Switching from 150mg Zoloft (Sertraline) to Lexapro (Escitalopram)
Use a cross-tapering approach over 2-3 weeks: start escitalopram 10 mg daily while simultaneously reducing sertraline from 150 mg to 75 mg for one week, then discontinue sertraline while continuing escitalopram. 1
Cross-Taper Schedule
Week 1:
- Start escitalopram 10 mg once daily 2
- Reduce sertraline from 150 mg to 75 mg daily 1
- Monitor closely for withdrawal symptoms and serotonin syndrome 3
Week 2:
- Continue escitalopram 10 mg daily 2
- Discontinue sertraline completely 1
- This gradual reduction over 10-14 days limits withdrawal symptoms 3
Week 3 and beyond:
- Maintain escitalopram 10 mg daily for at least 3 weeks before considering dose adjustment 2
- If needed, increase to 20 mg after a minimum of one week at 10 mg 2
Critical Monitoring During Transition
Serotonin syndrome risk is highest in the first 24-48 hours after starting escitalopram while still on sertraline. 3 Watch for:
- Tremor, neuromuscular rigidity, hyperreflexia 1
- Agitation, confusion, mental status changes 1
- Tachycardia, hyperthermia, diaphoresis 1
Sertraline discontinuation syndrome (though less severe than paroxetine) may include: 3
- Dizziness, vertigo, sensory disturbances 3
- Irritability, anxiety, headache 3
- Nausea, fatigue, insomnia 3
Why This Approach
Sertraline has been associated with discontinuation syndrome, making abrupt cessation problematic 3. The cross-taper minimizes the risk of withdrawal while maintaining antidepressant coverage 1, 4. Escitalopram has the least effect on CYP450 enzymes compared to other SSRIs, reducing drug interaction concerns during the overlap period 3.
Common Pitfalls to Avoid
Do not abruptly stop sertraline at 150 mg - this high dose requires gradual reduction 3, 4. Conservative switching with complete washout periods can leave patients untreated and risk depressive relapse 4, making cross-tapering preferable.
Do not increase escitalopram dose during the first 3 weeks unless absolutely necessary, as initial SSRI side effects can include anxiety and agitation 3. The 10 mg dose is effective for most patients 2, 5.
If intolerable symptoms occur, resume the previous sertraline dose and taper more gradually 2.