Lexapro vs. Sertraline

See how Lexapro and Sertraline compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Lexapro is FDA-approved only for depression and generalized anxiety disorder, while sertraline carries approval for six different conditions, including OCD, panic disorder, and PTSD.

  • In trials, sertraline caused higher rates of nausea and diarrhea than Lexapro, whose most common side effects were generally reported at lower rates.

  • Lexapro's dosing is simple, with just two steps, while sertraline's dosing ranges from 25 mg to 200 mg with more titration steps along the way.

Lexapro vs. Sertraline Drug Summary

Lexapro

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) approved to treat major depressive disorder in adults and adolescents ages 12 to 17, and generalized anxiety disorder in adults. It comes as a tablet or oral solution and is taken once a day, usually starting at 10 mg.

Sertraline

Sertraline (Zoloft) is an SSRI approved to treat major depressive disorder, OCD, panic disorder, PTSD, social anxiety disorder, and PMDD in adults, plus OCD in children ages 6 to 17. It is also taken once daily, usually starting at 25 mg or 50 mg depending on the condition being treated.

Lexapro vs. Sertraline Side Effects

Lexapro

Most common
Nausea (up to 15%)
Insomnia (up to 9%)
Ejaculation disorder (up to 9%)
Somnolence (up to 6%)

Sertraline

Most common
Nausea (up to 26%)
Insomnia (up to 21%)
Diarrhea (up to 20%)
Ejaculation failure (up to 14%)

Lexapro vs. Sertraline Dosage

Lexapro

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily Week 1
Maximum dose 20 mg once daily Week 2 onward
Dose changes 1 increase Every week

Sertraline

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50 mg once daily At the start
Maximum dose 200 mg once daily If needed
Dose changes 3 increases As tolerated

Lexapro vs. Sertraline Indications

Lexapro

Lexapro is FDA-approved to treat major depressive disorder in adults and adolescents ages 12 to 17, along with generalized anxiety disorder in adults. It is not approved for depression in children under 12 or for anxiety disorders in pediatric patients.

  • Major depressive disorder in adults

  • Major depressive disorder in adolescents (12-17 years)

  • Generalized anxiety disorder in adults

  • Not FDA-approved for GAD in children or adolescents

Sertraline

Sertraline carries one of the broadest FDA-approved labels of any SSRI, covering major depressive disorder, OCD, panic disorder, PTSD, social anxiety disorder, and PMDD in adults. It is also approved for OCD in children and adolescents ages 6 to 17.

  • Major depressive disorder in adults

  • Obsessive-compulsive disorder in adults and children (6-17 years)

  • Panic disorder, PTSD, and social anxiety disorder in adults

  • Premenstrual dysphoric disorder (PMDD) in adult women

Lexapro vs. Sertraline Pros and Cons

Lexapro

Lexapro is a well-tolerated SSRI with a simple two-step dosing schedule and a comparatively low rate of nausea in trials. Its FDA approval is narrower than sertraline's, limited to depression and generalized anxiety disorder.

Pros

  • Approved for major depressive disorder in adolescents ages 12 to 17, an age group sertraline is not approved to treat for depression

  • Simple titration with only two tablet strengths, 10 mg and 20 mg

  • Lower nausea rate in trials (15%) than sertraline (up to 26%)

  • FDA-approved for generalized anxiety disorder, a use sertraline only has off-label

Cons

  • Narrower FDA-approved label, covering only two conditions versus sertraline's six

  • Not approved for OCD, panic disorder, PTSD, social anxiety disorder, or PMDD, all on sertraline's label

  • Shorter track record: FDA-approved in 2002, versus sertraline's approval in 1991

Sertraline

Sertraline is one of the most prescribed antidepressants in the US, with FDA approval spanning depression, OCD, panic disorder, PTSD, social anxiety disorder, and PMDD. That broader label comes with a wider dosing range and somewhat higher rates of GI side effects in trials.

Pros

  • Broadest FDA-approved label among common SSRIs, covering six distinct conditions

  • Approved for OCD in children and adolescents ages 6 to 17, a pediatric use Lexapro lacks

  • Longer track record, FDA-approved since 1991, over a decade before Lexapro

  • Wider dosing range (25 mg to 200 mg) allows finer adjustment for symptom control

Cons

  • Higher rates of GI side effects in trials, including nausea (up to 26%) and diarrhea (up to 20%)

  • Not approved for major depressive disorder in pediatric patients, unlike Lexapro's adolescent approval

  • Not FDA-approved for generalized anxiety disorder, only used off-label for that condition

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