Escitalopram and sertraline are probably the two most versatile SSRI antidepressants available to us. Its versatility lies in its wide range of indications for use. In addition to being widely used for major depression, they are also used for panic disorder, agoraphobia, social anxiety disorder (social phobia), post-traumatic stress disorder, obsessive-compulsive disorder (OCD), generalized anxiety, and premenstrual dysphoric disorder (PMDD). Despite these common indications for use, there are subtle differences between the two antidepressants.
Sertraline is marketed under the names Lustral ® And Zoloft ®. While escitalopram is sold in pharmacies under the names Cipralex ® and Lexapro ®.
Similarities between escitalopram and sertraline
The main similarity between sertraline and escitalopram is that they belong to the same family of antidepressants. The group of antidepressants they belong to is called SSRIs or selective serotonin reuptake inhibitors. These are two antidepressants with similar efficacy and tolerability for depression. Both drugs are activating antidepressants, so they are preferably prescribed in the morning. Overall, these are two very well tolerated antidepressants with only slight differences, which we will now look at, in their side effect profiles. Even in pregnant and lactating women, they have a very high safety profile.
To choose between escitalopram and sertraline, we have to consider their differences, not their similarities. Let’s now look at what the most significant differences are and which antidepressant might be better: sertraline or escitalopram?
The differences between escitalopram and sertraline
The differences between escitalopram and sertraline are certainly subtle. Their main differences are in the side effect profile and drug interactions, where the difference is most obvious. Escitalopram has a better side effect profile, especially in the area of sexual side effects. We can also say that escitalopram has fewer drug interactions than sertraline. However, in favor of sertraline is the fact that it is usually one of the most commonly used drugs for the treatment of OCD and that it is more active than escitalopram. We decipher which antidepressant is better: escitalopram or sertraline.
Differences between escitalopram and sertraline: effectiveness for depression
Efficacy of an antidepressant is one of its main characteristics. There have been several studies comparing the effectiveness of different antidepressants, and there is generally little or no difference between them. In this sense, we cannot say that one is better than the other. However, in my experience, I prefer escitalopram for depression and sertraline for OCD.
Differences between escitalopram and sertraline: effectiveness in OCD
Escitalopram and sertraline are two drugs indicated for the treatment of obsessive-compulsive disorder, so both have proven effectiveness. Sertraline is usually prescribed as the drug of first choice for OCD. In many cases, treatment with escitalopram has also been considered in certain situations. Some of these situations: intolerance or lack of effectiveness of sertraline, comorbidity with anxiety attacks, previous good response to escitalopram, etc.д.
Differences between escitalopram and sertraline: effectiveness in panic attacks
For the treatment of panic attacks, sertraline is usually prescribed as the first remedy, while for OCD, escitalopram is better preferred. Sertraline has an increased risk of increasing anxiety in the first days of treatment and of triggering panic attacks in susceptible individuals. Although escitalopram can also provoke such anxiety attacks, this happens less often if low doses are used in the first days of treatment.
Differences between escitalopram and sertraline: mechanism of action
Escitalopram is the SSRI antidepressant with the highest selectivity for serotonin transporter (SERT). Estcitalopram is much more selective than sertraline on SERT. This greater selectivity for serotonergic neurotransmission does not make it a more effective antidepressant. Another property that escitalopram has (and sertraline does not) is that it can bind to the allosteric receptor SERT. This binding to the allosteric receptor enhances the effect of binding to the orthosteric receptor. Sertraline, like other SSRI antidepressants, binds only to the orthosteric receptor. This difference may mean that, in general, Excitaloram is more effective than other SSRIs. However, escitalopram has not been shown to be more effective than sertraline.
On the other hand, sertraline has a weak inhibitory effect on the dopamine transporter (DAT). As a result of this effect on dopaminergic neurotransmission, sertraline acts more actively than other antidepressants and this activation may contribute to efficacy. Another effect of sertraline is its binding to the Sigma 1 receptor. Although the properties of the Sigma 1 receptor are unclear, it probably gives sertraline an anxiolytic effect and greater efficacy in psychotic and delusional depression.
Differences between escitalopram and sertraline: side effects
We are talking about two antidepressants with few and mild side effects. Tolerability of sertraline and escitalopram are similar. However, in my experience, escitalopram has fewer side effects than sertraline. Although the most common side effect with both drugs is nausea, each drug causes more side effects than the other. Sertraline is more than twice as likely to cause diarrhea, headaches and insomnia, and sexual dysfunction. Escitalopram may cause more emotional indifference and drowsiness. Now we’re going to break down the side effects that are most common or cause the most concern in the population and see which drug has the most side effects: escitalopram or sertraline?
Differences between escitalopram and sertraline: drowsiness
Specifically, escitalopram and sertraline are antidepressants that very rarely cause drowsiness. In fact, complaints of increased activation and anxiety are more common in the first few days of treatment. Perhaps between the two drugs, sertraline is more activating because of the pro-dopaminergic effect mentioned above. Therefore, if drowsiness is going to be caused by one of these two drugs, it will be Escitalopram. This drowsiness usually subsides within a few days of treatment.
