Lexapro vs Zoloft: Differences, Similarities and Which One Is Right For You?

By Zina Semenovskaya, MD
Medically reviewed checkmarkMedically reviewed
January 20, 2022

If you suffer from depression, anxiety, or another mental health disorder, prescription drugs may help you manage your symptoms.

Two of the most common, Lexapro (escitalopram oxalate) and Zoloft (sertraline hydrochloride), are safe, effective, and generally tolerable medications.

When taken appropriately, they can help rebalance your emotions, restore your quality of life, and improve your day-to-day functioning. 

Both Lexapro and Zoloft are brand-name medications that are a part of a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

They work by increasing your body’s levels of serotonin, a neurotransmitter that affects your mood, appetite, and sleep, among other things.

Researchers are still studying the relationship between mental health and low serotonin, but we know that, in general, when patients use an SSRI to rebalance their body’s neurochemistry, they feel happier, healthier, and more productive. 

The Food and Drug Administration (FDA) approved Zoloft for patient use in 1999 and Lexapro in 2002, and although the medications work similarly, they are not identical. 

In the roughly 20 years that they’ve been on the market, both Lexapro and Zoloft have helped millions of patients improve their lives.

If you believe you might benefit from an antidepressant, read on. In this article, I’ll explore the differences between the two prescription drugs, the conditions they treat, and how they should be taken.

I’ll explain the most common side effects and drug interactions, and whether you should see a healthcare provider to discuss whether these medications are appropriate for you.

Differences Between Lexapro and Zoloft

Lexapro and Zoloft are both SSRI antidepressants, but they are not the same medications.

They each come in different forms and dosage strengths.

Brand NameGeneric NameWhat year was it approved for patient use by the Food and Drug Administration?What form does it come in?What dosages are available?
LexaproEscitalopram oxalate2002Tablet and liquid (generic only)5mg 10mg 20mg 
ZoloftSertraline hydrochloride1999Capsule, tablet, and liquid25mg 50mg 100mg 

Conditions Treated by Both

Although the FDA has approved Lexapro and Zoloft for similar uses, they are not identical.

They treat only some of the same conditions and only certain types of patients. 

Mental Health ConditionLexaproZoloft
Binge-eating disorderOff-labelOff-label
Bulimia nervosa Off-labelOff-label
Generalized anxiety disorder (GAD)YesOff-label
Major depressive disorder (MDD) – AdultYesYes
Major depressive disorder (MDD) – Pediatric patients, age 12-17 YesNo
Obsessive-compulsive disorder (OCD) – AdultOff-labelYes
Obsessive-compulsive disorder (OCD) – Pediatric patients age 6-17NoYes
Panic disorderNoYes
Post-Traumatic stress disorder (PTSD)Off-labelYes
Premenstrual dysphoric disorder (PMDD)Off-labelYes
Social anxiety disorder (SAD)NoYes

How Should They Be Taken?

Both Lexapro and Zoloft are available by prescription. If you believe you might benefit from taking an antidepressant, begin by seeking medical advice from your healthcare provider.

If they think that Lexapro or Zoloft is the proper medication for you, they will give you a prescription that allows you to purchase your medication from a local or online pharmacy.

In most cases, doctors begin patients on a low dose of Zoloft or Lexapro and then increase the dosage strength when an individual condition calls for it.

By slowly acclimating someone to their medication, doctors can decrease the risk of serious side effects or allergic reactions. 

The recommended starting dose of Lexapro is 10mg, and the recommended starting dose for Zoloft is more variable and depends on the mental health condition treated. 

If a patient is taking Lexapro, they take the drug by mouth at the same time every day, with or without food.

If a patient takes Zoloft, they take it by mouth once a day in the morning or the evening.

If it comes in a tablet or liquid form, they can take their treatment with or without food.

If it comes as a capsule, their doctor will recommend that they take the medication with food to help improve absorption.

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Side Effects

Every individual reacts to medication differently.

Zoloft and Lexapro can cause side effects for some patients. 

Common side effectsLexaproZoloft
Agitation, nervousnessNoYes
ConstipationYesYes
DiarrheaNoYes
DizzinessYesYes
Dry mouthYesYes
Fatigue, drowsiness, sleepinessYesYes
GasYesNo
HeadacheNoYes
HeartburnYesNo
Insomnia YesYes
Loss of appetiteYesYes
Nausea, upset stomachYesYes
Ringing in the ears (tinnitus) YesNo
Sexual dysfunction (decreased libido, difficult or abnormal ejaculation, difficulty with orgasm, impotence)YesYes
Skin rashNoYes
Weight changeYesYes
YawnYesNo

In rare cases, patients who take Lexapro or Zoloft can develop serious side effects.

Call your doctor immediately or go to the ER if you are taking any SSRI medication and begin to experience: 

  • Muscle tension, tremors, or rigidity 
  • Flu-like symptoms 
  • Excessive sweating 
  • Heart palpitations or a racing heart
  • Difficulty thinking, concentrating or remembering things 
  • Vomiting 
  • Hallucinations 
  • Loss of coordination or balance
  • Fainting 
  • Seizure
  • Difficulty breathing 

Experiencing one or more of these symptoms may indicate that you suffer from serotonin syndrome, a rare but life-threatening condition that requires immediate medical attention.

While this generally happens when someone is on a higher dose of the medication, or on two similar medications, it can occur at any dose and at any time.

Drug Interactions

Both Lexapro and Zoloft can mix poorly with some substances and cause adverse effects.

Talk to your doctor about any prescription medicines, over-the-counter treatments, homeopathic remedies, or street drugs that you take before you begin taking any SSRI. 

