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.
Both Lexapro and Zoloft are effective SSRIs for treating depression and anxiety. Lexapro is often considered slightly better tolerated with fewer drug interactions, while Zoloft has a broader FDA-approved indication list and more flexibility in dosing.
| Feature | Lexapro (escitalopram) | Zoloft (sertraline) |
|---|---|---|
| Drug Class | SSRI | SSRI |
| FDA-Approved For | Major depression, Generalized anxiety disorder | Major depression, OCD, Panic disorder, PTSD, Social anxiety, PMDD |
| Typical Starting Dose | 10 mg once daily | 50 mg once daily |
| Usual Effective Dose | 10-20 mg/day | 50-200 mg/day |
| Time to Effect | 2-4 weeks | 2-4 weeks |
| Half-Life | 27-32 hours | 26 hours |
| Drug Interactions | Fewer (minimal CYP450 inhibition) | More (moderate CYP2D6 inhibition) |
| Weight Effects | Weight neutral to slight gain | Weight neutral to slight loss initially |
| Sexual Side Effects | Common (similar to other SSRIs) | Common (similar to other SSRIs) |
| GI Side Effects | Less common | More common (diarrhea, nausea) |
| Approved for Children | 12+ years (depression) | 6+ years (OCD) |
| Pregnancy Category | Use with caution | Preferred SSRI in pregnancy |
| Generic Available | Yes | Yes |
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.
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.
Both medications share common SSRI side effects including nausea, headache, insomnia, sexual dysfunction, and drowsiness. However, there are notable differences:
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).
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.
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+.
Both are used in older adults. Lower starting doses are recommended. Watch for hyponatremia (low sodium) with either medication.
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.
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.
There's no universally "better" choice - it depends on your specific situation: