Zoloft (sertraline) vs. Prozac (fluoxetine)

• Zoloft (sertraline) and Prozac (fluoxetine) are selective serotonin reuptake inhibitor (SSRI) type antidepressants used to treat depression, obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder (PMDD).
• Zoloft is also used to treat post-traumatic stress disorder (PTSD) and social anxiety disorder.
• Prozac is also used to treat bulimia, and it is also prescribed in combination with olanzapine (Zyprexa) to treat resistant depression and depression associated with bipolar disorder.
• Side effects of Zoloft and Prozac that are similar include drowsiness/sleepiness, sleep problems (insomnia), nausea, skin rash, loss of appetite, and headache.
• Side effects of Zoloft that are different from Prozac include sleepiness, nervousness, dizziness, tremor, constipation, upset stomach, diarrhea, abnormal ejaculation, decreased interest in sexual activity, dry mouth, increased sweating, and weight loss.
• Side effects of Prozac that are different from Zoloft include anxiety, vasculitis (inflammation of small blood vessels), and increased blood pressure.
• Do not stop using Zoloft or Prozac suddenly, or you could have unpleasant withdrawal symptoms.

Zoloft (sertraline) is a selective serotonin reuptake inhibitor (SSRI) type antidepressant used to treat depression, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). Other SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Brisdelle, Paxil, Paxil CR, Pexeva), citalopram (Celexa), and fluvoxamine (Luvox CR). Depression may be caused by disturbances in the balance between serotonin and other neurotransmitters. Experts believe that drugs such as Zoloft restore the chemical balance among neurotransmitters in the brain. Selective serotonin inhibitors block the reuptake of serotonin, therefore changing the level of serotonin in the brain. A serotonin balance is reached between attachment to the nearby nerves and reuptake.

Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat depression, bulimia, obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder (PMDD). It is also prescribed in combination with olanzapine (Zyprexa) to treat resistant depression and depression associated with bipolar disorder. Other SSRIs include citalopram (Celexa), paroxetine (Paxil), and sertraline (Zoloft). Prozac affects the neurotransmitters serotonin. Experts believe an imbalance among neurotransmitters is the cause of depression. Prozac works by preventing the reuptake of one neurotransmitter, serotonin, by nerve cells after it has been released. The reduced uptake caused by Prozac increases free serotonin that stimulates nerve cells in the brain.

Zoloft

WARNING

• As demonstrated in short-term studies, antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Zoloft or any other antidepressant in a child or adolescent must balance this risk with the clinical need for the antidepressant. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

The most common side effects of Zoloft are:

• Sleepiness
• Nervousness
• Insomnia
• Dizziness
• Nausea
• Tremor
• Skin rash
• Constipation
• Upset stomach
• Loss of appetite
• Headache
• Diarrhea
• Abnormal ejaculation
• Decreased interest in sexual activity
• Dry mouth
• Increase in sweating, known as diaphoresis
• Weight loss

Possible serious side effects of Zoloft include:

• Irregular heartbeats
• Serious allergic reactions
• Worsening of depression
• Serotonin syndrome
• Hyponatremia
• Abnormal bleeding
• Priapism (prolonged erection)
• Decreased liver function
• Suicidality
• Activation of mania in patients with bipolar disorder

Important side effects are irregular heartbeats, allergic reactions and activation of mania in patients with bipolar disorder.

If Zoloft is discontinued abruptly, some patients experience side effects such as:

• Abdominal cramps
• Fatigue
• Nausea
• Vomiting
• Diarrhea
• Headaches
• Lightheadedness
• Dizziness
• Diminished appetite
• Flu-like symptoms
• Sweating
• Chills
• Sleep disturbances
• Memory impairment

A gradual dose reduction of Zoloft is recommended when therapy is discontinued.

Prozac

WARNING

Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of fluoxetine or any other antidepressant in a child or adolescent must balance this risk of suicide with the clinical need. Patients who begin therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

Prozac, as with most antidepressants, can cause:

• Nausea
• Headaches
• Anxiety
• Insomnia
• Drowsiness
• Loss of appetite

Prozac has been implicated in serious skin rashes and vasculitis (inflammation of small blood vessels).