Common medicationsPotential interaction with LexaproPotential interaction with Zoloft
Antipsychotics including flecainideSeriousModerate
Fentanyl Moderate Moderate
Lithium ModerateModerate
MeperidineSeriousSerious
Monoamine oxidase inhibitors (MAOIs) including Marplan (isocarboxazid), Nardil (phenelzine), Emsam (selegiline), and Parnate (tranylcypromine)Very SeriousVery Serious
Non-steroidal anti-inflammatory drugs (NSAIDs) including Aleve (naproxen), Aspirin (acetylsalicylic acid) and Advil (ibuprofen) ModerateModerate
PimozideVery SeriousVery Serious
Selective serotonin reuptake inhibitors (SSRIs) including Celexa (citalopram), Luvox (fluvoxamine), Paxil (paroxetine, Prozac (fluoxetine) and Viibryd (vilazodone)Very SeriousVery Serious
Serotonin and norepinephrine reuptake inhibitors (SNRIs), including Cymbalta (duloxetine), Effexor XR (venlafaxine), Fetzima (levomilnacipran), and Pristiq (desvenlafaxine)Very SeriousVery Serious
St. John’s WortSeriousSerious
TramadolSeriousVery Serious
Tricyclic Antidepressants including Elavil (amitriptyline), Norpramin (desipramine), Sinequan (doxepine), Tofranil (imipramine), Pamelor (nortriptyline), Anafranil (amoxapine, clomipramine), Ludiomil (maprotiline), Surmontil (trimipramine) and Vivactil (protriptyline).Very SeriousVery Serious
Triptans including Imitrex (sumatriptan), Maxalt (rizatriptan), Amerge (naratriptan), Zomoig (zolmitriptan), Relplax (eletriptan), Axert (almotriptan), and Frova (frovatriptan)SeriousSerious
TryptophanVery SeriousVery Serious
Blood thinners, including warfarin and aspirinSeriousSerious

Cost and Insurance Information 

The cost of Lexapro and Zoloft can vary depending on the prescribed dosage, formulation (tablet vs capsule), a patient’s insurance coverage, and pharmacy.

If you are concerned about the price of your prescription, talk to your healthcare provider about whether a generic medication would be more appropriate for you.

Generic forms of brand-name medications contain the same active ingredients and offer identical benefits to patients.

The only difference between them and their brand-name counterparts is that they tend to cost significantly less. 

A generic version of Lexapro is available, which is called escitalopram.

The generic version of Zoloft is called sertraline, and it is available in tablet and liquid forms.

Another way to keep drug costs low is to research and compare local and online pharmacy prices.

You can now order many of your medications online and get them sent directly to your door for less than it costs to purchase them through your neighborhood pharmacy.

Warnings of Lexapro and Zoloft

Research suggests that certain selective serotonin reuptake inhibitors (SSRI) medications may adversely affect healthy fetal development.

If you are pregnant or breastfeeding, talk to your doctor about the costs and benefits of taking Lexapro, Zoloft, or another SSRI, and whether these drugs are right for you. 

Lexapro, Zoloft, and other SSRIs are linked to increased suicidal thoughts and behavior among some pediatric patients.

If you or someone you know is at risk of harming themselves or others, call 9-1-1 or go to the nearest emergency room immediately. 

Withdrawal Symptoms

If you are taking either Lexapro or Zoloft, do not stop taking your medication without speaking to a doctor first.

If you stop taking your pills abruptly, you may experience withdrawal. Common symptoms include fatigue, nausea, muscle aches, agitation, irritation, anxiety, hallucinations, insomnia or vivid dreams, sweating, and blurry vision.

Withdrawal symptoms are reversible and usually last between 1-2 weeks, but you can avoid them entirely by not stopping the medication suddenly, and instead talking to your healthcare provider about how to taper off your medication over time. 

When To Seek Medical Attention

If you are suffering from depression, anxiety, or other mental health symptoms that are intrusive, intense, affect your quality of life, or have lasted more than two weeks, talk to a doctor about your experience and discuss whether an antidepressant like Zoloft, Lexapro, or something else might be right for you. 

Which One Is Better? 

Both Lexapro and Zoloft have been used for decades to help millions of Americans.

They are both considered effective, safe, tolerable first-line medications for the mental health conditions they are approved to treat.

If you believe you could benefit from an antidepressant, talk to your doctor about your experience and whether one of these medications might be right for you. 

When To Talk To A Doctor

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Nearly 20% of adults in the US suffer from mental health illness, and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.

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Frequently Asked Questions

Is Lexapro or Zoloft better for OCD?
Some healthcare professionals will prescribe Lexapro “off-label” to treat OCD in adult patients, but only Zoloft is FDA-approved to treat adult and pediatric patients with the condition.
Do Lexapro and Zoloft cause weight gain?
Both Lexapro and Zoloft are associated with appetite and weight-related side effects, but every patient is different. Some gain weight while taking antidepressants, some lose weight, and some do not experience changes to their weight at all.
Does Lexapro or Zoloft treat anxiety?
Both Lexapro and Zoloft are FDA-approved to treat specific anxiety disorders. Lexapro is approved to treat generalized anxiety disorder (GAD). Some doctors also prescribe it “off-label” to treat related conditions such as post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). Zoloft is FDA-approved to treat panic disorder, social anxiety disorder (SAD), PTSD, and OCD in adult and pediatric patients over six. Doctors will also prescribe it “off-label” to treat GAD when an individual’s condition calls for it. Zoloft is also the only SSRI that is considered relatively safe in pregnant and breastfeeding women.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Zina Semenovskaya, MD

Dr. Semenovskaya specializes in emergency medicine, and received her medical degree from Weill Cornell Medical College. She is currently the medical director at Remote Emergency Medicine Consulting, LLC and splits her time working clinically as an emergency medicine attending in California and Alaska. She is the first of our doctors to be fluent in Russian.