Prozac vs. Sertraline

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

Key Takeaways

  • Prozac and sertraline are both SSRIs for depression, but Prozac also has FDA approval for bulimia nervosa and bipolar depression with olanzapine.

  • Sertraline is FDA-approved for PTSD, social anxiety disorder, and PMDD, uses that are not on Prozac's label.

  • Prozac's long half-life allows a once-weekly dosing option after initial treatment, while sertraline is taken every day without exception.

Prozac vs. Sertraline Drug Summary

Prozac

Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depression, OCD, panic disorder, and bulimia nervosa. It comes as a daily capsule, tablet, or liquid, and also as a once-weekly capsule once a stable daily dose is reached.

Sertraline

Sertraline is a selective serotonin reuptake inhibitor (SSRI) used to treat major depression, OCD, panic disorder, PTSD, social anxiety disorder, and PMDD. It is taken as a tablet, capsule, or liquid once a day, usually in the morning or evening.

Prozac vs. Sertraline Side Effects

Prozac

Most common
nausea (up to 21%)
diarrhea (up to 12%)
insomnia (33%, bulimia trials)
anxiety/nervousness (up to 15%)

Sertraline

Most common
nausea (up to 26%)
diarrhea (up to 20%)
tremor (up to 11%)
dyspepsia (up to 8%)

Prozac vs. Sertraline Dosage

Prozac

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily At the start
Maximum dose 90 mg once weekly If needed
Dose changes 2 increases As tolerated

Sertraline

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25-50 mg once daily At the start
Maximum dose 200 mg once daily If needed
Dose changes 3 increases As tolerated

Prozac vs. Sertraline Indications

Prozac

Prozac is FDA-approved for major depression, OCD, panic disorder, and bulimia nervosa, plus bipolar depression and treatment-resistant depression when combined with olanzapine. Doctors also prescribe it off-label for premenstrual dysphoric disorder and binge eating disorder.

  • Major depressive disorder (MDD)

  • Obsessive-compulsive disorder (OCD)

  • Bulimia nervosa

  • Panic disorder

  • Bipolar I depression (with olanzapine)

Sertraline

Sertraline is FDA-approved for major depression, OCD, panic disorder, PTSD, social anxiety disorder, and premenstrual dysphoric disorder (PMDD). It is sometimes used off-label to treat premature ejaculation in men.

  • Major depressive disorder (MDD)

  • Obsessive-compulsive disorder (OCD)

  • Panic disorder

  • Post-traumatic stress disorder (PTSD)

  • Social anxiety disorder (SAD)

Prozac vs. Sertraline Pros and Cons

Prozac

Prozac has one of the broadest FDA-approval lists among SSRIs, covering eating disorders and treatment-resistant depression that sertraline is not approved for. Its long-acting metabolite means milder symptoms if a dose is missed, but it can also make Prozac more activating for some people.

Pros

  • FDA-approved for bulimia nervosa and bipolar depression

  • Once-weekly dosing option after initial daily treatment

  • Long half-life causes milder withdrawal if a dose is missed

  • Available since 1987, with decades of clinical use data

Cons

  • Not FDA-approved for PTSD or social anxiety disorder

  • Can be more activating, causing more insomnia and anxiety

  • Long half-life means a longer wait before starting an MAOI

  • No approved use for premenstrual dysphoric disorder on label

Sertraline

Sertraline covers more anxiety-related conditions on its FDA label, including PTSD and social anxiety disorder, along with PMDD. Its shorter half-life clears the body faster, which can mean quicker relief from side effects but more noticeable symptoms if a dose is missed.

Pros

  • FDA-approved for PTSD, social anxiety disorder, and PMDD

  • Shorter half-life allows faster switching to other medications

  • Widely used off-label for premature ejaculation

  • Flexible daily dosing lets doctors adjust doses quickly

Cons

  • Not FDA-approved for bulimia nervosa or bipolar depression

  • No once-weekly dosing option available

  • Shorter half-life can cause more noticeable withdrawal symptoms

  • GI side effects like diarrhea tend to be more common

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