Lexapro vs. Zoloft: Differences, similarities, and which is better for you

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Side effects
• Drug interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Side effects
• Drug interactions
• Warnings
• FAQs

Lexapro (escitalopram) and Zoloft (sertraline) are SSRIs (selective serotonin reuptake inhibitors) indicated for the treatment of depression and other psychological conditions. An SSRI works by increasing serotonin levels in the brain, which helps improve symptoms. Both prescription drugs are approved by the Food and Drug Administration (FDA). Other drugs in the SSRI class of medications are  Prozac (fluoxetine), Celexa (citalopram), and Paxil (paroxetine). Although Lexapro and Zoloft are similar, they have notable differences in their indications and cost. 

RELATED: About Lexapro | About Zoloft | About Prozac | About Celexa | About Paxil

What are the main differences between Lexapro vs. Zoloft?

The two drugs have more similarities than differences. Distinctions between Lexapro and Zoloft show up mostly in their official Food and Drug Administration (FDA) indications and price. In addition, you will notice that Zoloft has a wider dosing range, which permits more dose titration options when determining how much medication is needed.

	Lexapro	Zoloft
Drug class	Selective serotonin reuptake inhibitor (SSRI)	Selective serotonin reuptake inhibitor (SSRI)
Brand/generic status	Brand and generic	Brand and generic
What is the generic name?	Escitalopram oxalate	Sertraline hydrochloride
What form(s) does the drug come in?	Tablet and liquid	Tablet and liquid
What is the standard dosage?	Adults: 10 mg daily; maximum 20 mg per day (maximum 10 mg per day in older adults) Children: 10 mg daily; maximum 20 mg per day  Taper gradually when discontinuing	Adults: 50-200 mg daily; maximum 200 mg per day Children: 25-50 mg daily; maximum 200 mg per day Taper gradually when discontinuing
How long is the typical treatment?	6 months to 1 year; many patients continue for years	6 months to 1 year; many patients continue for years
Who typically uses the medication?	Ages 7 to adult, depending on indication; sometimes prescribed off-label for younger children	Ages 6 to adult, depending on indication; sometimes prescribed off-label for younger children

Conditions treated by Lexapro and Zoloft

Lexapro is an SSRI indicated for acute and maintenance treatment of major depressive disorder (MDD) in adolescents aged 12-17 years and adults, and acute treatment of generalized anxiety disorder (GAD) in children 7 years and older as well as adults. The drug is also used off-label for other mental health conditions.

Zoloft is an SSRI indicated for the treatment of major depressive disorder (MDD), panic disorder (PD),  post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD) in adults and obsessive-compulsive disorder (OCD) in children 6 years and older as well as adults. Additional off-label use occurs.

Conditions treated with an FDA indication by Lexapro and Zoloft
Condition	Lexapro	Zoloft
Major Depressive Disorder (MDD)	Yes	Yes
Generalized Anxiety Disorder (GAD)	Yes	No
Obsessive-compulsive disorder (OCD)	No	Yes
Panic disorder (PD)	No	Yes
Post-traumatic stress disorder (PTSD)	No	Yes
Social anxiety disorder (SAD)	No	Yes
Premenstrual dysphoric disorder (PMDD)	No	Yes

Is Lexapro or Zoloft more effective?

Lexapro was shown in clinical studies to be significantly more effective than placebo in treating Major Depressive Disorder and Generalized Anxiety Disorder.

Zoloft was shown in clinical studies to be significantly more effective than placebo in treating major depressive disorder, panic disorder, PTSD, OCD, SAD, and PMDD. 

A 2014 study published in International Clinical Psychopharmacology suggested that Lexapro may be more effective and better tolerated than Zoloft or Paxil. Lexapro has different binding site interactions, which may lead to better efficacy and tolerability. However, another study found that Zoloft led to outcomes that were at least as good as or better than patients using Lexapro or Celexa in terms of adherence, drug costs, and medical spending. 

The most effective medication, though, should only be determined by your healthcare provider, taking into account your medical condition(s), medical history, and other medications you are taking.

Coverage and cost comparison of Lexapro vs. Zoloft

Lexapro is typically covered by both insurance and Medicare Part D. The generic will have a much lower copay compared to the brand name, which may not be covered at all. Lexapro is available in 5, 10, or 20 mg tablets (brand or generic) and as a liquid in 5 mg/5 ml oral solution (generic). Lexapro costs about $552 for 30 tablets of 10 mg brand name tablets, but with a SingleCare card, you can expect to pay $7 to $27 for generic escitalopram depending on your pharmacy. 

Zoloft is typically covered by both insurance and Medicare Part D. The copay for generic will be much lower than for the brand, which may not be covered at all. Zoloft is available in 25, 50, or 100 mg tablets (brand or generic) and as a liquid in 20 mg/ml oral solution (brand or generic). Zoloft costs about $514 for 30 tablets of 50 mg brand name tablets, but with a SingleCare card, you can expect to pay $6 to $16 for generic sertraline. 

Lexapro vs. Zoloft costs and coverage
	Lexapro	Zoloft
Typically covered by insurance?	Yes (generic; brand may have a high copay or may not be covered)	Yes (generic; brand may have a high copay or may not be covered)
Typically covered by Medicare Part D?	Yes (generic; brand may have a high copay or may not be covered)	Yes (generic; brand may have a high copay or may not be covered)
Standard dosage	5, 10, or 20 mg tablets (brand or generic), 5 mg/5 ml oral solution (generic)	25, 50, or 100 mg tablets (brand or generic), 20 mg/ml oral solution (brand or generic)
SingleCare cost	$7-27 (generic)	$6-16 (generic)

Common side effects of Lexapro and Zoloft

Both drugs have a long list of serious warnings, which are included in the warning section below. Additionally, you may experience other, more common adverse effects from Lexapro or Zoloft. 

