From the Research
The equivalent dose of Effexor XR (venlafaxine extended-release) to Lexapro (escitalopram) 20 mg is approximately 150 mg daily, based on the study by 1 which found that fluoxetine 40mg/day was equivalent to venlafaxine 149.4mg/day and escitalopram 18.0mg/day. When switching from Lexapro 20 mg to Effexor XR, it's typically recommended to start at 75 mg daily for a few days, then increase to 150 mg daily, with potential adjustment up to 225 mg if needed based on response. This conversion is not exact because these medications work differently - Lexapro is a selective serotonin reuptake inhibitor (SSRI), while Effexor XR is a serotonin-norepinephrine reuptake inhibitor (SNRI) that affects both serotonin and norepinephrine neurotransmitters. Some key points to consider when switching between these medications include:
- The study by 2 found that escitalopram was at least as effective as venlafaxine XR in reducing Montgomery-Asberg Depression Rating Scale scores from baseline.
- The study by 3 found that escitalopram had a statistically significantly greater improvement in mean MADRS total scores than venlafaxine XR at endpoint in severely depressed patients.
- The study by 4 found that escitalopram-treated patients achieved higher remission rates compared to venlafaxine-treated patients. When switching between these medications, a cross-tapering approach is recommended where one medication is gradually decreased while the other is gradually increased to minimize withdrawal symptoms and side effects. This transition should always be supervised by a healthcare provider who can monitor for side effects and adjust dosing as needed based on individual response.