Lexapro vs. Zoloft: Understanding the Differences

Lexapro vs. Zoloft: Understanding the Differences

Authored by Monique Deluge, / Medically Reviewed by Dr. Conor Sheehy, PharmD, BCPS
Last Updated: November 8, 2023


Trying to figure out if Lexapro or Zoloft is right for you? Coping with everyday stressors is hard for all of us, but some people’s ability to cope is impacted so greatly that they require professional help. According to the World Health Organization, about 280 million people around the world have been diagnosed with depression this year. Mental health conditions are a serious issue in 2023! Pharmaceutical companies are stepping up their game to develop prescription drugs that can help. Selective serotonin reuptake inhibitors (SSRIs) are one of the most commonly prescribed antidepressants on the market. They have been proven to lessen the symptoms of anxiety and depression and have a lower risk of serious adverse effects than other antidepressants. Lexapro and Zoloft are two examples of commonly used SSRIs. Unsure which is better for you? This article offers a comprehensive comparison of Lexapro and Zoloft.

The effectiveness of Lexapro vs. Zoloft

Are Lexapro and Zoloft the same?

Lexapro and Zoloft work in similar ways to relieve symptoms of mood disorders, but they are not the same. Both are FDA-approved SSRIs. Zoloft was approved in 1991, and Lexapro followed a few years later in 2002.

Escitalopram, sold under the brand names Lexapro and Cipralex, is mainly prescribed in the US for the treatment of major depressive disorder (MDD) in adults and teenagers aged 12–17 and for generalized anxiety disorder (GAD) in adults. In other countries, such as those in Europe, Lexapro is used to treat obsessive compulsive disorder (OCD), social anxiety disorder (SAD), and panic disorder in addition to MDD and GAD.

Zoloft, also known by the generic name sertraline, is effective in treating people with SAD, MDD, and GAD. Those with OCD have also shown significant improvement when using Zoloft in combination with cognitive behavioral therapy. Though also FDA approved for use in women with post-traumatic stress disorder (PTSD), Zoloft has only shown mild to moderate success in such treatment. It also relieves symptoms in young women experiencing premenstrual dysphoric disorder (PMDD).

Which is more effective, Lexapro or Zoloft?

Lexapro and Zoloft are similarly effective, though it is important to bear in mind that everyone responds to drugs differently. A recent analysis of 12 new-generation antidepressants showed that Lexapro and Zoloft are most effective in treating adults during the initial phases of mental health conditions. Compared with other antidepressants, these drugs offer users greater overall improvement in quality of life. Lexapro is the safest antidepressant to prescribe for children and adolescents, while Zoloft is generally better tolerated than other tricyclic antidepressants (TCAs). It may also be better than Prozac at treating depression during the acute phase (i.e., the first four weeks).

Lexapro vs. Zoloft – Cost, dosage, and methods of use

Which is cheaper, Lexapro or Zoloft?

Between Lexapro and Zoloft, the high costs are comparable to each other. Without insurance coverage or other forms of financial assistance, many find this cost crippling. These prices vary depending on factors such as your prescribed dosage, your location, the pharmacy’s location, and whether your health insurance covers prescription medication. These variables often make it challenging to afford prescription drugs.

The Rx Advocates can help you manage medication expenses by helping you apply for a patient assistant program.

Lexapro and Zoloft dosage and usage tips

Lexapro and Zoloft dosage is decided by the prescribing doctor and depends on the condition being treated, associated symptoms, and whether the patient has other chronic diseases.


  • Typically taken once a day in the morning or evening
  • Dosage ranges from 10 to 20 mg
  • Maximum daily dose is 20 mg


  • Because insomnia is a common symptom, it is best to take in the morning
  • For MDD, dosage starts at 25 mg and can be increased to as much as 200 mg
  • For other mental health conditions, 25 to 50 mg is typically prescribed, but dosage may be increased to 200 mg for severe cases

Drug interactions of Lexapro and Zoloft

Some drug interactions influence how Lexapro and Zoloft work or can increase the risk of developing adverse effects. You should be aware of the following drugs that interact with Lexapro and Zoloft:

Most notably, avoid taking MAO inhibitors while using Lexapro and Zoloft, as this interaction can cause a potentially life-threatening condition known as serotonin syndrome. MAO inhibitors must be stopped at least two weeks before starting treatment with SSRIs.

Tell your doctor if you are taking any of the following MAO inhibitors:

  • Isocarboxazid
  • Linezolid
  • Metaxalone
  • Methylene blue
  • Moclobemide
  • Phenelzine
  • Procarbazine
  • Rasagiline
  • Safinamide
  • Selegiline
  • Tranylcypromine

Also, be honest and tell your doctor if you take any stimulant drugs, opioids, herbal supplements, or other antidepressants, as these drugs too can interact with Lexapro and Zoloft to cause serotonin syndrome.

Alternatives to Lexapro and Zoloft

For people unable to cope with the adverse effects, there are alternatives to Lexapro and Zoloft:

Warnings and precautions of Lexapro and Zoloft

Every drug has side effects and risks. Talk to your doctor before starting any new treatment. You should also do your own research using credible sources. Here are a few warnings and precautions of Lexapro and Zoloft you should know:

  • Some people experience increased suicidal tendencies when starting Lexapro and Zoloft. Frequent consultations with your doctor are necessary to check your progress, and your loved ones should provide greater support during this phase.
  • Some SSRIs can trigger manic or hypomanic episodes in people with bipolar disorder.
  • Lexapro and Zoloft increase the risk of bleeding, which is why they should not be used in combination with NSAIDs or anticoagulants.