The most common adverse reactions of Lexapro are headache, upset stomach/nausea, sexual dysfunction/ejaculatory delay, insomnia, fatigue, and sleepiness. 

The most common adverse reactions from Zoloft are nausea, diarrhea, sexual dysfunction/ejaculatory delay, dry mouth, insomnia, and sleepiness.

The most common side effects of both drugs include the following:

• Headache
• Nausea
• Diarrhea
• Sexual dysfunction
• Ejaculatory disorder
• Dry mouth
• Sleepiness
• Insomnia

Potential side effects vary; this is a partial list. A medication guide will be given to you with a new or refilled prescription of Lexapro or Zoloft with information about side effects and other warnings. Consult your healthcare professional for a complete list of side effects.

Drug Interactions of Lexapro vs. Zoloft

Because both drugs are in the same category, they have similar drug interactions.

MAO inhibitors such as selegiline should not be used within 14 days of Lexapro or Zoloft; the combination may increase the risk of serotonin syndrome, a life-threatening medical emergency due to a buildup of serotonin. 

Triptans used to treat migraines, such as Imitrex (sumatriptan), as well as other antidepressants, such as Elavil or Cymbalta, require caution or should not be used in combination with Lexapro or Zoloft due to the risk of serotonin syndrome.

Other drugs that may interact with Lexapro or Zoloft include macrolide antibiotics such as Zithromax, NSAIDs (non-steroidal anti-inflammatory drugs) such as Mobic, or painkillers such as Ultram.

Alcohol should not be used with Lexapro or Zoloft. 

Lexapro vs. Zoloft drug interactions
Drug	Drug Class	Lexapro	Zoloft
Selegiline, Parnate (tranylcypromine)	MAOIs (Monoamine oxidase inhibitors)	Yes	Yes
Alcohol	Alcohol	Yes	Yes
Imitrex (sumatriptan), etc	Triptans	Yes	Yes
Jantoven (warfarin)	Anticoagulants	Yes	Yes
St. John’s Wort	Supplement	Yes	Yes
Ultram (tramadol)	Painkiller	Yes	Yes
Zithromax (azithromycin), Biaxin (clarithromycin), erythromycin	Macrolide antibiotics	Yes	Yes
Motrin (ibuprofen), Naprosyn (naproxen), Meloxicam	NSAIDs	Yes	Yes
Effexor (venlafaxine), Cymbalta (duloxetine), Pristiq (desvenlafaxine)	SNRIs	Yes	Yes
Amitriptyline, Pamelor (nortriptyline)	TCA (tricyclic antidepressant)	Yes	Yes

This is not a complete list of drug interactions. Consult your healthcare provider for medical advice. 

Warnings of Lexapro and Zoloft

Like most antidepressants, both Lexapro and Zoloft come with an FDA black box warning for antidepressants and suicidality. Children to young adults taking antidepressants have an increased risk of suicidal thoughts and behavior. All patients on antidepressants should be carefully monitored.

Other warnings with both drugs include:

• Serotonin syndrome: A life-threatening medical emergency caused by the buildup of too much serotonin. Patients should be carefully monitored for symptoms including hallucinations, seizures, and agitation. 
• Discontinuation: When discontinuing one of these medications, patients should taper off the drug very slowly to avoid withdrawal symptoms.
• Seizures: In patients who have seizures, Lexapro or Zoloft should be used only with caution.
• Hyponatremia: Low sodium concentrations in the blood can occur, leading to headaches, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness.
• Angle-Closure Glaucoma: SSRIs should be avoided in patients with untreated anatomically narrow angles.
• Bleeding: SSRIs may increase bleeding risk, particularly with concomitant use of aspirin, NSAIDs, or warfarin.
• Activation of mania or hypomania: In patients with bipolar disorder, an antidepressant may precipitate a mixed/manic episode.

Lexapro or Zoloft should only be used in pregnancy and breastfeeding if the benefit to the mother is greater than the risk to the baby, and this must be evaluated on a case-by-case basis. Stopping the medication may cause a relapse of depression or anxiety. If you are already on Lexapro or Zoloft and find out you are pregnant, contact your healthcare provider immediately. In breastfeeding mothers, the baby should be evaluated for any adverse reactions. 

Zoloft oral solution contains 12% alcohol and should not be used while pregnant or breastfeeding because of the alcohol content. 

Frequently asked questions about Lexapro vs. Zoloft

Which is better, Lexapro or Zoloft?

Lexapro and Zoloft are SSRI medications, but their indications vary (see above). Because they are in the same category, they have many of the same drug interactions and side effects. 

Can I use Lexapro vs. Zoloft while pregnant?

It depends. Consult your healthcare provider for advice. Your healthcare provider will weigh the benefits of taking an antidepressant versus the risk to the baby. Some doctors will prescribe a low dose of antidepressant while pregnant. If you are already on Lexapro or Zoloft and find out that you are pregnant, consult your OB/GYN immediately for advice. If you are breastfeeding, consult your OB/GYN as well. 

Can I use Lexapro vs. Zoloft with alcohol?

No. Combining antidepressants with alcohol can worsen symptoms of depression or anxiety, impair your thinking and alertness, and increase sedation and drowsiness.

Which is the best SSRI for anxiety?

SSRIs can be very useful in treating anxiety, but it is best to consult with your healthcare provider about which one is best for you, taking into account your medical history, medical condition(s), and other medications you are taking. 

Does Lexapro or Zoloft cause more weight gain?

Fortunately, neither Lexapro or Zoloft has a common side effect of significant weight gain. Weight should be monitored on either medication.