Zoloft vs. Paxil
See how Zoloft and Paxil compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Zoloft and Paxil are both SSRIs used for depression and anxiety disorders, but Paxil is also FDA-approved for generalized anxiety disorder while Zoloft is not.
Zoloft's longer half-life tends to make missed doses and stopping treatment more forgiving than Paxil's shorter half-life.
Both drugs carry the same boxed warning about suicidal thoughts in young people and commonly cause nausea, dry mouth, and sexual side effects.
Zoloft vs. Paxil Drug Summary
Zoloft
Zoloft (sertraline) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, PTSD, social anxiety disorder, and premenstrual dysphoric disorder. It comes as a tablet or oral solution taken once daily, usually starting at 25 to 50 mg. Its relatively long half-life means an occasional missed dose is less likely to cause noticeable withdrawal effects.
Paxil
Paxil (paroxetine) is also an SSRI, FDA-approved for major depressive disorder, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, and PTSD. It is taken once daily as an immediate-release tablet, extended-release tablet (Paxil CR), or oral suspension, typically starting around 20 mg. Its short half-life means stopping abruptly or missing doses can bring on more noticeable discontinuation symptoms.
Zoloft vs. Paxil Side Effects
Zoloft
Paxil
Zoloft vs. Paxil Dosage
Zoloft
Paxil
| STAGE | DOSE | WHEN |
| Starting dose | 25-50 mg once daily | At the start |
| Maximum dose | 50-200 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 50 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Zoloft
| STAGE | DOSE | WHEN |
| Starting dose | 25-50 mg once daily | At the start |
| Maximum dose | 50-200 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Paxil
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 50 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Zoloft vs. Paxil Indications
Zoloft
Zoloft is FDA-approved for major depressive disorder, obsessive-compulsive disorder, panic disorder, PTSD, and social anxiety disorder. It works by boosting serotonin levels in the brain to help regulate mood and reduce anxious or compulsive symptoms. It is not FDA-approved for generalized anxiety disorder, though doctors sometimes prescribe it off-label for that purpose.
Major depressive disorder (MDD)
Obsessive-compulsive disorder (OCD)
Panic disorder
Posttraumatic stress disorder (PTSD)
Social anxiety disorder
Paxil
Paxil is FDA-approved for major depressive disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, and generalized anxiety disorder. It works the same way, by increasing serotonin activity in the brain to ease depression and anxiety symptoms. It is not approved for use in children or teenagers.
Major depressive disorder (MDD)
Obsessive-compulsive disorder (OCD)
Panic disorder
Social anxiety disorder
Generalized anxiety disorder (GAD)
Zoloft vs. Paxil Pros and Cons
Zoloft
Sertraline (Zoloft) is one of the most widely prescribed SSRIs, with a long half-life that makes it more forgiving of missed doses. It carries the same boxed warning for suicidal thoughts as other antidepressants and shares typical SSRI side effects like nausea and sexual dysfunction.
Pros
Longer half-life makes missed doses and tapering off more forgiving than paroxetine.
The only SSRI of the two that is FDA-approved for premenstrual dysphoric disorder (PMDD).
Weaker CYP2D6 inhibition means fewer dose adjustments needed for other medications.
Cons
Not FDA-approved for generalized anxiety disorder, so that use is off-label.
GI side effects like nausea and diarrhea are common, especially in the first weeks.
Sexual side effects, including ejaculation difficulty, affect a meaningful share of men.
Paxil
Paroxetine (Paxil) treats a similarly broad range of anxiety and depressive disorders, with FDA approval for generalized anxiety disorder that sertraline lacks. Its short half-life means withdrawal symptoms can be more noticeable if a dose is missed or the medication is stopped abruptly.
Pros
FDA-approved for generalized anxiety disorder, an indication sertraline lacks.
Also available as an extended-release tablet (Paxil CR) or oral suspension.
Its sedating effect can help patients whose anxiety or depression includes prominent insomnia.
Cons
Short half-life means missed doses or stopping treatment can trigger more noticeable withdrawal symptoms.
Strong CYP2D6 inhibitor, requiring dose adjustments for many commonly co-prescribed drugs.
Not approved for use in pediatric patients, unlike some of sertraline's indications.
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