What to combine with Lexapro for anxiety? Exploring proven strategies

October 12, 2025 •

5 min read

Around one-third of patients with major depressive disorder do not respond sufficiently to standard SSRI therapy, and many with anxiety may experience similar partial relief. When Lexapro alone does not fully manage anxiety symptoms, healthcare providers may recommend combination therapy, adjunct medications, or psychotherapy to enhance treatment effectiveness. This guide explores what to combine with Lexapro for anxiety to provide more comprehensive and lasting symptom relief.

Quick Summary

Adjunct medications like Buspar or Wellbutrin can augment Lexapro's effects by targeting different neurochemical pathways. Combining Lexapro with psychotherapy, such as CBT, is also highly effective for managing anxiety. Lifestyle adjustments and select supplements can further support overall well-being. Any combination therapy requires medical supervision to ensure safety and effectiveness.

Key Points

Combine with Buspar for lingering anxiety: Adding buspirone (Buspar), which works on a different serotonin pathway, is a proven method for augmenting Lexapro's effects, especially for persistent generalized anxiety.
Use Wellbutrin to combat side effects: Combining Lexapro with bupropion (Wellbutrin) can help with symptoms of low energy, lack of motivation, and sexual side effects that sometimes result from SSRI treatment.
Utilize benzodiazepines for short-term relief: For acute or severe anxiety during the initial weeks of Lexapro treatment, benzodiazepines can offer immediate relief, but they should be used cautiously and for short durations due to dependence risk.
Enhance treatment with psychotherapy: Integrating therapy, especially cognitive behavioral therapy (CBT), with Lexapro can lead to more durable and comprehensive relief by addressing psychological and behavioral patterns.
Incorporate lifestyle changes: Complement your treatment with healthy habits like regular exercise, good sleep hygiene, and avoiding alcohol and caffeine to maximize Lexapro's benefits and manage side effects.
Consult a professional for supplements: Always discuss with a doctor before adding supplements like magnesium or omega-3 fatty acids, as they can have interactions with Lexapro.

For many people, Lexapro (escitalopram), a selective serotonin reuptake inhibitor (SSRI), is a common and effective first-line treatment for managing anxiety symptoms. However, it is not a cure-all, and some individuals may not achieve full remission or might experience persistent or residual symptoms. In these cases, your healthcare provider may suggest combining Lexapro with other treatments to achieve a more complete therapeutic response. This approach, known as augmentation or combination therapy, uses different mechanisms of action to address complex and resistant anxiety symptoms effectively.

Augmentation with other medications

Adding a second medication to Lexapro is a common strategy for individuals who have a partial response. This is done to target different neurochemical pathways and provide a more comprehensive treatment.

Adding Buspar (Buspirone) to Lexapro

Buspirone, sold under the brand name Buspar, is an anti-anxiety medication with a different mechanism of action than Lexapro. While Lexapro increases serotonin by blocking its reabsorption, Buspar acts as a partial agonist at a specific serotonin receptor (5-HT1A). This combination is a well-established strategy for augmenting the effects of SSRIs, particularly for treating generalized anxiety disorder (GAD).

Benefits: Buspar can help improve anxiety symptoms, especially excessive worry, when Lexapro alone is not enough. It is not a benzodiazepine and therefore does not carry the same risk of dependence or sedation.
Considerations: When combining Buspar with Lexapro, healthcare providers must monitor for the rare but serious risk of serotonin syndrome, as both medications affect serotonin levels. The effects of Buspar can take several weeks to become noticeable.

Combining Wellbutrin (Bupropion) with Lexapro

Wellbutrin, or bupropion, is an atypical antidepressant that works by affecting dopamine and norepinephrine, rather than serotonin. Combining it with Lexapro, which primarily targets serotonin, offers a multi-mechanism approach that can be very effective, especially for patients with co-occurring anxiety and depression.

Benefits: This combination can help address symptoms that Lexapro may not fully resolve, such as fatigue, low motivation, and poor concentration. It is also known to counteract some of the common sexual side effects associated with SSRIs.
Considerations: Wellbutrin can potentially increase anxiety in some individuals, particularly in the initial days of treatment. Combining it with Lexapro also increases the risk of seizures, especially at higher doses, and necessitates careful monitoring by a doctor.

Short-term use of Benzodiazepines

In cases of severe anxiety, panic attacks, or agitation during the initial weeks of Lexapro treatment, a doctor may prescribe a fast-acting benzodiazepine like Xanax (alprazolam) or Ativan (lorazepam). This provides rapid, temporary relief while the Lexapro builds up to its full therapeutic effect.

Benefits: Offers quick relief from acute anxiety and panic symptoms.
Considerations: Benzodiazepines are only recommended for short-term use (typically 2–4 weeks) due to the high risk of dependence and withdrawal symptoms with long-term use.

The power of psychotherapy

For many anxiety disorders, the most robust and lasting results come from combining medication with psychotherapy. This addresses both the biological and psychological aspects of the condition.

