You and your doctor or prescribing nurse may want to begin by narrowing your search to one specific category of medication frequently used to treat depression or anxiety—such as the selective serotonin reuptake inhibitors (SSRIs). Two SSRIs that you might consider are Lexapro and Zoloft.
Whether this is your first time taking one of these medications or you are thinking about switching from Lexapro to Zoloft (or switching from Zoloft to Lexapro), this Minded Medication Guide will take a closer look at Lexapro and Zoloft to help you understand which medication might be the better choice for you. This information can be helpful to you when talking with your doctor, prescribing nurse, or Minded provider in choosing the medication used in your treatment plan.
Read on to learn more about these two medications, including:
Minded Medication Guides, including Zoloft vs Prozac and Wellbutrin vs Lexapro, are intended as educational aids only. They are not intended as medical advice for individual conditions or treatment. They are not a substitute for a medical exam, nor do they replace the need for services provided by medical professionals. Talk to your doctor, nurse, or pharmacist before taking any prescription medication or following any treatment or regimen.
Antidepressant medications are typically grouped by how and which neurotransmitters (tiny molecules in the brain that relay messages from nerve to nerve) they primarily affect in order to relieve depression symptoms. As mentioned above, both Lexapro and Zoloft are selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication that also may be used to treat anxiety.
As their name implies, SSRIs affect the levels of serotonin (a neurotransmitter) in your brain. Serotonin helps to keep your mood balanced and plays a role in feelings of contentment, optimism, and satisfaction, as well as your overall sense of well-being. SSRIs increase the serotonin levels in your brain by preventing serotonin from being reabsorbed into the neurons (nerves in your brain) and thus inactivated.
Even though Lexapro and Zoloft are both SSRI medications, that does not mean they are exactly the same. Looking more closely at each of these medications can help you determine which medication might be a better choice for your treatment plan.
Lexapro is the brand name of the generic drug escitalopram. It is used to treat generalized anxiety disorder (GAD) and major depressive disorder (MDD).
Lexapro may also sometimes be prescribed for “off-label” uses. “Off-label” use means taking a medication for a condition that it has not been approved by the FDA to treat. This is a common and acceptable medical practice. Lexapro may be used “off-label” to help treat obsessive-compulsive disorder (OCD), eating disorders (including binge eating disorder or bulimia nervosa), panic disorder, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).
Lexapro (escitalopram) is available in tablet and liquid forms:
The recommended starting dose for Lexapro—whether you are taking it for depression or anxiety—is typically 10 mg taken once a day. Your doctor or prescribing nurse may gradually increase the dosage over the course of several weeks, if necessary. The maximum recommended dose is 20 mg, though some people need higher doses to achieve symptom relief.
Lexapro is taken once a day, with or without food. It can be taken in the morning or the evening, whichever is more convenient for you.
If you miss a dose of Lexapro, you will want to either take the missed dose as soon as you remember, or if it is closer to the time when you would take your next dose, just take the next dose.
As with most SSRIs, you may notice that your sleep, energy, and/or appetite begins to improve within the first two weeks of starting Lexapro. However, it may take up to 6 to 8 weeks (or longer) before the improvement of symptoms such as depressed mood or decreased interest in activities become noticeable.
Common side effects of Lexapro include:
Some Lexapro side effects may improve over the first week or two as you continue to take the medication. However, sexual side effects may not decrease over time.
Talk to your doctor or Minded provider if you experience any of these or other side effects.
Rare or serious side effects of Lexapro include:
SSRI antidepressant medications—like Lexapro—may also put you at an increased risk for potentially life-threatening bleeding, especially when they are taken with medications such as aspirin, nonsteroidal anti-inflammatories (NSAIDs—like ibuprofen or naproxen), and warfarin (an anticoagulant medication), or other anticoagulants. Lexapro taken with any single or combination of these medications could cause your gums, nose, stomach, or intestines to bleed more easily.
Seek medical attention right away if you experience any of these (or other) serious side effects.
Lexapro comes with an FDA “Black Box” warning, which means that the FDA has identified certain serious safety risks from taking it. While these are serious safety warnings, the actual risk may be very low, or even rare.
The Black Box warning for Lexapro states that children, adolescents, and young adults who are taking antidepressants may be at an increased risk for suicidal thoughts or behaviors. Lexapro is not approved for use in children younger than 12 years of age. There is no upper age limit for its use.
