by Nicole Evans M.D.

Created on: March 27, 2010   Last Updated: March 28, 2010

Zoloft and Lexapro are antidepressant prescription medications.  Both of these antidepressants are in the class known as selective serotonin reuptake inhibitors or SSRIs.  SSRI antidepressants are considered first-line medications for the treatment of depression and anxiety.

It is often difficult to decide which medication will be most effective and best tolerated in an individual.  However, when comparing Lexapro and Zoloft there are significant differences that may aid this decision.

Zoloft is the U.S. brand name for the medication that is generically known as Sertraline.  There are several Canadian brand names for the antidepressant Sertraline.  These include Apo-Sertraline®; CO Sertraline; Dom-Sertraline; Mylan-Sertraline; Novo-Sertraline; Nu-Sertraline; PHL-Sertraline; PMS-Sertraline; ratio-Sertraline; Riva-Sertraline; Sandoz-Sertraline; and Zoloft®.

Lexapro is the U.S. brand name for the medication that is generically known as Escitalopram.  In Canada, Escitalopram is known as the brand name antidepressant Cipralex.

Lexapro has FDA approved and labeled indications for the treatment of major depressive disorder and generalized anxiety disorders (GAD).  The unlabeled and/or investigational uses of Lexapro include the treatment of mild dementia-associated agitation in people who do not have a psychotic disorder.

The safety and efficacy of  Escitalopram has not been established in children less than 12 years of age with major depressive disorder or in children less than 18 years of age with generalized anxiety disorder.  Additionally, Escitalopram is not FDA approved for the treatment of bipolar depression in people of any age.

Zoloft has FDA approved and labeled indications for the treatment of several psychological conditions. The FDA approved indicatons for Zoloft include:

-Major depression

-Obsessive-compulsive disorder (OCD)

-Panic disorder

-Post-traumatic stress disorder (PTSD)

-Premenstrual dysphoric disorder (PMDD)

-Social anxiety disorder

The unlabeled and/or investigational uses of Zoloft include eating disorders, generalized anxiety disorder (GAD), impulse control disorders, and the treatment of mild dementia-associated agitation in non-psychotic patients.

Both Zoloft and Lexapro should be used in caution in people who have any degree of liver failure.  The metabolic clearance of these drugs is decreased in people with hepatic impairment, meaning that the concentrations in the blood are increased.  Therefore, a lower dosage of Lexapro and Zoloft may be needed in people with liver failure.

Lexapro and Zoloft are both generally safe in people with mild to moderate renal failure.  However, they should be used with caution in patients with severe renal impairment.

Zoloft and Lexapro should also be used with caution in patients with a previous seizure disorder or any condition that predisposes a person to seizures such as brain damage or alcoholism.

In addition to these precautions, Zoloft may cause weight loss in some people.  Zoloft should therefore be used with caution in people where weight loss is undesirable. 

Unlike Lexapro, Zoloft should also be used with caution in patients at risk of uric acid nephropathy.  Zoloft can exacerbate this disorder because it acts as a mild uricosuric.

There are many similarities between the SSRI antidepressants Lexapro and Zoloft.  However, there are significant differences in the approved and off-label uses as well as the contraindications of these two popular medications.

Source: Lexi-Comp Online. Accessed Mar 27, 2010.

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