Lexapro vs Zoloft: What is the difference between Zoloft and Lexapro?
Key Takeaways
- Lexapro and Zoloft are both SSRI antidepressant medications that are also prescribed for anxiety. Zoloft is FDA-approved to treat more conditions than Lexapro, including panic disorder, OCD, and social anxiety disorder.
- Both medications can have similar side effects, including diarrhea, dizziness, nausea, and sexual dysfunction.
- Neither medication is better than the other for everyone. Healthcare providers consider several factors, like your diagnoses, medical history, and current medications, to decide which one might suit you best.
If you’re managing depression or anxiety, your healthcare provider may have mentioned Lexapro or Zoloft. These two medications are considered top-tier modern antidepressants.
Keep reading to learn about their different FDA-approved uses, as well as how they can impact your body and brain.
What are Lexapro and Zoloft?
Lexapro (escitalopram) and Zoloft (sertraline) are both prescribed to treat major depressive disorder (MDD). They both fall into the same drug family—a class of medications called selective serotonin reuptake inhibitors (SSRIs).
Both Lexapro and Zoloft are available as oral tablets and oral solutions. Generic escitalopram has recently become available in capsule form.
How do Lexapro and Zoloft work?
Lexapro and Zoloft are believed to work by changing how much of the chemical serotonin is available in your brain. Serotonin is a neurotransmitter that affects your mood, sleep-wake cycle, memory, appetite, thoughts, and how you feel pain.
Most people notice an improvement in their depression and anxiety symptoms over a few weeks of taking Lexapro or Zoloft.
This table shows which conditions the FDA has approved each drug to treat.
| Condition | Lexapro | Zoloft |
|---|---|---|
| Major depressive disorder (MDD) | ✔ | ✔ |
| Generalized anxiety disorder (GAD) | ✔ | |
| Post-traumatic stress disorder (PTSD) | ✔ | |
| Premenstrual dysphoric disorder (PMDD) | ✔ | |
| Social anxiety disorder (SAD) | ✔ | |
| Obsessive-compulsive disorder (OCD) | ✔ | |
| Panic disorder (PD) | ✔ |
Providers may prescribe these medications off-label (for an unapproved use) to treat other conditions.
Lexapro is sometimes prescribed off-label for:
- Social anxiety disorder (SAD)
- Panic disorder (PD)
- Body dysmorphic disorder (BDD)
- Post-traumatic stress disorder (PTSD)
- Bulimia nervosa (BN)
Zoloft is sometimes prescribed off-label for:
- Generalized anxiety disorder (GAD)
- Binge eating disorder (BED)
- Body dysmorphic disorder (BDD)
- Bulimia nervosa (BN)
Children can be prescribed Lexapro for both of its primary, FDA-approved uses: MDD and GAD. For children, Zoloft is only FDA-approved to treat obsessive-compulsive disorder (OCD)—even though adults can take it for a much wider range of conditions.
Zoloft vs. Lexapro side effects
Zoloft and Lexapro share many common side effects:
- Gastrointestinal (GI) side effects: This includes stomach upset, constipation, abdominal pain, bloating, loss of appetite, and vomiting. Both drugs can also cause diarrhea and nausea, but they are more common with Zoloft than Lexapro.
- Dizziness: This is more common with Lexapro than Zoloft.
- Drowsiness: This occurs equally with both SSRIs and is usually more common early in treatment. It can reappear after increasing your dose.
- Dry mouth: This common side effect of all SSRIs seems to occur equally with both drugs.
- Excessive sweating: This side effect may happen later in treatment for both drugs.
- Headache: More common with Lexapro than Zoloft.
- Sexual dysfunction: Symptoms can include delayed or failed ejaculation and/or lowered sex drive.
- Trouble sleeping: In some studies, this was more common with Zoloft.
- Weight gain or loss: This may look like modest early weight gain or loss, then more noticeable weight gain over months of treatment.
Both Lexapro and Zoloft can have rare but serious side effects. Both medications share the same FDA Boxed Warning for suicidal thoughts and behaviors in children, teens, and young adults under 25 years old.
Get emergency medical attention right away if you experience any of the following serious side effects of Lexapro and Zoloft:
- Allergic reactions: Including a widespread rash, blisters, or skin detachment.
- Seizures or convulsions: Any unexplained convulsions or sudden loss of motor control.
- Serotonin syndrome: Symptoms include agitation, hallucinations, a racing heart, confusion, and muscle stiffness.
- Manic episodes: Sudden, extreme spikes in energy, racing thoughts, or unusually risky behaviors.