It is important to discuss your depression medication with your doctor if you are planning on becoming pregnant because taking SSRIs—like Lexapro—during pregnancy or while breastfeeding may impact your baby.
Drinking alcohol is not recommended if you are taking Lexapro or other antidepressant medications, for several reasons. While alcohol may seem to improve your mood in the short term, it may actually worsen anxiety or depression symptoms in the long run. Alcohol can decrease the benefits of antidepressant medications and increase their negative side effects, such as sedation. There is also a risk of accidentally overdosing on Lexapro if it is taken with alcohol.
Symptoms of an overdose of Lexapro may include:
Because SSRIs like Lexapro must be taken regularly to be effective (and to avoid withdrawal symptoms), you should not skip doses of Lexapro in order to drink alcohol.
If you need to stop taking Lexapro for any reason, work with your doctor or prescribing nurse to develop a plan to do so gradually and carefully to avoid withdrawal symptoms. While antidepressant medication withdrawal symptoms may sometimes be mild and last only a week or two, in some cases, withdrawal symptoms may last weeks or even months.
Lexapro withdrawal symptoms may include:
Always let your provider know about any other medications (and supplements, often called nutraceuticals) you are taking to determine if Lexapro might have any negative interactions with them.
Zoloft is the brand name of the generic drug sertraline. It is used to treat major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and social anxiety disorder.
Zoloft is also sometimes used “off-label” for generalized anxiety disorder (GAD), binge eating disorder, and bulimia nervosa.
Zoloft (sertraline) is available in tablet and liquid forms:
At first, your doctor or prescribing nurse may have you start out on a lower dose of Zoloft—such as 25 or 50 mg per day. They may then gradually increase your dosage over the course of several weeks, if necessary. The maximum recommended dose is typically no more than 200 mg daily, though some people need higher doses for symptom relief.
Zoloft is taken one time per day (usually in the morning or evening), with or without food.
If you miss a dose of Zoloft, you will want to either take the missed dose as soon as you remember or, if it is closer to the time when you would take your next dose, just take the next dose.
As with Lexapro, when you first begin taking Zoloft, you may notice your sleep, energy, and/or appetite improve within the first two weeks. However, it may take 6 to 8 weeks (or longer) for the improvement of other common depression symptoms (such as low mood or decreased interest in activities) to become noticeable.
Common Zoloft side effects include:
Like Lexapro, some of these side effects may decrease over the course of the first few weeks of taking Zoloft. However, others—such as lowered sex drive or difficulty performing sexually—might not improve over time.
Talk to your doctor or prescribing nurse or the experts at Minded if you experience any of these or other side effects.
Rare or serious Zoloft side effects include:
And because it is an SSRI like Lexapro, Zoloft may also increase your risk for potentially life-threatening bleeding in your gums, nose, stomach, or intestines. This risk is increased if you are also taking medications such as aspirin, nonsteroidal anti-inflammatories (NSAIDs—like ibuprofen or naproxen), and warfarin, or other anticoagulant drugs.
You should seek medical attention right away if you experience any of these (or other) serious side effects.
Like Lexapro, Zoloft comes with an FDA “Black Box” warning. The Black Box warning for Zoloft says that antidepressant medications may increase the risk of suicidal thoughts or behaviors in children and young adults under 25 years old.
Zoloft is an SSRI that can affect your baby during pregnancy and while breastfeeding. Be sure to discuss your depression or anxiety treatment plan with your doctor if you are pregnant or breastfeeding, or are planning to do so.
As with Lexapro, you should not drink alcohol while taking Zoloft. Alcohol may temporarily appear to improve your mood, but it can actually worsen depression and anxiety symptoms long-term. Alcohol can also decrease the benefits of medications like Zoloft and increase their negative side effects (such as sedation). And there is a risk of accidentally overdosing on Zoloft if it is taken with alcohol.
Because SSRIs like Zoloft must be taken regularly to be effective (and to avoid withdrawal symptoms), you should not skip doses of Zoloft in order to drink alcohol.
Like Lexapro, if you need to stop taking Zoloft, you will want to work with your doctor to come up with a plan to do so carefully and gradually to avoid withdrawal symptoms. In some cases, antidepressant medication withdrawal symptoms are mild and last only a week or two. However, in other cases, withdrawal symptoms may last weeks or even months.
