From the Research
A recommended cross-tapering regimen from Zoloft (sertraline) 75mg to Lexapro (escitalopram) typically involves gradually decreasing the Zoloft while simultaneously introducing and increasing the Lexapro over 2-4 weeks. Start by reducing Zoloft to 50mg daily while beginning Lexapro at 5mg daily for one week. Then decrease Zoloft to 25mg daily while increasing Lexapro to 10mg daily for another week. Finally, discontinue Zoloft completely while maintaining Lexapro at 10mg daily (the typical therapeutic dose) 1. This gradual approach helps minimize discontinuation symptoms from Zoloft while allowing the body to adjust to Lexapro. The cross-tapering method is preferred because it maintains consistent serotonergic activity in the brain during the transition. Patients should monitor for side effects like increased anxiety, headaches, or sleep disturbances during this period. It's essential to note that this regimen should be personalized by a healthcare provider based on individual factors such as sensitivity to medication changes, history of discontinuation symptoms, and specific mental health needs 2, 3. Morning administration of Lexapro is typically recommended as it may be less likely to cause sleep disturbances than evening dosing. The most recent and highest quality study on antidepressant switching patterns in the elderly suggests that almost half of the switches were not implemented according to guideline recommendations, highlighting the need for careful consideration and personalized approach in cross-tapering regimens 3. Additionally, a study on bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression found that any one of the medications in the study provided a reasonable second-step choice for patients with depression, supporting the idea that cross-tapering to Lexapro can be an effective strategy 4. However, the optimal dose of sertraline, which is 50 mg daily, should be considered when initiating the cross-tapering regimen, as it is the usually effective therapeutic dose and the optimal dose when considering both efficacy and tolerability for most patients 5.