Increased blood pressure can occur, and blood pressure should be monitored.

Seizures have been reported as has sexual dysfunction.

Prozac and other antidepressants have been associated with angle closure attacks in people with narrow angle glaucoma.

Some patients may experience withdrawal reactions upon stopping Prozac. The dose of Prozac should be gradually reduced when therapy is discontinued. Symptoms of withdrawal include:

• Anxiety
• Nausea
• Nervousness
• Insomnia

Zoloft

The recommended dose of sertraline is 25 to 200 mg once daily. Treatment of depression, OCD, panic disorder, PTSD, and social anxiety disorder is initiated at 25 to 50 mg once daily. Doses are increased at weekly intervals until the desired response is seen.

The recommended dose for PMDD is 50 to 150 mg every day of the menstrual cycle or for 14 days before menstruation.

Zoloft may be taken with or without food.

Prozac

Depression in adults is treated with 20 to 80 mg of Prozac daily. The recommended dose for treating depression in children is 10 to 20 mg daily. After 13 weeks of daily administration, 90 mg once weekly may be effective in some patients.

Zoloft

All SSRIs, including Zoloft, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example

• isocarboxazid (Marplan),
• phenelzine (Nardil),
• tranylcypromine (Parnate),
• selegiline (Eldepryl, Emsam, Elazar), and
• procarbazine (Matulane).

Other drugs that inhibit monoamine oxidase include

• linezolid (Zyvox) and
• intravenous methylene blue.

Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. (A period of 14 days without treatment should lapse when switching between Zoloft and MAOIs.) Similar reactions occur when Zoloft is combined with other drugs for example, tryptophan, St. John's wort, meperidine (Demerol, Meperitab), tramadol (ConZip, Synapryn FusePaq, Ultram) that increase serotonin in the brain.

Cimetidine (Cimetidine Acid Reducer, Tagamet HB ) may increase the levels in blood of Zoloft by reducing the elimination of Zoloft by the liver. Increased levels of Zoloft may lead to more side effects.

Zoloft increases the blood level of pimozide (Orap) by 40%. High levels of pimozide can affect electrical conduction in the heart and lead to sudden death. Therefore, patients should not receive treatment with both pimozide and Zoloft.

Through unknown mechanisms, Zoloft may increase the blood thinning action of warfarin (Coumadin, Jantoven). The effect of warfarin should be monitored when Zoloft is started or stopped.

Prozac

Taking Prozac with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Many drugs can interact with Prozac. Tell your doctor about all your current medicines and any you start or stop using, especially:

• any other antidepressant
• St. John's wort
• tryptophan (sometimes called L-tryptophan)
• a blood thinner -- warfarin (Coumadin, Jantoven)
• medicine to treat anxiety, mood disorders, thought disorders, or mental illness -- amitriptyline, buspirone, desipramine, lithium, nortriptyline, and many others
• medicine to treat ADHD or narcolepsy -- Adderall, Concerta, Ritalin, Vyvanse, Zenzedi, and others
• migraine headache medicine -- rizatriptan, sumatriptan, zolmitriptan
• narcotic pain medicine -- fentanyl, oxycodone, hydrocodone, and others

Taking monoamine oxidase inhibitors (MAOIs) with Prozac may cause a serious (possibly fatal) drug interaction. Avoid taking MAOIs (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with Prozac. Most MAOIs should also not be taken for 2 weeks before and at least 5 weeks after treatment with Prozac. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including other SSRIs such as citalopram/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Many drugs besides Prozac may affect the heart rhythm (QT prolongation), including pimozide and thioridazine, among others. Aspirin can increase the risk of bleeding when used with Prozac. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81 to 325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products), because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Zoloft

Use of Zoloft during the third trimester of pregnancy may lead to adverse effects in the newborn.

Use of Zoloft by nursing mothers has not been adequately evaluated.

Prozac

Prozac should only be used during pregnancy if the potential benefit justifies the potential risks to the fetus.

Prozac is excreted in breast milk. Therefore, use of Prozac while nursing is not recommended.