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Xanax and Lexapro are similar in that they are both approved to treat anxiety, but their mechanism of action and indications for use are somewhat different.

Xanax is a benzodiazepine a class of drugs with many medical applications often prescribed for anxiety. Xanax is FDA approved to (1) treat acute anxiety states, (2) for the management of anxiety disorders, (3) for panic disorder with or without agoraphobia, and (4) for anxiety associated with depression. Benzodiazepines, particularly Xanax, act very quickly, typically providing relief in 30 min or less. Xanax is typically effective for 4hrs (maximum 6hrs), if taken for continuous anxiety relief it requires four (occasionally three) doses daily. Xanax and other benzodiazepines act on the neurotransmitter GABA the brains principal inhibitory neurotransmitter. By acting on GABA Xanax alters the action potential (the ability of a nerve to fire) by causing a rapid influx of sodium ions into ion channels causing the polarity of the membrane to reverse, thus the ion channels to deactivate. Simply put Xanax reduces the ability of nerves to fire causing a reduction in activity in the brain (ie making it more quiet) which causes anxiolysis. Benzodiazepines are schedule IV controlled substances and have a potential for abuse, misuse, criminal diversion, and addiction. As a result benzodiazepines are typically prescribed for a short time period although long term use of benzodiazepines is appropriate in some situations. People with a history of substance abuse, especially to alcohol or barbiturates, are at a much higher risk of addiction. People with a legitimate anxiety disorder without a history of substance abuse rarely develop a problem. Physical dependency occurs in 1/3 to 1/2 of all long term users. Physical dependency is not addiction however benzodiazepines should be slowly discontinued under a doctors care since withdrawal can be severe, even life threatening for long term, high dose users.

Lexapro is a selective serotonin reuptake inhibitor (SSRI), a class of antidepressants. Unlike Xanax, Lexapro works on the neurotransmitter serotonin. Low levels of serotonin have been linked to both anxiety and depression. Lexapro is FDA approved to treat depression and generalized anxiety disorder. Lexapro is also effective for treating other anxiety disorders.

Lexapro is not a drug of abuse nor is it a controlled substance like Xanax is. However, like Xanax, people may develop physical dependence for long term use so Lexapro should be slowly discontinued under a doctors supervision. Unlike Xanax it can take up to six weeks before Lexapro has any effect. In fact many people experience a temporary increase in anxiety when starting Lexapro much. Xanax is safer in an overdose situation. Death due to Xanax toxicity is almost unheard of and typically thousands of milligrams are required for death to occur. Benzodiazepines are among the safest drugs and are almost never lethal unless mixed with other drugs like alcohol, opioids, or barbiturates.

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14y ago

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