Is sertraline (Zoloft) or escitalopram (Lexapro) more effective for anxiety?

From the Guidelines

Lexapro (escitalopram) is likely a better choice than Zoloft (sertraline) for treating anxiety, due to its potentially faster onset of action and more favorable side effect profile, as suggested by recent studies 1. When considering the treatment of anxiety, both medications are effective, but the choice between them depends on various factors, including the patient's specific symptoms, medical history, and potential drug interactions.

• Lexapro typically starts at 10mg daily and can be increased to 20mg if needed, while Zoloft usually begins at 25-50mg daily and can be titrated up to 200mg.
• A recent study published in 2023 1 found that escitalopram showed a statistically significant difference in change in LSAS-J total scores between the placebo and 20-mg escitalopram groups, although the primary endpoint did not show a statistically significant difference between the 10-mg escitalopram and placebo groups.
• Another study from 2020 1 discussed the mechanism of action of SSRIs, including escitalopram and sertraline, and how they increase the availability of serotonin at the synaptic cleft, leading to a downregulation of inhibitory serotonin autoreceptors and eventually heightening the serotonergic neuronal firing rate.
• The choice of a specific SSRI, such as escitalopram or sertraline, is governed by considerations such as pharmacokinetics, pharmacodynamics, and potential side effects, as well as individual patient factors 1.
• Common side effects for both medications include initial nausea, headache, and sexual dysfunction, which often improve over time.
• It is essential to consider the individual patient's response to the medication, as some patients may respond better to Zoloft, especially those with multiple anxiety disorders or comorbid conditions like OCD.

From the Research

Comparison of Sertraline and Escitalopram for Anxiety

• The efficacy of sertraline (Zoloft) and escitalopram (Lexapro) for anxiety disorders has been studied in various research papers 2, 3, 4, 5, 6.
• A study published in 2006 discussed the role of serotonergic agents, such as selective serotonin reuptake inhibitors (SSRIs), including sertraline, in the treatment of anxiety disorders 2.
• Another study published in 2019 found that SSRIs, including sertraline, and serotonin-norepinephrine reuptake inhibitors (SNRIs) are effective in treating anxiety disorders, with no significant differences in efficacy between the two classes of medications 3.
• A network meta-analysis published in 2019 compared the efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults, and found that escitalopram showed better efficacy than other drugs, including sertraline 5.
• A qualitative review published in 2004 discussed the possible role of venlafaxine, an SNRI, in the treatment of anxiety disorders, and found that it was as efficacious as SSRIs, including sertraline, in treating anxiety 6.

Efficacy of Sertraline and Escitalopram

• The study published in 2019 found that higher doses of SSRIs, including sertraline, were associated with significantly greater symptom improvement and likelihood of treatment response, but also with an increased likelihood of dropout due to side effects 3.
• The network meta-analysis published in 2019 found that escitalopram showed better efficacy than sertraline in the treatment of generalized anxiety disorder 5.
• The study published in 2006 discussed the potential advantages of dual-reuptake inhibitors, such as SNRIs, over selective reuptake inhibitors, such as SSRIs, in the treatment of anxiety disorders 2.

Acceptability of Sertraline and Escitalopram

• The study published in 2019 found that higher doses of SSRIs, including sertraline, were associated with an increased likelihood of dropout due to side effects 3.
• The network meta-analysis published in 2019 found that escitalopram showed better acceptability than sertraline in the treatment of generalized anxiety disorder 5.
• The qualitative review published in 2004 found that venlafaxine, an SNRI, had comparable tolerability to SSRIs, including sertraline, in the treatment of anxiety disorders 6.