Which one is for me? Lexapro vs Zoloft
Lexapro (escitalopram) and Zoloft (sertraline) are prescription medications used to treat depression and anxiety. They belong to a class of drugs called SSRIs, which stands for selective serotonin re-uptake inhibitors. SSRIs are considered first line treatment options for depression and anxiety because they are very effective, well tolerated, and safe.
But how do they work?
Serotonin is a neurotransmitter (or chemical messenger) in your body that affects your mood, happiness, and anxiety. It can also affect your sleeping, eating, and digestion patterns. Low levels of serotonin have been linked to depression. SSRIs work to relieve symptoms of depression and other mood disorders by increasing levels of serotonin in your brain.
What other conditions do they treat?
Lexapro is approved by the FDA to treat major depressive disorder and generalized anxiety disorder. Zoloft is approved to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, PTSD, premenstrual dysphoric disorder, and social anxiety disorder. Both medications are also used off-label (which means not approved by the FDA) to treat a variety of other disorders, including binge eating, bulimia, and premature ejaculation.
Which is more effective?
Studies have shown that both Lexapro and Zoloft work very well for treating depression; one medication has not been shown to be more effective than another. Some people may experience more side effects with one SSRI over another. Only your doctor can help decide which medication is best for you; it may require some trial and error before the correct medicine and dosing is found.
How much do they cost?
Generic formulations of both medications are covered by most Medicare and commercial insurance plans; brand names are often not covered or may have a high copay. If you are having trouble paying for medications, Easy Drug Card may be able to provide medication discounts at one of the 65,000+ participating nationwide and local neighborhood pharmacies.
What are some common side effects?
Because Lexapro and Zoloft are both SSRIs, they share many possible side effects, including:
- Nausea, vomiting, or diarrhea
- Dry mouth
- Nervousness, agitation, or restlessness
- Sexual problems, such as reduced sexual desire, difficulty reaching orgasm, or inability to maintain an erection
- Appetite changes which may lead to weight loss or weight gain
What else should I know?
It is always important to tell your doctor and pharmacist about all medications, OTCs, vitamins, and herbal supplements you take before starting a new medication, including an SSRI. This information can help prevent possible drug interactions and serious side effects.
Lexapro and Zoloft can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults. All patients starting an antidepressant should be closely monitored for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when starting an antidepressant, immediately contact your doctor or seek emergency help.
A rare but serious condition called serotonin syndrome may occur when taking Lexapro, Zoloft or other SSRIs. This risk is greater if you are taking other medications that affect the levels of serotonin in your body, like certain pain relievers or other antidepressants. Seek immediate medical attention if you notice agitation, change in balance, confusion, hallucinations, fever, rapid heart rate, muscle stiffness, seizures, shivering, or a severe headache.
SSRIs are not addictive, but they should not be stopped suddenly. Several missed doses or stopping therapy abruptly can cause withdrawal-like symptoms, which can include:
- Flu-like symptoms
You should work closely with your doctor to taper off Lexapro, Zoloft, or other SSRIs to avoid these symptoms.
It is important to remember that SSRIs take time to work. You may notice small improvements within 1-2 weeks of starting a medication, but it can take 4-6 weeks or even longer before you notice the full benefits.
Talk with your doctor to find out more about Lexapro and Zoloft and which medication might be right for you. Consider asking your doctor these questions during your visit:
- How long will it take before I feel the benefits of this medication?
- What side effects should I expect from this medication and will they go away?
- What else can I do to manage my symptoms?
1. Marion, DW. Lexapro. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2021.
2. Marion, DW. Zoloft. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2021
3. U.S. National Library of Medicine. (n.d.). Escitalopram: MedlinePlus Drug Information. MedlinePlus. https://medlineplus.gov/druginfo/meds/a603005.html
4. U.S. National Library of Medicine. (n.d.). Sertraline: MedlinePlus Drug Information. MedlinePlus. https://medlineplus.gov/druginfo/meds/a697048.html
3. U.S. Department of Health and Human Services. (n.d.). Mental Health Medications. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/mental-health-medications/