Paxil vs. Sertraline

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

Key Takeaways

  • Paxil and sertraline are both SSRIs approved for major depressive disorder, OCD, panic disorder, and social anxiety disorder, but only Paxil covers generalized anxiety disorder and only sertraline covers PMDD.

  • Paxil has a shorter half-life than sertraline, which is linked to more noticeable withdrawal symptoms if a dose is missed or the drug is stopped abruptly.

  • Sertraline is widely available as a low-cost generic, while brand-name Paxil carries a much higher monthly list price.

Paxil vs. Sertraline Drug Summary

Paxil

Paxil (paroxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, generalized anxiety disorder, and post-traumatic stress disorder. It comes as an immediate-release tablet, an extended-release tablet (Paxil CR), and an oral suspension, all taken once daily. Paxil has been FDA-approved since 1992.

Sertraline

Sertraline is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder. It comes as a tablet, capsule, or oral solution, taken once daily. Sertraline is the generic form of Zoloft and has been sold as a generic since 2006.

Paxil vs. Sertraline Side Effects

Paxil

Most common
nausea (up to 26%)
somnolence (up to 23%)
dry mouth (up to 18%)
asthenia (up to 15%)

Sertraline

Most common
nausea (up to 26%)
insomnia (up to 21%)
diarrhea (up to 20%)
ejaculation failure (up to 14%)

Paxil vs. Sertraline Dosage

Paxil

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily At the start
Maximum dose 50 mg once daily If needed
Dose changes 3 increases As tolerated

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

Paxil vs. Sertraline Indications

Paxil

Paxil is approved for major depressive disorder, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, and PTSD. It is the only drug of this pair with an FDA approval for generalized anxiety disorder. Paxil is not approved for use in children or teens.

  • Major depressive disorder

  • Obsessive-compulsive disorder

  • Panic disorder

  • Social anxiety disorder

  • Generalized anxiety disorder

Sertraline

Sertraline covers most of the same conditions as Paxil, plus premenstrual dysphoric disorder, which Paxil does not carry as an indication. It does not have an FDA approval for generalized anxiety disorder. Sertraline's OCD approval also extends to children ages 6 and up.

  • Major depressive disorder

  • Obsessive-compulsive disorder

  • Panic disorder

  • Post-traumatic stress disorder

  • Premenstrual dysphoric disorder

Paxil vs. Sertraline Pros and Cons

Paxil

Paxil offers coverage for generalized anxiety disorder that sertraline lacks, plus extended-release and liquid options for dosing flexibility. Its strong effect on the CYP2D6 liver enzyme means it interacts with many other medications, and stopping it abruptly can trigger more noticeable withdrawal symptoms than some other SSRIs.

Pros

  • Only SSRI here approved for generalized anxiety disorder

  • Available as extended-release tablet or oral suspension

  • Long track record dating back to 1992 approval

Cons

  • Strong CYP2D6 inhibitor, more drug interactions

  • Short half-life makes withdrawal symptoms more likely

  • Not approved for use in anyone under 18

Sertraline

Sertraline treats PMDD, an indication Paxil does not carry, and has pediatric approval for OCD starting at age 6. It carries less drug-interaction risk than Paxil and tends to be easier to stop, though sexual side effects and diarrhea show up more often on its label.

Pros

  • Only SSRI here approved for PMDD

  • Pediatric OCD approval starting at age 6

  • Weaker CYP2D6 inhibition means fewer drug interactions

Cons

  • Not approved for generalized anxiety disorder

  • Diarrhea more common than with Paxil

  • Sexual side effects, including ejaculation failure, common in men

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.