Sertraline vs. Fluoxetine
See how Sertraline and Fluoxetine compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Sertraline and fluoxetine are both SSRIs, but sertraline is FDA-approved for panic disorder, PTSD, social anxiety, and PMDD, while fluoxetine covers bulimia nervosa and depression in children as young as 8.
Fluoxetine's long-acting metabolite allows a once-weekly maintenance dose and causes fewer withdrawal symptoms if a dose is missed, while sertraline requires daily dosing throughout treatment.
Both carry a boxed warning for increased suicidal thoughts in people under 25 and are widely available as inexpensive generic medications.
Sertraline vs. Fluoxetine Drug Summary
Sertraline
Sertraline is a selective serotonin reuptake inhibitor (SSRI) approved for major depressive disorder, OCD, panic disorder, PTSD, social anxiety disorder, and premenstrual dysphoric disorder. It comes as a tablet, capsule, or oral solution taken once a day, usually starting at 50 mg.
Fluoxetine
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) approved for major depressive disorder, OCD, bulimia nervosa, and panic disorder, plus bipolar and treatment-resistant depression when combined with olanzapine. It comes as a capsule, tablet, or oral solution, usually starting at 20 mg once daily, with a once-weekly maintenance option.
Sertraline vs. Fluoxetine Side Effects
Sertraline
Fluoxetine
Sertraline vs. Fluoxetine Dosage
Sertraline
Fluoxetine
| 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 |
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | Week 1 |
| Maximum dose | 90 mg once weekly | If needed |
| Dose changes | 4 increases | Every week |
Sertraline
| 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 |
Fluoxetine
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | Week 1 |
| Maximum dose | 90 mg once weekly | If needed |
| Dose changes | 4 increases | Every week |
Sertraline vs. Fluoxetine Indications
Sertraline
Sertraline holds FDA approval for six separate conditions, more than most other SSRIs, spanning depression and several anxiety-related disorders. Doctors also prescribe it off-label for generalized anxiety disorder and body dysmorphic disorder.
Major depressive disorder (MDD)
Obsessive-compulsive disorder, ages 6+
Panic disorder and PTSD
Social anxiety disorder
Premenstrual dysphoric disorder (PMDD)
Fluoxetine
Fluoxetine was the first SSRI approved in the United States and covers depression, OCD, and bulimia nervosa, plus pediatric depression down to age 8. It's also approved in combination with olanzapine for bipolar depression and treatment-resistant depression.
Major depressive disorder, including ages 8+
Obsessive-compulsive disorder, ages 7+
Bulimia nervosa and panic disorder
Bipolar depression (with olanzapine)
Treatment-resistant depression (with olanzapine)
Sertraline vs. Fluoxetine Pros and Cons
Sertraline
Sertraline covers more FDA-approved anxiety disorders than fluoxetine, making it a common first choice when anxiety and depression overlap. It is a generic, insurance-friendly medication that requires a daily dosing routine.
Pros
FDA-approved for PTSD and panic disorder
FDA-approved for social anxiety disorder
Shorter half-life may allow faster dose adjustments
Cons
Not FDA-approved for pediatric depression
Higher rate of diarrhea in trials
No once-weekly dosing option
Fluoxetine
Fluoxetine's long-acting metabolite means missed doses cause fewer withdrawal symptoms than most SSRIs, and it offers a once-weekly maintenance option after stabilization. It is also approved for younger children with depression than sertraline.
Pros
FDA-approved for pediatric depression from age 8
Once-weekly maintenance dosing option
Lower risk of discontinuation symptoms from missed doses
Cons
Not FDA-approved for PTSD or social anxiety
Higher rate of insomnia than sertraline in trials
Long half-life can delay resolution of side effects
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