta-analysis were of short duration”. 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low. 409 (78%) of 522 studies were funded by pharmaceutical companies. the trials excluded people with psychotic, treatment-resistant or bipolar depression, and the paper says it cannot guide the next choice after a first drug fails. a difference between two odds ratios in the table above is not a difference between the drugs unless the direct comparison shows one.
Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 2018; doi:10.1016/S0140-6736(17)32802-7. funding of the analysis: National Institute for Health Research Oxford Health Biomedical Research Centre and the Japan Society for the Promotion of Science. The funder of this study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit for publication. read 2026-10-11 at PMC.
side effects by rate: what each label prints, not a head-to-head trial
the labels' own warning, first: “Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice.” the two columns below come from different trials, in different people, under different inclusion rules. read each against its own placebo column, not against the other drug.
| reaction | Lexapro (N=715) vs Placebo (N=592) | 5 mg/day (N=1013) / 10 mg/day (N=699) / 15 mg/day (N=449) / 20 mg/day (N=455) vs Placebo (N=1621) |
|---|---|---|
| nausea | 15% vs 7% | 21% / 26% / 32% / 32% vs 9% |
| dry mouth | 6% vs 5% | 7% / 7% / 6% / 8% vs 6% |
| diarrhea | 8% vs 5% | 7% / 7% / 10% / 7% vs 6% |
| constipation | 3% vs 1% | 3% / 5% / 6% / 6% vs 3% |
| dizziness | 5% vs 3% | 6% / 6% / 8% / 9% vs 6% |
- Lexapro (escitalopram): 6% stopped for an adverse reaction vs 2% on placebo (Lexapro label, Revised:4/2024 (as printed in the SPL)).
- Trintellix (vortioxetine): 5%, 6%, 8%, and 8% (5, 10, 15, and 20 mg/day) stopped for an adverse reaction vs 4% on placebo (Trintellix label, SPL effective 2025-03-05).
what makes each table, in the labels' words
- Lexapro (escitalopram), Revised:4/2024 (as printed in the SPL), 6 ADVERSE REACTIONS / 6.1 Clinical Trials Experience. inclusion rule: “Reactions included are those occurring in 2% or more of patients treated with Lexapro and for which the incidence in patients treated with Lexapro was greater than the incidence in placebo-treated patients.” trials: “Adverse reactions information for Lexapro was collected from 715 patients with major depressive disorder who were exposed to escitalopram and from 592 patients who were exposed to placebo in double-blind, placebo-controlled trials. Doses ranged from 10 to 20 mg/day; incidences are rounded to the nearest percent by the label itself.” DailyMed
- Trintellix (vortioxetine), SPL effective 2025-03-05, 6 ADVERSE REACTIONS / 6.1 Clinical Studies Experience. inclusion rule: “Table 2: Adverse Reactions Occurring in ≥2% of Patients Treated with Any TRINTELLIX Dose and at Least 2% Greater Than the Incidence in Placebo-Treated Patients” trials: “Table 2 shows the incidence of common adverse reactions that occurred in ≥2% of MDD patients treated with any TRINTELLIX dose and at least 2% more frequently than in placebo-treated patients in the 6 to 8 week placebo-controlled studies.” DailyMed
every row above was transcribed from the current FDA label on 2026-09-08; the full tables, including the reactions only one label lists, are on side-effect rates, drug vs placebo. the sexual side-effect rows carry each label's own underreporting caveat on the SSRI sexual side effects page.
escitalopram (Lexapro)
SSRI antidepressant
- FDA approval
- 2002 · full approval journey →
- Who takes it (US, 2024)
- 9,460,411 patients · 41,800,787 prescriptions (AHRQ MEPS)2014 → 2024: 19,639,202 → 41,800,787 prescriptions, up 113%Correction (29 September 2026): An earlier version of this section took its numbers from ClinCalc DrugStats, a third-party site that republishes this survey; we now compute them from AHRQ’s public-use files ourselves. It showed 9,451,175 people and 41,773,078 prescriptions for 2024; the file gives 9,460,411 and 41,800,787.
- Who pays (2024)
- Medicare: 12,700,559 claims · 2,728,707 beneficiariesMedicaid: ≥6,618,277 prescriptionsCommercial claims: not published in any public dataset — a real absence, not a zero.
- Boxed warning
- Yes — on the current FDA label. read it in context →
- Adverse-event reports (FAERS)
- Caveat first: FAERS counts unverified REPORTS, not patients or rates — no denominator, and attention inflates reporting. Never compare these counts head-to-head; a longer-marketed, more-prescribed drug accumulates more reports by exposure alone. how to read FAERS →139,512 all-time reports; most-reported terms: fatigue, nausea, drug ineffective
- Legal & safety record
- the full litigation & recall record →
vortioxetine (Trintellix)
serotonin modulator
- FDA approval
- 2013 · full approval journey →
- Who takes it (US, —)
- No year from 2014 to 2024 meets AHRQ’s reliability rule for this drug, so we print no count. Years not shown, under AHRQ’s reliability rule: 2014, 2015, 2021, 2022, 2023, 2024 (AHRQ masks the name in the public file); 2016, 2017, 2018, 2019, 2020 (fewer than 60 survey respondents).Correction (29 September 2026): An earlier version of this section took its numbers from ClinCalc DrugStats, a third-party site that republishes this survey; we now compute them from AHRQ’s public-use files ourselves. It showed 341,417 people and 1,826,351 prescriptions for 2020. No year meets AHRQ’s reliability rule for this drug, so that count is removed. It said prescriptions were up 6% since 2016; too few years meet the rule to show a trend, so that line is removed.
