Which to choose?
Sertraline: first choice in pregnancy, breastfeeding and cardiovascular comorbidity. Escitalopram: predominant generalised anxiety, younger patient without heart disease. Both are first-line SSRIs — the choice depends on the patient profile.
Point-by-point comparison
Brands: Lustral · Zoloft
Brands: Cipralex · Lexapro
| Sertraline | Escitalopram | |
|---|---|---|
| Mechanism | Selectively inhibits presynaptic serotonin reuptake. | Same as sertraline but more selective for the SERT transporter. |
| Indications | Depression, OCD, PTSD, panic disorder, social anxiety. | Depression, generalised anxiety, panic disorder, social anxiety. |
| Adult dose | 50-200 mg/day. | 10-20 mg/day. |
| Onset of effect | 2-4 weeks for a meaningful antidepressant effect. | 2-4 weeks. |
| Duration of effect | Intermediate half-life (26 h). | Half-life 27-32 h. |
| Pregnancy | Generally preferred in pregnancy when treatment is needed. | Compatible if needed. |
| Breastfeeding | Compatible (one of the best studied). | Compatible. |
| Paediatric use | OCD from 6 years. | From 12 years (depression). |
| Advantages | Good profile in pregnancy and breastfeeding. Few interactions. Less sexual dysfunction than other SSRIs. | Lower dosing. Good profile in generalised anxiety. Well tolerated. |
| Disadvantages | Diarrhoea is common at the start. | QT prolongation at high doses (>20 mg/day) — caution in heart disease. |
Source: BNF, NICE NG222, Spanish SmPC (AEMPS)
Frequently asked questions
Which is better, sertraline or escitalopram?
Sertraline: first choice in pregnancy, breastfeeding and cardiovascular comorbidity. Escitalopram: predominant generalised anxiety, younger patient without heart disease. Both are first-line SSRIs — the choice depends on the patient profile.
Can sertraline or escitalopram be taken in pregnancy?
Sertraline: Generally preferred in pregnancy when treatment is needed. Escitalopram: Compatible if needed. Always ask a doctor or pharmacist before taking a medicine in pregnancy.
And while breastfeeding?
Sertraline: Compatible (one of the best studied). Escitalopram: Compatible.