Lexapro vs. Zoloft: Complete Comparison Guide

If you’ve ever struggled with depression or anxiety, chances are you’re familiar with two of the most commonly prescribed medications that can help with each. Lexapro is the brand name for a generic antidepressant known as escitalopram, and Zoloft is the brand name for the generic medication sertraline.

Both of these are similar in many ways, but there are some key differences that set them apart. Understanding what makes them each unique can help you to communicate with your doctor about which one might work best for you.

Here is a complete guide to the similarities and differences between Lexapro (escitalopram) and Zoloft (sertraline).

Drug Class

Lexapro (escitalopram) and Zoloft (sertraline) both belong to a class of medications known as selective serotonin reuptake inhibitors, or SSRIs. This is a newer generation of antidepressant that works by inhibiting the reabsorption of serotonin into the brain, therefore making it more abundant.

Serotonin is a neurochemical that plays a pivotal role in anxiety and depression. It’s believed both conditions are associated with low levels of this neurotransmitter. By increasing the abundance of serotonin in the brain, these medications can help to improve and stabilize mood.

Conditions Treated

Lexapro (escitalopram) and Zoloft (sertraline) have many similarities, but there are some key differences in the conditions that each is approved to treat.

Depressive Disorders

Major depressive disorder (MDD) is a mood disorder characterized by persistent and inundating feelings of sadness and hopelessness. Individuals with MDD often feel little pleasure in daily activities, have difficulty concentrating, and feel a lack of self worth. It’s a common mental health condition, though it can be easily treated through psychotherapy or medication.

Both Lexapro (escitalopram) and Zoloft (sertraline) are approved by the Food and Drug Administration (FDA) for the treatment of major depressive disorder.

Anxiety Disorders

The FDA has also approved Lexapro (escitalopram) for the treatment of generalized anxiety disorder. GAD is a common mental health condition marked by persistent and intense feelings of fear or worry. Symptoms of GAD can take many different forms, such as hyperalertness, restlessness, rapid heart rate, and difficulty sleeping.

While Zoloft (sertraline) is not FDA-approved for treating GAD, it is often prescribed “off-label” to treat it. Other off-label uses for this medication include binge eating disorder, bulimia nervosa, and body dysmorphic disorder.

In addition, Zoloft is FDA-approved to treat a number of other anxiety disorders such as obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and post-traumatic stress disorder. Lexapro has not been officially FDA-approved for any of these, though it may be prescribed off-label.

Zoloft is also approved to treat premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS) that includes intense behavioral symptoms during the onset of menstruation.

Effectiveness

Both Lexapro (escitalopram) and Zoloft (sertraline) are effective forms of antidepressants for treating a wide range of symptoms.

In an analysis of studies, it was found that Lexapro is effective for treating both anxiety and depression symptoms. Additionally, it was found to be the more effective and well-tolerated antidepressant when compared to 12 novel medications.

Zoloft was also found to perform significantly better than placebos for treating generalized anxiety disorder.

While few studies have compared the two, one study from 2014 found that since Lexapro has a different binding site at the serotonin transporter, it was generally more effective and better tolerated than Zoloft.

With that said, the only people who can tell if a medication is effective are you and your doctor. The medication that works best for you may be either one of these, or it may be something completely different.

Side Effects

Any antidepressant medication runs the risk of causing some side effects. Both Lexapro (escitalopram) and Zoloft (sertraline) have similar side effects.

Common ones that both share include:

Headache
Nausea
Diarrhea
Dry mouth
Nervousness or restlessness
Insomnia or other sleep disturbances

The good news is that these side effects are usually temporary and should subside after a short period of time as long as you continue to take the medication.

Additionally, both Lexapro and Zoloft can cause sexual side effects such as erectile dysfunction, ejaculatory delay, or loss of libido. These often do not diminish over time.

In rare circumstances, each of these medications can cause serotonin syndrome. This occurs when an excess of serotonin causes physical symptoms such as diarrhea, rapid heart rate, dilated pupils, loss of muscle coordination, or confusion.

Other rare, but serious, side effects of Lexapro and Zoloft include low sodium blood levels, teeth grinding, or increased bleeding risk. If you notice any severe reaction to either medication, stop use and contact a doctor immediately.

Lexapro and Zoloft are not habit-forming, meaning there is a low risk of developing a physical dependency on either.

Drug Interactions

When taking two or more medications at the same time, there is risk for an adverse reaction known as a drug-drug interaction.

Lexapro (escitalopram) and Zoloft (sertraline) may interact negatively with some other medications.

Neither drug should be taken with or within two weeks of using monoamine oxidase inhibitors (MAOIs).

Additionally, taking these medications alongside other antidepressants, certain pain medications, or migraine medications may increase the risk of developing serotonin syndrome.

They may also increase the effects of medications that act as blood thinners, such as ibuprofen or aspirin.

Additionally, alcohol can worsen some of the side effects of Lexapro and Zoloft. It may also worsen the symptoms of anxiety or depression, which may cause the medication to feel less effective.

In Conclusion

Lexapro (escitalopram) and Zoloft (sertraline) are both SSRI antidepressants that are FDA-approved for treating major depressive disorder. Lexapro is also approved for treating generalized anxiety disorder, though Zoloft can be prescribed off-label for it.

Both are effective for treating a variety of mental health conditions, though some studies have found Lexapro to be generally better tolerated. Both have a similar range of side effects, including headaches, nausea, or loss of libido.

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