- Who pays (2024)
- Medicare: 609,743 claims · 100,662 beneficiariesMedicaid: ≥386,748 prescriptionsCommercial claims: not published in any public dataset — a real absence, not a zero.
- Boxed warning
- Yes — on the current FDA label. read it in context →
- Adverse-event reports (FAERS)
- Caveat first: FAERS counts unverified REPORTS, not patients or rates — no denominator, and attention inflates reporting. Never compare these counts head-to-head; a longer-marketed, more-prescribed drug accumulates more reports by exposure alone. how to read FAERS →16,915 all-time reports; most-reported terms: nausea, fatigue, drug ineffective
- Legal & safety record
- no dedicated record page yet; the journey page carries label history
questions for your prescriber, built from this page
this page does not tell you to start, stop or switch anything. it arms the conversation where that decision belongs. take these in:
- which of Lexapro and Trintellix did you have in mind first, and what in my history points that way?
- these two are different classes (SSRI antidepressant; serotonin modulator). what are they each being asked to do for me, and is that use on the label or off it?
- the label lists these reactions above placebo for the one you're suggesting. which of them should i expect in the first weeks, and which would make you want to hear from me the same day?
- how long were the approval trials, and what do we know past that point?
- how will we judge whether it is working, by when, and what is the plan if it isn't?
- if i ever want to come off it, how is that done, and over how long?
- is there a cheaper generic or a formulation that changes the dosing, and does my insurance prefer one of these two?
the longer checklist, for any antidepressant, is questions to ask before starting antidepressants. if you are already on one and it feels like it stopped working, that has its own page.
What the warnings mean, drug by drug
Each explainer reads one drug's current FDA label and the studies in our library, in both directions: the boxed warnings with the label's own numbers, the trials behind the approval and how long they ran, side effects by rate, and the research since.
Questions people search
Is Lexapro or Trintellix better?
No honest page can answer that in one line. Head-to-head differences between comparable psychiatric medications are usually smaller than rankings suggest, and which fits you depends on your history, other medications, and side-effect trade-offs, a prescriber conversation. What can be compared is the public record (usage, payers, label warnings, approval history, litigation), which is what this page does, with sources.
Is Lexapro the same as escitalopram, and Trintellix the same as vortioxetine?
Lexapro is a brand name for escitalopram. Trintellix is a brand name for vortioxetine. escitalopram is a SSRI antidepressant; vortioxetine is a serotonin modulator. This page uses the generic names because the federal datasets do.
Which has fewer side effects, Lexapro or Trintellix?
The two FDA labels cannot be compared head to head, in their own words, because each drug's trials ran in different people under different rules. What each label prints: Lexapro (escitalopram): 6% stopped for an adverse reaction vs 2% on placebo (Lexapro label, Revised:4/2024 (as printed in the SPL)). Trintellix (vortioxetine): 5%, 6%, 8%, and 8% (5, 10, 15, and 20 mg/day) stopped for an adverse reaction vs 4% on placebo (Trintellix label, SPL effective 2025-03-05). The page shows the reactions both labels list, each against its own placebo column. In the 2018 Lancet network meta-analysis, all-cause dropout against placebo was 0.90 for escitalopram and 1.01 for vortioxetine.
Is Lexapro or Trintellix more effective for depression?
In the 2018 Lancet network meta-analysis of 522 trials and 116,477 adults with major depressive disorder, both beat placebo on response at about 8 weeks: escitalopram odds ratio 1.68 (95% CrI 1.50 to 1.87), vortioxetine 1.66 (1.45 to 1.92). The authors described the differences between drugs as mostly modest, with wide intervals. The certainty of evidence was moderate to very low, 78% of the trials were industry funded, and the pooled effect of all antidepressants against placebo was a standardised mean difference of 0.30. None of that says which one fits you.
Which is prescribed more, Lexapro or Trintellix?
The page shows federal survey estimates we compute from AHRQ’s Medical Expenditure Panel Survey public-use files for both escitalopram and vortioxetine: patients and prescriptions in the latest reliable year, and the yearly series from 2014 where AHRQ’s reliability rule allows it, with a direction stated only when the change is larger than the survey’s margin of error. Prescription volume reflects habits, prices, and marketing as much as evidence, so it is context, not a verdict.
Where these numbers come from
- Patients and prescriptions: computed by us from AHRQ's public-use Medical Expenditure Panel Survey Prescribed Medicines files, 2014 (HC-168A) to 2024 (HC-254A), with AHRQ's reliability rule (a year with fewer than 60 respondents or a relative standard error over 50% is not shown) — counts of people filling prescriptions, not outcomes. A direction is stated only when the change is larger than the survey's margin of error. Until 29 September 2026 these came from ClinCalc DrugStats, a third-party site; see the correction under each drug where a figure changed.
- Medicare/Medicaid: CMS public datasets; commercial insurance publishes no per-drug series, so it renders as an absence, never a synthesized number.
- Label facts: the drugs' current FDA labels via DailyMed — quoted in context on each drug's approval-journey page.
- FAERS: openFDA — reports, never rates; the caveat travels above every count.
- Litigation: court records and regulator documents only, on the linked record pages; settled is never adjudicated.
Explore both drugs in depth: /m/escitalopram · /m/vortioxetine · or the whole library →