Lexapro vs. Zoloft: Differences, Similarities and Which is Better

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Lexapro and Zoloft are two popular Food and Drug Administration (FDA)-approved antidepressants that belong to a class of drugs called selective serotonin reuptake inhibitors (SSRIs).

Other examples of SSRIs include citalopram (Celexa), fluoxetine (Prozac), and paroxetine (Paxil). 

Lexapro and Zoloft are the brand name counterparts to the generic brands escitalopram and sertraline hydrochloride, respectively. The drugs are commonly used to treat major depression, which affects an estimated 17 million adults in the United States each year. They have been used to treat bipolar disorder, in addition to the treatment of depression

If you’re one of the millions of people suffering from a common mental health condition like depression and are considering treatment with prescription medication, it is helpful to know the differences and similarities between Lexapro and Zoloft.

Conditions Treated

Lexapro, sold under the generic name escitalopram, and Zoloft, sold under the generic name sertraline, are both used for the treatment of major depressive disorder.

Zoloft is only used to treat major depressive disorder in adults, while Lexapro can be used to treat the condition in adolescents as young as 12.  

However, Zoloft has other indications in which it can be used to treat children as young as six years old.  Both medications treat other conditions that do not overlap with the other drug. 

Other Conditions Treated by Lexapro

In addition to treating major depressive disorder in adults and adolescents as young as age 6, Lexapro is also used to treat generalized anxiety disorder in adults. No other conditions are treated by Lexapro.

Other Conditions Treated by Zoloft

In addition to treating major depressive disorder, Zoloft is also used for the treatment of obsessive compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). Zoloft is used to treat OCD in patients as young as six years old.

Effectiveness

The studies that have been conducted comparing the effectiveness of Lexapro vs. Zoloft focus on the medications’ treatment of major depressive disorder, as this is the only overlapping condition treated by both medications. 

The results of these studies are mixed. One study found that Lexapro is likely more effective and may be better tolerated than Zoloft due to a lower incidence of side effects caused by the drug in most patients. 

However, another study found that Zoloft was just as good, if not better, than Lexapro at treating major depressive disorder and was not associated with a higher risk of side effects.

The mixed results of the studies reflect the reality that antidepressants work differently for each individual and some medications work better for some people than others.

If you take Lexapro and find that the drug does not work to treat your symptoms, or you experience too many side effects, you may have better results with Zoloft, or vice versa.

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Side Effects

Antidepressants like Lexapro and Zoloft are associated with many different side effects, but the drugs will affect each person differently. As noted above, some studies show that Lexapro causes fewer and less severe side effects than Zoloft, while other studies show that the medications are similarly tolerated.

Zoloft

Zoloft can cause different side effects in adults than in children, but some side effects overlap. Side effects that are known to occur in both adults and children, include 

  • Loss of appetite
  • Nausea
  • Diarrhea
  • Indigestion 
  • Shaking or tremors
  • Fatigue and drowsiness 
  • Changes in sleep habits
  • Increased sweating
  • Sexual problems, including reduced sex drive and ejaculation failure
  • Agitation

Additional side effects associated with the use of Zoloft in children include:

  • Abnormal increase in muscle movement or agitation
  • Nose bleeds
  • Slowed growth rate 
  • Heavy menstrual periods
  • Frequent urination
  • Aggressiveness
  • Weight gain or weight loss

Zoloft is also associated with certain serious side effects, including:

  • Suicidal thoughts and behaviors
  • Serotonin syndrome. This condition can be life-threatening. Symptoms can include:
    • Fast heart rate
    • Sweating
    • Nausea
    • Muscle tremor or stiff muscles
    • Sweating
    • Hallucinations
    • Vomiting
    • Changes in blood pressure such as high blood pressure
    • Diarrhea
    • Seizures
    • Dizziness
    • Shakiness
  • Severe allergic reactions with signs and symptoms such as:
    • Swelling of the face, tongue, eyes, or mouth
    • Severe rash
    • Trouble breathing
  • Seizures 
  • Abnormal bleeding
  • Manic episodes. Symptoms can include:
    • Severe trouble sleeping
    • Talking more or faster than usual
    • Excessive happiness or irritability
    • Unusually grand ideas
    • Racing thoughts
    • Reckless behavior
    • Greatly increased energy
    • Changes in appetite or weight
  • Low sodium levels with signs and symptoms such as:
    • Confusion
    • Headache
    • Weakness or unsteadiness
  • Glaucoma

Lexapro

Like Zoloft, Lexapro can cause different side effects in children and adults, but some side effects are common to both populations. 

Common side effects of Lexapro use in children and adults include:

  • Nausea
  • Sleepiness
  • Dry mouth
  • Loss of appetite
  • Trouble sleeping
  • Sweating
  • Weight gain
  • Shaking
  • Weakness
  • Infection
  • Dizziness
  • Anxiety
  • Unusual changes in sex drive and other sexual issues like erectile dysfunction and premature ejaculation 
  • Constipation
  • Yawning

Adolescents ages 12 to 18 also experience additional side effects in addition to those listed above, including:

  • Nosebleeds
  • Abnormal increase in muscle movement or agitation
  • Heavy menstrual periods
  • Increased thirst
  • Slowed growth and weight change or weight loss
  • Trouble urinating

In addition to the mild side effects listed above, Lexapro can also cause rare but serious side effects. Rare but serious side effects associated with Lexapro include:

  • Severe allergic reaction, as indicated by:
    • Swelling of the face, tongue, eyes, or mouth
    • Severe rash, hives, or blisters that may be accompanied by fever or joint pain
    • Difficulty breathing
  • Seizures or convulsions
  • Low sodium levels, as indicated by:
    • Trouble concentrating
    • Weakness
    • Seizures
    • Confusion
    • Thinking or memory problems
    • Irregular heartbeat
    • Headache
    • Unsteadiness that can lead to falls
  • Serotonin syndrome, as indicated by:
    • Diarrhea
    • Shivering
    • Severe muscular tightness
    • Confusion
    • Fever
    • Seizures
    • Death
  • Manic episodes, as indicated by:
    • Reckless behavior
    • Talking quickly or more than normal
    • Racing thoughts
    • Severe sleeping trouble
    • Unusually grand ideas
    • Greatly increased energy
    • Excessive happiness or irritability
  • Vision problems, as evidenced by:
    • Changes in your vision
    • Swelling or redness in or around your eye
    • Eye pain

If you experience any of these side effects, seek medical attention immediately. 

Summary

Research conducted on the effectiveness of Lexapro and Zoloft has yet to reach a firm conclusion about the comparative effectiveness of the medications.

Lexapro may be more effective and better tolerated for some patients, while Zoloft may be more effective and better tolerated for others. 

Both drugs are used to treat major depressive disorder in adults, but Lexapro can also be used to treat the condition in children as young as 12.

Seek medical advice to determine whether Lexapro or Zoloft are right for you. 

Lexapro and Zoloft may cause adverse effects related to prescription drug interactions with monoamine oxidase inhibitors (MAOIs), antipsychotics like pimozide, opiate analgesics like tramadol, serotonin and norepinephrine reuptake inhibitors (SNRIs) including duloxetine or venlafaxine, blood thinners such as warfarin, and nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen. 

Regardless of whether Lexapro or Zoloft is the right antidepressant for you, you can save on the cost of your medication with a pharmacy discount card from Pharmacists.org.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047306/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608926/ 

https://www.healthline.com/health/depression/lexapro-vs-zoloft

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