To ensure Lexapro and Zoloft are safe for your use, tell your doctor if you have ever experienced any of the following:

  • Liver or kidney problems
  • Serious allergic reactions to other SSRIs
  • Severe suicidal thoughts or behavior 
  • Heart disease
  • Vision problems, especially glaucoma
  • Sexual dysfunction
  • Recurrent seizures
  • Stroke
  • Uncontrolled high blood pressure
  • Bleeding disorders

Lexapro vs. Zoloft withdrawal symptoms

Abruptly stopping an SSRI can cause withdrawal symptoms. You should never stop taking these drugs without guidance from your healthcare provider. To minimize these symptoms, a gradual reduction in dosage is usually recommended over several weeks or months until the medication is no longer needed. The following are some common withdrawal symptoms of Lexapro and Zoloft:

  • Flu-like symptoms, such as headache, malaise, and fatigue
  • Nausea, vomiting, diarrhea, or abdominal discomfort
  • Electric shock sensations through your head (called “brain zaps”)
  • Insomnia, vivid dreams, or changes in sleep patterns
  • Irritability, mood swings, or sudden anxiety
  • Vertigo, dizziness, or lightheadedness
  • Emotional outbursts, crying spells, or emotional instability
  • Sudden changes in energy levels ranging from lethargy to extreme excitement or restlessness
  • Memory issues or difficulty concentrating

Withdrawal symptoms may last from a few days to weeks and vary in intensity. The severity of symptoms is based on an individual’s response to the medication, mental health conditions, duration of use, and rate of drug tapering.

Comparing the adverse effects of Lexapro and Zoloft

Common adverse effects of Lexapro and Zoloft

Common adverse effects are generally described as mild and tend to resolve as a user becomes accustomed to the medication. Because Lexapro and Zoloft are both SSRIs, they share many common adverse effects:

  • Nausea
  • Loss of appetite, sometimes leading to weight loss
  • Indigestion
  • Changes in sleep patterns
  • Fatigue
  • Headache
  • Dry mouth
  • Excessive sweating
  • Tremors
  • Diarrhea
  • Constipation
  • Sexual dysfunction

As Lexapro has a shorter half-life than Zoloft, its users often note adverse effects earlier than do Zoloft users. In addition, while Lexapro is often reported to have an energizing effect, Zoloft tends to have a calming, relaxing effect. Zoloft is also more likely than Lexapro to cause difficulty sleeping and gastrointestinal problems, such as nausea.

Serious adverse effects of Lexapro and Zoloft

Although Lexapro and Zoloft are often well tolerated, they can cause serious adverse effects:

  • Increased incidence of suicidal thought and actions
  • Allergic reactions
  • Abnormal bleeding
  • Seizures
  • Manic episodes

Especially important to note is serotonin syndrome, a rare but life-threatening condition caused by high levels of serotonin in the brain. This is an emergency, so you should seek immediate medical attention if you notice the following symptoms:

  • Agitation
  • Hallucinations
  • Rapid heartbeat
  • Fever
  • Muscle stiffness
  • Lack of coordination

Lexapro and Zoloft: How to cope with adverse sexual effects

Some people object to taking Lexapro and Zoloft due to the problems they cause in the bedroom, including decreased libido and difficulty reaching orgasm in both males and females. Understanding how these medications affect your sex life can help you and your partner cope.

Why do Lexapro and Zoloft cause adverse sexual effects?

Remember, Lexapro and Zoloft are SSRIs that work by increasing the levels of serotonin in the brain, causing users to feel a sense of calm and happiness. On the flip side, however, this sense of calm can decrease sex drive. Our bodies generate a sexual response following the release of certain chemicals, such as dopamine. Serotonin works against these, knocking you out of the mood for sex.

Adverse sexual effects of Lexapro and Zoloft in women

For women, common sexual effects of Lexapro and Zoloft include:

  • Delayed lubrication
  • Inability to reach orgasm
  • Lack of desire
  • Irritability
  • Discomfort during sex

Adverse sexual effects of Lexapro and Zoloft in men

For men, common sexual effects of Lexapro and Zoloft include:

  • Decreased libido
  • Difficulty getting and maintaining an erection
  • Delayed or blocked orgasm
  • Decreased sperm count

Lexapro and Zoloft: What can I do to manage adverse sexual effects?

Many users of Lexapro and Zoloft are frustrated with the sexual effects associated with the drugs. Here are a few tips for managing these effects that you can discuss with your doctor:

  • Adjust to a lower dose
  • Take the medication after the time you usually have sex
  • Practice patience, as sexual side effects usually present in the initial phase of treatment and may resolve
  • Talk to your partner about the effects of the antidepressants, as emotional comfort and support can help boost libido

Receive monthly Lexapro and Zoloft discounts with The Rx Advocates

If you’re experiencing mental health problems, Lexapro or Zoloft might help you regain some control over your life. At The Rx Advocates, we firmly believe that no one should face the difficult choice between purchasing essential medicines and managing their everyday expenses. This is why we want to help you gain access to a patient assistance program that offers substantial savings. We understand that the process of applying for these programs is confusing and stressful, which is why we are here to simplify it for you.

We even go the extra mile to offer the convenience of home deliveries. No more trips to the pharmacy! We arrange for your medications to be delivered right to your doorstep every month. Plus, there’s no extra cost for handling refills.

If you’re curious about how The Rx Advocates can help you save more each month by making brand-name medications more affordable, talk to our representatives today. Contact us to determine your eligibility for patient assistance programs. Your mental health matters, and we’re committed to helping you regain control over your health care and your life.

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