Lexapro vs. Zoloft: What’s The Difference?

Mental health disorders are prevalent, affecting approximately one out of every five adults in the United States. Two frequently prescribed medications for addressing specific mental health issues are Lexapro (escitalopram) and Zoloft (sertraline). Both belong to the class of medications known as selective serotonin reuptake inhibitors (SSRIs), designed to enhance serotonin levels in the brain. When considering treatment options, it’s essential to compare Lexapro vs. Zoloft to make an informed decision about which medication may be more suitable for an individual’s specific needs.

Despite their similar mechanisms of action, Lexapro and Zoloft are tailored to treat distinct mental health conditions. In the following sections, we will explore the commonalities and distinctions between Lexapro and Zoloft, identify potential side effects to be mindful of, discuss potential interactions with other medications, and suggest pertinent questions to discuss with your healthcare provider regarding these two medications.

What Is Lexapro?

Lexapro, also referred to as escitalopram, is categorized as an antidepressant belonging to the selective serotonin reuptake inhibitor (SSRI) class of medications. SSRIs function by inhibiting the reuptake of serotonin, a neurotransmitter, within nerve cells in the brain. This inhibition increases the quantity of available serotonin for transmitting messages among adjacent nerve cells. Given that serotonin is believed to have a beneficial influence on mood and emotions, augmenting serotonin levels in the brain may contribute to symptom alleviation in individuals with specific mental health disorders.

Conditions Lexapro Treats

According to Dr. Jessica Turner, a board-certified psychiatrist in Palm Beach Gardens, Florida, Lexapro has received approval from the Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD).

Furthermore, Dr. Turner mentions that Lexapro may also be prescribed “off-label” for addressing various other mental health conditions, including panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). The term “off-label” refers to the common and lawful practice of utilizing a medication to treat a condition other than the ones for which it has received FDA approval.

Lexapro Dosage

The typical starting dosage for Lexapro is 10 milligrams per day, with the option to incrementally raise it to a maximum of 20 milligrams per day, as outlined by Dr. Peter Zafirides, a psychiatrist practicing privately in Columbus, Ohio. In specific cases, such as obsessive-compulsive disorder (OCD), panic disorder, and major depressive disorder that are challenging to treat, a higher Lexapro dosage is frequently required, Dr. Zafirides notes.

Lexapro Side Effects

As detailed by Dr. Jessica Turner and Dr. Peter Zafirides, some of the most common side effects associated with Lexapro include:

Gastrointestinal issues, such as abdominal pain and gastrointestinal discomfort.

Insomnia.
Tremors.
Sweating.
Headaches.
Sexual dysfunction, encompassing difficulties with orgasm, decreased libido, and delayed ejaculation.

Dr. Turner notes that while rare, there are some serious side effects of Lexapro to be aware of, including seizures, suicidal thoughts in teenagers and young adults, mania, and abnormalities in blood work.

It’s crucial to avoid taking Lexapro if you are currently using any of the following medications due to the risk of serotonin syndrome, a potentially life-threatening condition resulting from excessive serotonin production:

Monoamine oxidase inhibitors (MAOIs).

Other SSRIs.
Fentanyl.
Lithium.
Tramadol.
Buspirone.
Amphetamines.
St. John’s Wort.

Combining Lexapro with these medications is contraindicated due to the potential to trigger serotonin syndrome.

What is Zoloft?

Zoloft, which is also known as sertraline, is classified as an antidepressant in the SSRI (selective serotonin reuptake inhibitor) class of medications.

Conditions Zoloft Treats

According to Dr. Jessica Turner, Zoloft has received FDA approval for the treatment of major depressive disorder (MDD), premenstrual dysphoric disorder (PMDD), social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

Additionally, Dr. Turner notes that Zoloft is frequently prescribed “off-label” for addressing generalized anxiety disorder (GAD), binge eating disorder, body dysmorphic disorder, bulimia nervosa, and premature ejaculation. “Off-label” usage refers to the common practice of using a medication to treat a condition other than those it has received FDA approval for.

