From the Guidelines
Sertraline (Zoloft) is the preferred choice over Escitalopram (Lexapro) for depression and anxiety, particularly in patients with cardiovascular disease, due to its lower risk of QTc prolongation and extensive study in this population. When considering treatment for depression and anxiety, it's essential to weigh the benefits and risks of each medication.
- Sertraline is often prescribed at starting doses of 25-50mg daily, gradually increasing to 50-200mg if needed, and works well for both depression and various anxiety disorders 1.
- Escitalopram typically starts at 10mg daily (5mg for elderly patients) and may increase to 20mg, and is known for having fewer side effects and drug interactions than some alternatives, but may have a higher risk of QTc prolongation compared to sertraline 1.
- The choice between these medications should be made in consultation with a healthcare provider, considering the patient's specific symptoms, medical history, and potential drug interactions.
- Treatment typically continues for at least 6-12 months after symptom improvement, and these medications take 4-6 weeks to reach full effectiveness 1.
- Side effect profiles differ: Sertraline commonly causes gastrointestinal issues and sexual dysfunction, while Escitalopram tends to have milder side effects but can still cause sexual problems 1.
- It's crucial to note that never stopping these medications abruptly can lead to withdrawal symptoms, and patients should be closely monitored by their healthcare provider 1.
From the Research
Comparison of Sertraline and Escitalopram
- Both sertraline and escitalopram are selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety disorders 2, 3.
- Studies have shown that escitalopram is effective in treating anxiety disorders, including panic disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder 3.
- Sertraline has been shown to be effective in reducing anxiety symptoms, improving mental health-related quality of life, and self-reported improvements in mental health 4.
- A review of escitalopram's efficacy and safety in major depressive disorder found that it was superior to placebo and nearly equal or superior to other SSRIs, including sertraline 5.
- Escitalopram has been shown to have a favorable tolerability profile, with associated adverse events generally being mild and temporary 5.
- Sertraline has been found to be well-tolerated, with a low risk of lethality in overdose and no dependence potential 2.
Efficacy in Depression and Anxiety
- A network meta-analysis found that escitalopram was one of the most effective antidepressants for the treatment of depression, and was also well-tolerated 6.
- Sertraline was found to be effective in reducing depressive symptoms, but the evidence was not as strong as for escitalopram 4.
- Escitalopram has been shown to be effective in treating anxiety disorders, including panic disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder 3.
- Sertraline has been shown to be effective in reducing anxiety symptoms, but the evidence was not as strong as for escitalopram 4.
Patient Acceptability
- Escitalopram has been found to have high patient acceptability, with a meta-analysis and pooled analysis showing that it was more favorable than other new antidepressants 5.
- Sertraline has been found to be well-tolerated, but the evidence on patient acceptability was not as strong as for escitalopram 2.