Differences between escitalopram and sertraline: weight gain
Although weight gain is a common problem among people taking antidepressants, weight gain is usually not significant when taking SSRI antidepressants, and this activation may contribute to their effectiveness. Specifically, sertraline is more likely to cause decreased appetite and weight gain than increased appetite. The decrease in appetite occurs mainly in relation to carbohydrates. In fact, sertraline, along with fluoxetine, is commonly used to reduce overeating in people with bulimia nervosa or overeating disorder. Estcitalopram, on the other hand, doesn’t usually cause weight gain, but it doesn’t help you lose weight either.
In conclusion, sertraline is better than escitalopram for people with depression or anxiety and overweight or overeating.
Differences between escitalopram and sertraline: sexual dysfunction
Antidepressants tend to cause sexual dysfunction in a large percentage of patients, and this is often the main reason for stopping the medication, especially in young people. Between the two drugs, sertraline causes more sexual dysfunction than escitalopram. This is a very important advantage of escitalopram over other antidepressants, especially among SSRIs.
Differences between escitalopram and sertraline: risk of addiction?
This is one of the most important questions for people starting antidepressants: should they take antidepressants? Estcitalopram or sertraline are addictive or dependent? The answer is categorically no. Antidepressants are not addictive and are not drugs from which a person can become addicted. Benzodiazepines are drugs that are truly addictive. Benzodiazepines are a group of medications used to reduce anxiety or treat insomnia. Benzodiazepines are often, but not necessarily, prescribed together with antidepressants. Antidepressants are usually mid- and long-term treatment, whereas benzodiazepines should be prescribed only in the short term.
Differences between escitalopram and sertraline: interactions with other drugs
In addition to having few side effects, escitalopram has another big advantage: it has almost no interaction with other medications. This favorable drug interaction profile is due to the lack of significant action on cytochrome P450.
On the other hand, sertraline is a weak inhibitor of cytochrome P450 2D6, so it may have weak interactions with other drugs that are metabolized through this pathway. Drugs with which sertraline may interact include: Codeine, atomoxetine, beta-blockers, thioridazine and pimozide, etc.
Differences between escitalopram and sertraline: use in pregnant women
Estcitalopram and sertraline are two of the best antidepressants during pregnancy. Both antidepressants are category C during pregnancy. In any case, prescribing antidepressants during pregnancy should be done in situations where the benefits outweigh the risks and the patient is aware of the risks. It is highly recommended that medication be taken under the supervision of an experienced psychiatrist. Neither antidepressant drug causes fetal malformations (teratogenesis).
Differences between escitalopram and sertraline: during lactation
We’re talking about two very safe antidepressants during pregnancy as well as during breastfeeding. Both sertraline and escitalopram are considered very low-risk drugs, according to the e-lactation website.org. In general, in recent years, sertraline has been recommended as the antidepressant of choice in breastfeeding women, so we conclude that sertraline is better than escitalopram during breastfeeding. In either case, the mother should be informed of the benefits and risks, the child’s pediatrician should be informed, and antidepressant treatment should be under the supervision of a psychiatrist.
Differences between escitalopram and sertraline – year
Sertraline is one of the SSRIs that came on the market in the 1990s, while escitalopram is a younger drug that came out in 2002. In both cases, the patent has expired, and generics of both active ingredients can be found in pharmacies.
Differences between escitalopram and sertraline: dosages
Scitalopram is recommended in a dosage range of 10 to 20 mg per day, with a starting dose of 5 to 10 mg per day. On the other hand, the recommended dose of sertraline ranges from 50 to 200 mg per day, with a starting dose of 25-50 mg per day. Although this is the dose recommended in the data sheet, there are patients who would benefit from a higher dose than the above.
Differences between escitalopram and sertraline: presentations
Sertraline is sold in Britain in 50-mg and 100-mg tablets. Excitalopram is available in 10, 15, and 20 mg tablets. Both sertraline and escitalopram are sold in pharmacies as drops, which is convenient for people who have trouble swallowing.
Differences between escitalopram and sertraline: timing of administration
Earlier we described escitalopram and sertraline as activating antidepressants. This means that sertraline, in particular, is preferably taken in the morning at breakfast. Sertraline is more likely to cause insomnia if taken in the afternoon or evening. While in some cases, some people prefer to take escitalopram in the evening because it causes drowsiness, nausea, or dizziness.
Escitalopram or sertraline, which is better?
These are two very good antidepressants. If you ask me for my opinion, I will answer you honestly.
For major depression, escitalopram is better than sertraline. However, for the treatment of OCD, sertraline is better than escitalopram. I find that anxiety attacks and agoraphobia are best treated with escitalopram. For pregnant women, I think they are both very good, while for breastfeeding women I prefer sertraline.