Lexapro plus CBT: A powerful combination

Cognitive Behavioral Therapy (CBT) is an evidence-based therapy that helps individuals identify and challenge unhelpful thought patterns and behaviors that fuel anxiety.

Benefits: While Lexapro stabilizes brain chemistry, CBT provides patients with practical coping strategies and tools to manage their anxiety. This combined approach leads to faster and more durable improvements, and a lower risk of relapse compared to using either treatment alone.

Lifestyle adjustments and supplements

Supporting your overall health can significantly enhance the effectiveness of medication and therapy. These strategies are not replacements for medical treatment but can be powerful complements.

Making lifestyle changes with Lexapro

Exercise: Regular physical activity can improve mood and reduce anxiety symptoms.
Sleep Hygiene: Establishing a consistent sleep routine is crucial, as sleep disturbances are common with anxiety.
Diet: Eating a balanced diet and staying hydrated supports overall brain function.
Limit Stimulants: Reducing caffeine intake can help minimize insomnia and anxiety.
Avoid Alcohol: Alcohol can interfere with Lexapro's effectiveness and worsen its side effects.

Supplemental support with Lexapro

Several supplements are sometimes explored for their potential anxiolytic properties, but they should only be used after consulting a healthcare provider due to potential interactions.

Magnesium: Some studies suggest that magnesium supplementation can have a supportive effect on anxiety, especially when taken alongside antidepressants.
Omega-3 Fatty Acids: Omega-3s, particularly EPA and DHA found in fish oil, have shown potential in supporting antidepressant effectiveness.
B Vitamins: Certain B vitamins, including B6 and B12, play a role in neurotransmitter metabolism and have been linked to mood regulation.

Comparison of adjunct therapies for anxiety


Adjunct Therapy	Primary Mechanism	Typical Use	Onset of Action	Potential Benefits	Key Considerations
Buspar (Buspirone)	Partial 5-HT1A agonist, affecting serotonin differently than Lexapro.	Augmentation for generalized anxiety when Lexapro is insufficient.	2–4 weeks.	Non-sedating, low risk of dependence, and addresses residual anxiety.	Risk of serotonin syndrome, requires careful monitoring.
Wellbutrin (Bupropion)	Norepinephrine-dopamine reuptake inhibitor (NDRI).	Augmentation for co-occurring depression, low energy, or sexual side effects.	Several weeks.	Improves motivation and energy; mitigates sexual side effects.	Can worsen initial anxiety, carries a seizure risk.
Benzodiazepines	Enhances GABA activity for a calming effect.	Short-term management of acute anxiety or panic attacks.	15–30 minutes.	Provides immediate relief for severe symptoms.	High risk of dependence, not suitable for long-term use.
Psychotherapy (CBT)	Addresses thought patterns and behaviors that contribute to anxiety.	Complements medication for sustained improvement and relapse prevention.	Varies based on individual progress.	Long-term coping skills, lower relapse rate, and addresses root causes.	Can be slower to show initial effects than medication.

Conclusion

For many individuals with anxiety, a single medication like Lexapro provides significant relief. However, when a full response isn't achieved, combining treatment strategies can provide a path forward for better management of symptoms. Whether through augmenting Lexapro with another medication like Buspar for residual anxiety or Wellbutrin for co-occurring depression, or by incorporating evidence-based psychotherapy like CBT, a multi-pronged approach often yields the most robust and lasting benefits. Crucially, any decision to combine medications, therapy, or supplements with Lexapro should be made in close consultation with a qualified healthcare professional. They can help navigate the potential benefits and risks of each strategy to create a personalized treatment plan that addresses your unique needs.

Frequently Asked Questions

Yes, but only under a doctor's supervision due to the rare but serious risk of serotonin syndrome, as both medications affect serotonin levels. A healthcare provider will carefully monitor your response and adjust doses as needed.

Yes, this combination is often prescribed by doctors, particularly for individuals with co-occurring depression and anxiety. The combination is sometimes used to counteract side effects like fatigue or sexual dysfunction associated with Lexapro.

Benzodiazepines, such as Xanax or Ativan, are typically used for short-term, immediate relief of severe anxiety symptoms, especially during the initial weeks while Lexapro is building up its long-term effect. They are not for long-term use due to the risk of dependence.

While Lexapro itself takes several weeks to reach full effect, adding an adjunct medication like Buspar also requires patience, with noticeable benefits often seen after 2–4 weeks. Your doctor will monitor your response over this time.

While Lexapro can be effective alone, combining it with psychotherapy like CBT addresses the psychological aspects of anxiety, leading to more comprehensive and sustained recovery, with a lower risk of relapse.

Regular exercise, a balanced diet, consistent sleep, stress management, and reducing caffeine and alcohol intake can all help enhance Lexapro's effects and manage side effects. It is important to avoid alcohol as it can worsen side effects.

You should always consult your doctor before taking any supplements, as some, like magnesium or omega-3s, might have a supportive role, but interactions are possible. A healthcare provider can determine if a supplement is safe and appropriate.