Lexapro vs. Zoloft drug interactions
Lexapro and Zoloft have similar drug interactions. This means that some prescription drugs, over-the-counter (OTC) medications, and supplements may change how they affect your body.
Here are just a few common drugs that Lexapro or Zoloft can interact with:
- Monoamine oxidase inhibitors (MAOI), like linezolid or methylene blue
- Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen
- Serotonergic drugs (drugs that increase serotonin), like SSRIs, SNRIs and St. John’s wort
- Blood thinners, like warfarin and aspirin
- QT-prolonging drugs, like pimozide and ziprasidone
Always share a complete list of all drugs, vitamins, and supplements you’re taking with your healthcare provider. They can help you avoid dangerous interactions and recommend the safest treatment for your body.
Is Zoloft better than Lexapro for anxiety and depression?
Healthcare providers prescribing Lexapro or Zoloft for anxiety or depression don’t choose one drug because it is universally “better.” Instead, they consider several factors to decide on the best treatment for you. These include:
- Your diagnosis
- How severe your symptoms are
- Common and serious side effects of each
- Your medical history, including any other conditions you may be managing
Your provider may decide Lexapro is more suitable if you are concerned about side effects. Lexapro consistently shows a better overall tolerability profile, especially for your stomach. Zoloft has the highest risk of digestive side effects (like diarrhea) when compared to similar drugs.
Because both of these medications affect everyone differently, your provider will monitor your response to help find the safest, most effective dosage for you.
Who should consider Lexapro or Zoloft?
You should only take Lexapro or Zoloft if a licensed healthcare provider has prescribed you one or the other. Both drugs are approved to treat specific symptoms or conditions, and can be dangerous if taken without professional advice.
Lexapro or Zoloft may not be suitable for you if you:
- Have kidney issues: Some kidney conditions can change how safe or appropriate SSRIs like Lexapro or Zoloft are for you.
- Are aged 65 or older: Older adults may have higher risks of dangerously low blood sodium (hyponatremia) and falls. Lexapro also increases your risk of heart problems (heart arrhythmia).
- Have a bipolar family history: Youth taking Lexapro face a high risk of severe agitation, restlessness, and sudden manic behavior.
Talk to your healthcare provider for personalized advice on using SSRIs while you are trying to conceive, pregnant, breastfeeding, or postpartum. The American College of Obstetricians and Gynecologists (ACOG) supports SSRI use during pregnancy for appropriate patients, highlighting the serious risks of untreated postpartum depression.
Frequently asked questions
Is Lexapro stronger than Zoloft?
Lexapro and Zoloft are both effective medications for their prescribed uses. Some studies show that Lexapro is slightly more effective at treating depression and anxiety.
What medications are similar to Lexapro?
Other SSRIs are the medications most similar to Lexapro. These modern antidepressants are often prescribed for depression and anxiety.
The closest alternative to Lexapro is citalopram (Celexa), its parent drug. Others include sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil).
Can you take Zoloft and Lexapro together?
No, taking Lexapro and Zoloft together is dangerous and not advised. Both are SSRIs, so they raise your brain’s serotonin levels the same way. Combining them significantly amplifies this effect. This raises your risk of two serious side effects: serotonin syndrome and heart rhythm irregularities.
Your provider will carefully taper your doses if you’re switching from one to the other.
Is Zoloft better than Lexapro?
Zoloft is not necessarily better than Lexapro or vice versa—what works best for you depends on your symptoms, health status, and how you react to them. Both are highly effective antidepressants. Clinical reviews often find Lexapro slightly more effective with fewer side effects (especially GI issues). However, Zoloft may be more cost-effective.
Is Lexapro or Zoloft used to treat ADHD?
When treating patients with ADHD alongside depression or anxiety, healthcare professionals may combine ADHD stimulants with Zoloft or Lexapro. However, clinical trials show few extra benefits for adding an SSRI on top of ADHD medication. Rather than prescribe one or the other, many providers will consider a single alternative like the non-stimulant ADHD medication atomoxetine.
How long do Lexapro and Zoloft take to work?
Many people taking Lexapro or Zoloft feel early changes to their main depression and anxiety symptoms within 1 to 2 weeks. While most patients experience the full benefits within 4 to 8 weeks, it can take longer depending on your symptoms and individual response to the medication.
Brain imaging studies show this delay happens because the drugs need 3 to 5 weeks to build and strengthen new nerve connections in your brain.
Do Lexapro or Zoloft cause weight gain?
While both medications are associated with mild weight gain—with the effect being slightly more noticeable with Lexapro in adults—individual responses vary. Some people experience no weight gain or loss at all, while others lose a little weight (for a short time) while taking Zoloft.
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Note that providers on Sesame do not prescribe controlled substances.
