Sertraline vs. Escitalopram

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

Key Takeaways

  • Sertraline is FDA-approved for six conditions, including OCD, panic disorder, and PTSD, while escitalopram covers only depression and generalized anxiety disorder.

  • Escitalopram uses a simpler two-step dosing schedule, while sertraline involves more gradual increases on the way to its higher maximum dose.

  • Both drugs carry the same boxed warning for suicidal thinking in children, teens, and young adults, and both are available as low-cost generics.

Sertraline vs. Escitalopram Drug Summary

Sertraline

Sertraline is a selective serotonin reuptake inhibitor (SSRI) approved for major depressive disorder, OCD, panic disorder, PTSD, social anxiety disorder, and PMDD. It is taken once daily by mouth, usually starting at 50 mg and increasing over several weeks up to a maximum of 200 mg.

Escitalopram

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) approved for major depressive disorder in adults and adolescents 12 and older, and for generalized anxiety disorder in adults. It is taken once daily, starting at 10 mg and moving to a 20 mg maintenance dose after one week.

Sertraline vs. Escitalopram Side Effects

Sertraline

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

Escitalopram

Most common
nausea (up to 15%)
insomnia (up to 9%)
ejaculation disorder (up to 9%)
fatigue (up to 8%)

Sertraline vs. Escitalopram Dosage

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

Escitalopram

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 vs. Escitalopram Indications

Sertraline

Sertraline is FDA-approved for six psychiatric conditions: major depressive disorder, obsessive-compulsive disorder, panic disorder, PTSD, social anxiety disorder, and premenstrual dysphoric disorder. This makes it one of the more broadly approved SSRIs, often used when anxiety-spectrum symptoms overlap with depression.

  • Major depressive disorder in adults

  • Obsessive-compulsive disorder in adults and children age 6+

  • Panic disorder, with or without agoraphobia

  • Post-traumatic stress disorder (PTSD)

Escitalopram

Escitalopram is FDA-approved for major depressive disorder in adults and adolescents ages 12 to 17, and for generalized anxiety disorder in adults. It is not approved for bipolar depression or for depression in children under 12, and any other use is considered off-label.

  • Major depressive disorder in adults

  • Major depressive disorder in adolescents ages 12-17

  • Generalized anxiety disorder in adults

  • Off-label: sometimes used for OCD, panic disorder, or PTSD

Sertraline vs. Escitalopram Pros and Cons

Sertraline

Sertraline covers more FDA-approved conditions than escitalopram, making it a common choice when anxiety disorders overlap with depression. It generally requires a longer titration process and tends to cause more gastrointestinal side effects.

Pros

  • FDA-approved for six conditions, including OCD, panic disorder, PTSD, and social anxiety disorder

  • More dosing flexibility, with steps up to 200 mg for patients who need it

  • Approved for pediatric OCD in children age 6 and older

Cons

  • Higher rates of nausea and diarrhea than escitalopram in trials

  • Requires more titration steps to reach an effective dose

  • Not FDA-approved for pediatric depression

Escitalopram

Escitalopram has a simpler dosing schedule and generally milder gastrointestinal side effects than sertraline. Its FDA approval is narrower, limited to depression and generalized anxiety disorder rather than a wider range of anxiety-spectrum conditions.

Pros

  • Simpler two-step dosing schedule, usually complete within two weeks

  • Lower rates of nausea and insomnia in clinical trials

  • FDA-approved for adolescent depression, ages 12-17

Cons

  • Narrower FDA approval, limited to depression and generalized anxiety disorder

  • Using it for OCD, panic disorder, PTSD, or social anxiety disorder is off-label

  • No FDA approval for pediatric OCD, unlike sertraline

Common Symptoms and Related Diseases You Can Explore

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