Compare Lexapro (escitalopram) and Zoloft (sertraline) - two commonly prescribed SSRIs for depression and anxiety. Learn about effectiveness, side effects, dosing, and which might be right for you.
Board-certified psychiatrists and mental health professionals
Medical Review Board
Published: January 3, 2026
Last Updated: January 2, 2025
Last Reviewed: January 3, 2026
Lexapro vs Zoloft
Compare Lexapro (escitalopram) and Zoloft (sertraline) - two commonly prescribed SSRIs for depression and anxiety. Learn about effectiveness, side effects, dosing, and which might be right for you.[object Object]
Details
Tags
—
Lexapro vs Zoloft: Overview
Lexapro (escitalopram) and Zoloft (sertraline) are both selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed class of antidepressants. Both work by increasing serotonin levels in the brain, improving mood, reducing anxiety, and helping regulate sleep and appetite. While they share the same mechanism, there are important differences in their side effect profiles, drug interactions, and FDA-approved uses.
Which Is More Effective?
Clinical studies show both medications are similarly effective for treating depression and anxiety. A large meta-analysis found escitalopram (Lexapro) had a slight edge in efficacy among SSRIs, but the difference is small. In practice, individual response varies significantly - some patients do better on one than the other. If one doesn't work well, switching to the other is a reasonable approach.
Side Effects Comparison
Both medications share common SSRI side effects including nausea, headache, insomnia, sexual dysfunction, and drowsiness. However, there are notable differences:
Drug Interactions
Lexapro has fewer drug interactions because it has minimal effects on cytochrome P450 enzymes. Zoloft moderately inhibits CYP2D6, which can affect levels of other medications including some beta-blockers, antipsychotics, and pain medications. Both interact dangerously with MAOIs and should not be combined with other serotonergic drugs without medical supervision (risk of serotonin syndrome).
Special Populations
{"type":"special_populations","heading":"Special Populations","subsections":[{"content":"Zoloft is generally considered the preferred SSRI during pregnancy due to more safety data. Both pass into breast milk but are generally considered compatible with breastfeeding.","heading":"Pregnancy & Breastfeeding"},{"content":"Zoloft is FDA-approved for OCD in children 6+ and is commonly used off-label for pediatric depression and anxiety. Lexapro is approved for depression in adolescents 12+.","heading":"Children & Adolescents"},{"content":"Both are used in older adults. Lower starting doses are recommended. Watch for hyponatremia (low sodium) with either medication.","heading":"Elderly"}]}
Switching Between Lexapro and Zoloft
If one SSRI isn't working well or causes intolerable side effects, switching to another is common practice. Your doctor may do a direct switch (stopping one and starting the other) or a cross-taper (gradually reducing one while starting the other). Never stop an antidepressant abruptly without medical guidance.
Cost Comparison
Both medications are available as generics and are similarly affordable. Generic escitalopram and sertraline typically cost $4-$30/month depending on pharmacy and insurance. Brand-name versions are significantly more expensive and rarely necessary.
Which Should You Choose?
There's no universally "better" choice - it depends on your specific situation: