Zoloft vs. Cymbalta
See how Zoloft and Cymbalta compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Zoloft is an SSRI approved for depression, OCD, panic disorder, PTSD, social anxiety disorder, and PMDD, while Cymbalta is an SNRI also approved for generalized anxiety disorder and chronic pain conditions.
Both carry an FDA boxed warning for increased suicidal thinking in people under 25, and both commonly cause nausea and headache early in treatment.
Cymbalta reaches its full maintenance dose within two weeks, while Zoloft may take several weeks of titration to reach higher doses up to 200 mg.
Zoloft vs. Cymbalta Drug Summary
Zoloft
Zoloft (sertraline) is a selective serotonin reuptake inhibitor, or SSRI, first approved by the FDA in 1991. It treats major depressive disorder, OCD, panic disorder, PTSD, social anxiety disorder, and PMDD. It comes as a tablet or oral liquid taken once a day, usually starting at 25 mg to 50 mg.
Cymbalta
Cymbalta (duloxetine) is a serotonin and norepinephrine reuptake inhibitor, or SNRI, approved by the FDA in 2004. It treats major depressive disorder, generalized anxiety disorder, diabetic nerve pain, and fibromyalgia. It comes as a delayed-release capsule taken once or twice a day.
Zoloft vs. Cymbalta Side Effects
Zoloft
Cymbalta
Zoloft vs. Cymbalta Dosage
Zoloft
Cymbalta
| STAGE | DOSE | WHEN |
| Starting dose | 25-50 mg once daily | At the start |
| Maximum dose | Up to 200 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 30 mg once daily | Week 1 |
| Maximum dose | 60 mg twice daily | If needed |
| Dose changes | 2 increases | Every week |
Zoloft
| STAGE | DOSE | WHEN |
| Starting dose | 25-50 mg once daily | At the start |
| Maximum dose | Up to 200 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Cymbalta
| STAGE | DOSE | WHEN |
| Starting dose | 30 mg once daily | Week 1 |
| Maximum dose | 60 mg twice daily | If needed |
| Dose changes | 2 increases | Every week |
Zoloft vs. Cymbalta Indications
Zoloft
Zoloft is FDA-approved to treat several mental health conditions beyond depression, including anxiety and trauma-related disorders. It is not approved for generalized anxiety disorder or any chronic pain condition, though doctors sometimes use it off-label for other anxiety issues.
Major depressive disorder (MDD)
Obsessive-compulsive disorder (OCD)
Panic disorder
Post-traumatic stress disorder (PTSD)
Social anxiety disorder
Cymbalta
Cymbalta is FDA-approved for both psychiatric and chronic pain conditions, making it one of the few antidepressants also used for nerve pain and fibromyalgia. It is not approved for other anxiety disorders such as panic disorder or PTSD.
Major depressive disorder (MDD)
Generalized anxiety disorder (GAD)
Diabetic peripheral neuropathic pain
Fibromyalgia
Chronic musculoskeletal pain
Zoloft vs. Cymbalta Pros and Cons
Zoloft
Zoloft has one of the longest track records among SSRIs and covers a wider range of anxiety-related conditions than Cymbalta. Generic sertraline has been available since 2006, making it one of the most affordable antidepressants on the market.
Pros
Approved for OCD, panic disorder, PTSD, social anxiety, and PMDD
Available as a liquid for people who cannot swallow pills
Generic sertraline often costs $20 to $75 a month without insurance
No specific liver or kidney dose restrictions in labeling
Cons
Not approved for any chronic pain or nerve pain condition
Diarrhea is a more common complaint than with Cymbalta
Not approved for generalized anxiety disorder
Cymbalta
Cymbalta covers chronic pain conditions that Zoloft is not approved to treat, giving it use beyond mental health care. It reaches its full maintenance dose faster than Zoloft, but it comes with more restrictions for people with liver or kidney disease.
Pros
Approved for generalized anxiety disorder unlike Zoloft
Also treats diabetic nerve pain, fibromyalgia, and chronic pain
Reaches target maintenance dose within two weeks
Fewer GI complaints like diarrhea compared with Zoloft
Cons
Must be swallowed whole; capsule cannot be crushed or opened
Should be avoided in liver disease or severe kidney impairment
Typically costs $130 to $500 a month without insurance
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