Sertraline vs Escitalopram (Zoloft vs Lexapro)

Short answer: Sertraline and escitalopram are both SSRI antidepressants that work about equally well for depression and anxiety for most people, and both are among the better-tolerated options. Escitalopram may be slightly gentler on the gut but needs care with heart rhythm problems. Sertraline is often preferred in pregnancy and breastfeeding.

Sertraline (Zoloft and generics)

Depression, OCD (including children from 6), panic disorder, social anxiety, PMDD; used for PTSD
Diarrhoea and nausea a bit more common early on
One of the most studied antidepressants in pregnancy; preferred when breastfeeding
Usually taken once a day, often with food

Escitalopram (Lexapro and generics)

Depression, generalised anxiety, panic disorder, social anxiety, OCD
Headache and nausea are the most common early side effects
Dose-related effect on heart rhythm (QT): lower maximum dose over 65
Once a day, with or without food

Do they work as well as each other?

A 2018 analysis of 522 trials (116,477 adults with depression) found every antidepressant worked better than placebo, with modest differences between them.
In head-to-head trials, escitalopram was among the more effective options. Both sertraline and escitalopram were among the best tolerated, with fewer people stopping than with many others.
In everyday practice the difference is small. The best medicine is the one that works for you with side effects you can live with, and that can take a trial or two to find.
Both take time: early benefit often after 2 to 4 weeks, fuller effect by 6 to 8 weeks.

Side effects

Both: nausea, headache, sweating, sleep changes, and sexual side effects (lower desire, delayed orgasm or ejaculation). Early side effects usually ease within a couple of weeks; sexual effects may not.
Sertraline: diarrhoea and loose stools are more of a feature, especially at first.
Escitalopram: a small, dose-related lengthening of the QT interval on the ECG. It isn’t used with known long QT or with other QT-prolonging medicines, and older adults have a lower maximum dose. Sertraline has a much smaller effect on QT.
Both: low sodium (more likely in older people), more bleeding risk with anti-inflammatories, aspirin or blood thinners, and serotonin syndrome if combined with other serotonin medicines such as tramadol, triptans, St John’s wort or other antidepressants.
Under 25s: thoughts of self-harm can increase in the first weeks or after a dose change, so check in with your doctor early.

Interactions

Escitalopram has fewer effects on liver enzymes that break down other medicines, which can make it simpler with complex medicine lists, apart from the QT caution.
Sertraline mildly to moderately affects some liver enzymes, so your pharmacist may check your other medicines.
Never combine either with an MAOI antidepressant.

Pregnancy and breastfeeding

Sertraline is one of the most studied antidepressants in pregnancy and is often continued when it’s working.
For breastfeeding, sertraline is a preferred choice because only low levels pass into breast milk. Escitalopram can be used with more caution.
Don’t stop either suddenly if you become pregnant: make a plan with your doctor. Untreated depression also carries risks for parent and baby.

Stopping

Both should be reduced slowly with your doctor’s help. Stopping suddenly can cause dizziness, “brain zaps”, irritability, flu-like feelings and poor sleep.
Most people continue for at least 6 to 12 months after feeling well, to lower the chance of depression coming back.

Cost in Australia

Both are PBS-listed for depression, and generic brands cost under the $25 PBS co-payment ($7.70 concession). Brand-name versions can cost a little more.

Get help now if

You have thoughts of suicide or self-harm: call Lifeline on 13 11 14 or 000 (Australia), or your local crisis line.
Fever, sweating, shaking, muscle jerks, confusion or a racing heart (possible serotonin syndrome).
Fainting or a racing, irregular heartbeat.

Common questions

Is sertraline or escitalopram better for anxiety?

Both are first-line choices for anxiety disorders, and there’s no clear winner overall. Escitalopram is approved for generalised anxiety disorder; sertraline for panic disorder, social anxiety and OCD, and both are used widely. The best one is the one that works for you with tolerable side effects.

Which has fewer side effects, sertraline or escitalopram?

Both are among the better-tolerated antidepressants. Sertraline causes diarrhoea a bit more often; escitalopram needs care with heart rhythm (QT) problems. Sexual side effects can happen with both.

Can I switch from sertraline to escitalopram?

Yes, switching between SSRIs is common, but do it with your doctor. They’ll advise whether to switch directly or taper first, to reduce withdrawal symptoms and avoid serotonin syndrome.

Which is safer in pregnancy and breastfeeding?

Sertraline is one of the most studied antidepressants in pregnancy and is a preferred choice when breastfeeding because little passes into breast milk. Don’t stop any antidepressant suddenly: talk to your doctor.

How long do sertraline and escitalopram take to work?

Usually 2 to 4 weeks for the first benefit and 6 to 8 weeks for the full effect. Early side effects often come first and usually fade.

Sources

Reviewed 8 November 2026. General education, not personal medical advice. Talk to your GP or pharmacist about what suits you.