Zoloft vs. Lexapro

See how Zoloft and Lexapro compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both drugs are SSRIs that treat depression similarly, but Zoloft covers more conditions, including OCD, panic disorder, PTSD, and PMDD, while Lexapro is approved only for depression and generalized anxiety disorder.

  • Lexapro's dosing is simpler, moving from 10 mg to one 20 mg maintenance dose, while Zoloft's dose can range from 25 mg up to 200 mg depending on what is being treated.

  • Zoloft tends to cause more nausea and diarrhea, while Lexapro is more associated with sexual side effects and somnolence at its approved doses.

Zoloft vs. Lexapro Drug Summary

Zoloft

Zoloft (sertraline) is a selective serotonin reuptake inhibitor approved for major depressive disorder, obsessive-compulsive disorder, panic disorder, PTSD, and PMDD. It comes as a tablet or oral solution taken once daily, with a starting dose of 25 mg or 50 mg depending on the condition being treated.

Lexapro

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor approved for major depressive disorder in adults and adolescents and for generalized anxiety disorder in adults. It is taken once daily as a tablet or oral solution, typically starting at 10 mg and moving to 20 mg after about a week if needed.

Zoloft vs. Lexapro Side Effects

Zoloft

Most common
Nausea (up to 26%)
Insomnia (up to 20%)
Diarrhea (up to 20%)
Dry mouth (up to 14%)

Lexapro

Most common
Nausea (up to 15%)
Insomnia (up to 9%)
Ejaculation disorder (up to 9%)
Somnolence (up to 6%)

Zoloft vs. Lexapro Dosage

Zoloft

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

Lexapro

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily Weeks 1-2
Maximum dose 20 mg once daily Week 2 onward
Dose changes 1 increase Every week

Zoloft vs. Lexapro Indications

Zoloft

Zoloft is an SSRI with one of the broadest FDA approval lists in its class. It treats major depressive disorder, OCD, panic disorder, PTSD, and PMDD, and can be dosed differently for each.

  • Major depressive disorder in adults

  • Obsessive-compulsive disorder in adults and children 6 and up

  • Panic disorder

Lexapro

Lexapro is an SSRI approved for major depressive disorder and generalized anxiety disorder. It is used in adults for both conditions, and in adolescents for depression only.

  • Major depressive disorder in adults

  • Major depressive disorder in adolescents ages 12-17

  • Generalized anxiety disorder in adults

Zoloft vs. Lexapro Pros and Cons

Zoloft

Zoloft carries FDA approval for six conditions, more than most SSRIs, which makes it useful when anxiety, OCD, or PTSD symptoms overlap with depression. It has been prescribed since 1991, giving doctors decades of real-world safety data to draw on.

Pros

  • FDA-approved for OCD, panic disorder, PTSD, and PMDD, not just depression

  • Long track record dating back to 1991

  • Available as a tablet or oral solution

  • Dose can be fine-tuned from 25 mg up to 200 mg for harder-to-treat cases

Cons

  • Higher rates of nausea and diarrhea than Lexapro

  • More dosing steps, with different starting doses by condition

  • Not FDA-approved specifically for generalized anxiety disorder

Lexapro

Lexapro's narrower approval list reflects its development as a purified, single-enantiomer SSRI. Its simple two-step dosing and comparatively mild GI side effect profile make it appealing for patients who haven't tolerated other SSRIs well.

Pros

  • FDA-approved for generalized anxiety disorder, not just depression

  • Simple two-step dosing: 10 mg starting dose, then 20 mg if needed

  • Lower rates of nausea and GI upset than Zoloft

  • Approved for adolescent depression starting at age 12

Cons

  • Not FDA-approved for OCD, panic disorder, PTSD, or PMDD

  • Fewer approved uses overall than Zoloft

  • Notable rate of sexual side effects, including ejaculation disorder in men

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