What are the differences between Zoloft vs. Lexapro?

  • Zoloft (sertraline) and Lexapro (escitalopram) are antidepressant drugs in the selective serotonin reuptake inhibitor (SSRI) class used for treating depression, and anxiety disorders.
  • Zoloft is also used to treat obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).
  • Lexapro is not approved for treating obsessive-compulsive disorders and panic disorders like other SSRIs.
  • Common side effects of Zoloft and Lexapro that are similar include drowsiness, nausea, tremor (shaking), increased or decreased appetite, headache, diarrhea, difficulty sleeping (insomnia), dry mouth, increased sweating, weight changes, sexual difficulties (decreased sexual ability or desire, ejaculatory delay), and upset stomach/indigestion.
  • Zoloft can cause different side effects than Lexapro including nervousness, dizziness, skin rash, or constipation. Lexapro can cause different side effects than Zoloft including agitation or restlessness, blurred vision, fever, frequent urination, and taste alterations.
  • Some patients experience withdrawal reactions when they stop using SSRIs such as Zoloft or Lexapro. Symptoms may include dizziness, tingling, tiredness, vivid dreams, irritability, or poor mood.

What are Zoloft and Lexapro?

Zoloft (sertraline) is used for treating depression, obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). It belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). Other drugs in this class are fluoxetine (Prozac, Sarafem), paroxetine (Brisdelle, Paxil, Paxil CR, Pexeva), citalopram (Celexa), and fluvoxamine (Luvox CR).

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used for treating depression and generalized anxiety disorder.

What are the side effects of Zoloft and Lexapro?

Zoloft

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.

Lexapro

WARNING

Some patients experience withdrawal reactions upon stopping SSRI therapy. Symptoms may include

  • dizziness,
  • tingling,
  • tiredness,
  • vivid dreams,
  • irritability, or
  • poor mood.

In order to avoid these symptoms, the dose of SSRI can be slowly reduced instead of abruptly stopped.

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Lexapro or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults beyond 24 years of age. There was a reduction in risk of suicidality with antidepressants compared with placebo in adults 65 years of age and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients who are started on therapy with antidepressants should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.

Common side effects associated with Lexapro are:

  • agitation or restlessness,
  • blurred vision,
  • diarrhea,
  • difficulty sleeping,
  • drowsiness,
  • dry mouth,
  • fever,
  • frequent urination,
  • headache,
  • indigestion,
  • nausea,
  • increased or decreased appetite,
  • increased sweating,
  • sexual difficulties (decreased sexual ability or desire, ejaculatory delay),
  • taste alterations, tremor (shaking), and
  • weight changes.

Other side effects include influenza-like symptoms and pain in neck or shoulders.

Although changes in sexual desire, sexual performance, and sexual satisfaction often occur as a result of depression itself, they also may be a consequence of the drugs used to treat depression. In particular, about one in 11 men given Lexapro report difficulties ejaculating.

Possible serious side effects of Lexapro include:

  • Serotonin syndrome
  • Suicidal thinking and behavior
  • Abnormal bleeding
  • Seizures
  • Manic episodes
  • Low sodium
  • Angle closure glaucoma

What is the dosage of Zoloft vs. Lexapro?

Zoloft

  • The recommended dose of sertraline is 25-200 mg once daily. Treatment of depression, OCD, panic disorder, PTSD, and social anxiety disorder is initiated at 25-50 mg once daily. Doses are increased at weekly intervals until the desired response is seen.
  • The recommended dose for PMDD is 50-150 mg every day of the menstrual cycle or for 14 days before menstruation.
  • Sertraline may be taken with or without food.

Lexapro

  • The usual starting dose of Lexapro for treating depression in adults or adolescents is 10 mg once daily in the morning or evening. The dose may be increased to 20 mg once daily after 1 week.
  • Benefit may not be seen until treatment has been given for up to 4 weeks. A daily dose of 20 mg may not be more effective than 10 mg daily for treatment of depression.
  • The dose for treating generalized anxiety disorder is 10 mg once daily.
  • Lexapro can be taken with or without food.

What drugs interact with Zoloft and Lexapro?

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.

Lexapro

  • All SSRIs, including Lexapro, should not be combined with drugs in the monoamine oxidase (MAO) inhibitor class of antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl) and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase such as linezolid (Zyvox) and intravenous methylene blue. Such combinations may lead to confusion, high blood pressure, high fevers, tremor or muscle rigidity, and increased activity. At least 14 days should elapse after discontinuing Lexapro before starting an MAO inhibitor. Conversely, at least 14 days should elapse after discontinuing an MAO inhibitor before starting Lexapro.
  • Similar reactions occur when SSRIs are combined with other drugs that increase serotonin in the brain, for example tryptophan, St. John's wort, meperidine (Demerol), lithium (Lithobid, Eskalith), triptans (for example, sumatriptan [Imitrex, Alsuma]), and tramadol (Ultram)
  • Use of selective serotonin inhibitors may increase the risk of gastrointestinal bleeding in patients taking warfarin (Jantoven, Coumadin), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and other drugs that cause bleeding.

Are Zoloft and Lexapro safe to use while pregnant or breastfeeding?

Zoloft

  • Use of sertraline during the 3rd trimester of pregnancy may lead to adverse effects in the newborn.
  • Use of sertraline by nursing mothers has not been adequately evaluated.

Lexapro

  • The safety of Lexapro during pregnancy and breastfeeding has not been established. Therefore, Lexapro should not be used during pregnancy unless, in the opinion of the physician, the expected benefits to a patient outweigh unknown hazards to the fetus.
  • Lexapro is excreted in human milk. Lexapro should not be given to nursing mothers unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the child.

Summary

Zoloft (sertraline) and Lexapro (escitalopram) are selective serotonin reuptake inhibitors (SSRIs) used for treating depression, and anxiety disorders. Zoloft is also approved for post traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD).

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