Zoloft withdrawal symptoms may include:
Always let your doctor or a Minded professional know about any other medications and/or supplements you are taking to determine if Zoloft might have any negative interactions with them.
Both Lexapro and Zoloft can take several weeks for improvement in your depression or anxiety symptoms to become noticeable. Because neither medication has a lead over the other in this area, it usually is not a factor in decision-making when choosing between these two medications.
In general, you might notice your sleep, energy, and appetite get better within the first two weeks of starting Lexapro or Zoloft. It can take 6 to 8 weeks for other symptoms—such as depressed mood or lack of interest in day-to-day activities—to improve as well.
Lexapro and Zoloft are similarly effective in terms of treating major depressive disorder (MDD). One study found that people on Lexapro and people on Zoloft reported similar levels of improvements in their depression symptoms. It also found that very few people discontinued treatment due to negative side effects (only 2% of people on Lexapro and 4% of people on Zoloft).
Zoloft and Lexapro have also been found to be effective treatment options for anxiety disorders. According to a 2018 study published in the Expert Opinion on Pharmacotherapy, both medications reduced anxiety symptoms compared to placebos, and both were well tolerated in terms of side effects.
While Lexapro and Zoloft have some possible side effects in common, they each come with their own more common side effects to keep an eye out for and bring to your doctor’s attention.
Weight gain is a common concern about antidepressant medications. While some of these medications may have a higher rate of weight gain compared to others, in some cases, weight gain is not directly caused by the medication itself.
For example, sometimes people lose weight when they are depressed before they have started treatment. When their appetite returns as their depression is treated effectively, they may begin to gain back the weight they lost. But this is not necessarily caused by the medication itself. Instead, it is actually a result of an improvement in depression symptoms.
That being said, a 2015 study published in General Hospital Psychiatry found that both Lexapro and Zoloft—as well as other antidepressant medications—could lead to weight gain.
While head-to-head comparisons for Zoloft vs Lexapro are not available, studies suggest that both can cause weight gain when taken long-term.
A study published in the Journal of Clinical Medicine in 2016, for example, found that people taking Zoloft over a two-year period gained an average of 10.5 pounds.
While a 2011 study in the International Journal of Neuropsychopharmacology found that people taking Lexapro over a 12-week period (i.e., short-term) gained an average of less than a pound, a 2007 study in Current Medical Research and Opinion found that people taking Lexapro over an 8-month period gained an average of 4 pounds.
Lexapro and Zoloft should not be taken together. Because both medications are SSRIs, taking them together can lead to dangerously high levels of serotonin collecting in your body. This is called serotonin syndrome, and it can be fatal.
You may consider switching medications if you have been on Lexapro or Zoloft at the right dose (determined by you and your doctor or nurse practitioner) for six or more weeks and have not seen a noticeable improvement in your depression or anxiety symptoms or are experiencing side effects you that find too difficult to tolerate.
Another reason you may want to consider switching antidepressant medications is if you have been on one of these medications for a while and no longer find it as effective as it initially was. In some cases, switching to a different medication can be exactly what is needed to get your treatment plan back on track.
Lexapro and Zoloft can both cause withdrawal symptoms if you stop taking them suddenly. When switching or stopping these types of medications, work with your doctor or a Minded professional to develop a plan to do so carefully and gradually. The plan may involve tapering down the dose of the medication you are currently taking and then starting the new medication.
Both Lexapro and Zoloft are worthy of consideration when you are developing your depression or anxiety treatment plan. Keep in mind that each of these medications comes with its own pros and cons. And while they are similar in many ways, there are some key differences as well.
For instance, Lexapro is approved to treat generalized anxiety disorder (GAD) and major depressive disorder (MDD). Zoloft is approved to treat depression, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and social anxiety disorder—though it is also used “off-label” to treat generalized anxiety disorder (GAD).
While both medications are similarly effective in treating both MDD and anxiety, one study found that slightly more people stopped using Zoloft because of side effects compared to Lexapro (4% compared to 2%).
However, it is also important to keep in mind that not everyone who takes a medication will experience the possible side effects of that medication—and some people find the side effects of one medication more tolerable than the side effects of another medication.
Seeking medical advice from your doctor, prescribing nurse or the experts at Minded can help you understand and choose which medication might be the better option for you.