Zoloft Dosage

According to Dr. Peter Zafirides, the initial recommended dosage of Zoloft is 50 milligrams per day. This dosage can be escalated to a maximum of 200 milligrams per day. Dr. Zafirides further explains that, similar to Lexapro, higher doses within this range may be necessary for individuals grappling with challenging-to-treat conditions such as major depressive disorder, panic disorder, and obsessive-compulsive disorder (OCD).

Zoloft Side Effects

As outlined by Dr. Jessica Turner and Dr. Peter Zafirides, some of the most commonly observed side effects associated with Zoloft encompass:

Gastrointestinal issues, including abdominal pain and gastrointestinal discomfort.
Emotional “flattening,” where emotions may appear muted or diminished.
Sweating.
Headaches.
Sedation.
Insomnia.
Dizziness.
Sexual dysfunction, which can manifest as difficulty achieving orgasm, reduced libido, and erectile dysfunction.
Tremors.

Dr. Turner also highlights that although infrequent, there are severe side effects linked to Zoloft, including bruising, bleeding, low blood pressure, seizures, mania, and suicidal thoughts in children and young adults.

Furthermore, it is crucial to avoid taking Zoloft if you are currently using any of the following medications:

Thioridazine.
Pimozide.
Monoamine oxidase inhibitors (MAOIs).

Exercise caution when taking the following medications alongside Zoloft, as they may heighten the risk of abnormal bleeding:

Another SSRI.
Aspirin.
Nonsteroidal anti-inflammatory drugs (NSAIDs).
Warfarin or other anticoagulant medications.

Differences between Lexapro and Zoloft

One of the primary distinctions between Lexapro and Zoloft lies in their FDA-approved indications for usage, as pointed out by Dr. Peter Zafirides.

Lexapro has received FDA approval specifically for the treatment of major depressive disorder and generalized anxiety disorder. On the other hand, Zoloft is not approved for generalized anxiety disorder but is approved for a broader range of conditions, including major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder, according to Dr. Zafirides.

Another significant differentiation, as noted by Dr. Zafirides, pertains to dosage. Zoloft typically begins at a dose of 50 milligrams per day, but it doesn’t attain therapeutic levels until the dose reaches approximately 150 milligrams per day. Achieving the therapeutic dose of Zoloft may necessitate several dosage adjustments over a span of weeks.

In contrast, Lexapro reaches therapeutic levels starting from the initial dose of 10 milligrams per day. Although it can be increased to 20 milligrams per day, both doses are considered therapeutic. Consequently, there is a higher likelihood of an individual responding to the initial dose of Lexapro compared to the initial dose of Zoloft, according to Dr. Zafirides.

Lexapro vs. Zoloft: Questions for Your Doctor

Here are some important questions to discuss with your healthcare provider when comparing Lexapro and Zoloft, as recommended by Ryan Sheridan, a board-certified psychiatric mental health nurse practitioner:

What are the potential benefits and risks of each medication for my condition?

Understanding the specific advantages and potential drawbacks of Lexapro and Zoloft for your mental health condition is essential.

Are there any side effects I should be aware of?

Inquire about common and uncommon side effects associated with both medications to make an informed decision.

How long does it take for these medications to start working?

Knowing the expected onset of action can help manage your expectations and plan for symptom relief.

Do I need to make any lifestyle changes or take special precautions while I take these medications?

Discuss any necessary lifestyle adjustments or precautions, such as dietary considerations or alcohol consumption, while on these medications.

Will these medications interact with other medications I’m currently taking?

Ensure a comprehensive review of your current medication regimen to prevent potential drug interactions.

How often will I need to come in for check-ups or monitoring?

Understand the recommended frequency of follow-up appointments to assess your progress and make necessary adjustments.

Considering my specific symptoms and challenges, which medication is the best recommendation for me?

Provide your doctor with detailed information about your symptoms and any unique circumstances that may help them tailor their recommendation.

Remember that your healthcare provider’s expertise is invaluable in making an informed decision regarding Lexapro or Zoloft, and open communication about your mental health needs is essential for effective treatment.