From the Guidelines
Sertraline is generally preferred over Lexapro for the treatment of PTSD due to its FDA approval and strong recommendation in the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. According to the guideline, sertraline, paroxetine, or venlafaxine are recommended for PTSD treatment, with a strong recommendation for use of specific manualized psychotherapies over pharmacotherapy 1. The guideline also recommends against use of benzodiazepines, cannabis, or cannabis-derived products.
Some key points to consider when using sertraline for PTSD treatment include:
- Starting dose: 25-50mg daily, gradually increased to an effective dose of 50-200mg daily as needed
- Treatment duration: at least 6-12 months after symptom improvement
- Common side effects: nausea, headache, insomnia, and sexual dysfunction, which often improve over time
- Importance of consistent dosing and gradual tapering to avoid withdrawal symptoms
It's also important to note that psychotherapy, particularly trauma-focused cognitive behavioral therapy, is recommended alongside medication for optimal PTSD treatment 1. Lexapro, while not FDA-approved for PTSD, may be used at 10-20mg daily if sertraline is not tolerated. However, the most recent and highest quality evidence supports the use of sertraline as a first-line treatment for PTSD 1.
From the Research
Comparison of Sertraline and Lexapro in PTSD Treatment
- There is no direct comparison between sertraline and Lexapro in the provided studies, as Lexapro (escitalopram) is not mentioned in the context of PTSD treatment in the given evidence.
- However, the studies suggest that sertraline is an effective treatment for PTSD, with proven efficacy and a favorable tolerability profile 2, 3, 4, 5.
- Sertraline is one of the best-evidenced drugs for PTSD treatment, along with fluoxetine, paroxetine, and venlafaxine 4.
- The studies also suggest that trauma-focused psychological interventions are the first-line treatment for PTSD, with medications such as sertraline and venlafaxine considered as second-line treatments 6.
- Paroxetine, another SSRI, is also FDA-approved for PTSD treatment and has shown similar efficacy to sertraline in some studies 5.
- It is essential to note that the response to treatment with SSRIs, including sertraline, can vary depending on individual factors such as symptom severity, childhood trauma, and index trauma 5.