Zoloft vs Celexa: Which one should I take?

Living with symptoms of anxiety or depression is difficult. Choosing the right medication shouldn’t be. In this article, we dive into Zoloft vs Celexa for treating anxiety and depression and what you need to know to talk to your provider.

Zoloft and Celexa are two commonly prescribed SSRIs or selective serotonin reuptake inhibitors (SSRIs) that are the first-line antidepressants used to treat anxiety and depression. Both medications have been found to be highly effective in improving mood and reducing thoughts that accompany anxiety.

Since these two medications belong to the same drug class, they have a similar mechanism of action and side effect profile, but there are key differences between them.

When anxiety or depression makes it difficult for you to enjoy your daily life, medications like Zoloft or Celexa could be the solution. If you need simple, insurance-free online depression or anxiety treatment, find a mental health provider who can recommend the right medication for you, if necessary, on Klarity.

Schedule an appointment today and speak with an experienced healthcare provider in just 48 hours. 

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

What is Zoloft?

Zoloft or sertraline is an SSRI medication that acts by blocking the re-uptake of a neurotransmitter in the brain called serotonin. It is one of the most commonly prescribed medications used to treat anxiety and depression. 

Forms and doses of Zoloft 

Zoloft is available in capsule, tablet, and liquid forms. Tablets and capsules are most commonly prescribed. The initial starting dose is typically 50 milligrams a day, which can then be increased in 25 milligram increments as needed. The typical maximum dose is 200 milligrams a day. 

Zoloft tablets are available in the following dosage forms:

• 25 milligrams 
• 50 milligrams
• 100 milligrams

Zoloft is available in capsule form in the following doses: 

• 150 milligrams
• 200 milligrams

Zoloft oral solution is available at 20 milligrams/milliliter.

Conditions Zoloft is used to treat

There are a number of different anxiety and depressive disorders that are commonly treated with Zoloft both on and off-label. 

Off-label use is when your healthcare provider prescribes a medication that’s been shown to have beneficial effects, but isn’t Food and Drug Administration (FDA)-approved to treat a particular condition. For example, Zoloft is approved to treat major depressive disorder, but it can also be used to treat binge eating disorder, even though it’s not FDA-approved to do so. 

Zoloft can be used to treat the following disorders: 

• Major depressive disorder 
• Generalized anxiety disorder
• Social anxiety disorder 
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Post-traumatic stress disorder (PTSD)

Symptoms of anxiety that Zoloft can treat

Zoloft is commonly used to treat anxiety symptoms that affect everyday life, including to: 

• Calm racing or unwanted thoughts
• Decrease fear that is out of proportion to the situation 
• Reduce the number and severity of panic episodes
• Reduce the urges associated with performing repetitive tasks in OCD

Symptoms of depression that Zoloft can treat

Zoloft can improve a number of depressive symptoms and overall increase quality of life, including to: 

• Improve mood and interest in pleasurable activities 
• Improve sleep quality 
• Increase energy levels 
• Restore appetite 

Off-label uses For Zoloft

Some off-label uses for Zoloft include: 

• Binge eating disorder 
• Body dysmorphic disorder 
• Bulimia nervosa 
• Premature ejaculation 
• Premenstrual dysphoric disorder 
• Neuropathic pain 

Zoloft costs

Zoloft is available in both generic and name-brand formulations. At the the time of last publishing, the average price of a 30-day supply of brand-name Zoloft oral tablets costs roughly $466 without a coupon code or insurance coverage according to drugs.com. A 30-days supply of generic sertraline ortal tablets cost roughly $11 per drugs.com. Zoloft and sertraline are covered by most insurance plans, and coupon codes are available at most large pharmacies or through sites like GoodRx, Drugs.com, SingleCare, and others.

Side effects of Zoloft 

All medication come with potential risks and benefits. Of note, SSRIs, including Zoloft, should be avoided or used with caution in elderly patients. This is due to the potential for an increased side effect profile, including electrolyte imbalances, such as sodium, calcium, and potassium, which are critical vital to key bodyily functions.

Common side effects ofZoloft include:

• Nausea, vomiting, diarrhea, gastrointestinal (GI) upset  
• Drowsiness or dizziness 
• Dry mouth 
• Loss of appetite 
• Increased sweating 
• Insomnia or difficulty sleeping
• Decreased libido, sexual dysfunction
• Muscle cramps or weakness
• Tremor 

Zoloft warnings

It’s important to note that there have been reported incidences of worsening depression and increased suicidal ideation. If you have thoughts of suicide or self-harm behaviors, contact your healthcare provider immediately or go to the nearest emergency department. 

The national suicide hotline can be reached by dialing 988 and is available 24×7.

Serotonin syndrome is a rare but serious drug reaction that occurs when excess serotonin levels build up in the brain. Call your healthcare provider or seek immediate medical attention if you begin to experience any of the following side effects: 

• Rapid heart rate and high blood pressure 
• High fever 
• Irregular heartbeat
• Agitation or restlessness
• Loss of muscle coordination or uncontrollable muscle twitching 
• Muscle rigidity 
• Increased sweating, shivering, or goosebumps
• Diarrhea 
• Headache 
• Dilated pupils 
• Confusion or altered consciousness

With any SSRI, there’s a potential for withdrawal when abruptly stopping the medication or decreasing the dose. It’s important to talk to your healthcare provider if you’re thinking about discontinuing an SSRI medication, including Zoloft. Your healthcare provider will work with you to slowly decrease the dose so that you’re less likely to experience withdrawal. 

Withdrawal syndrome symptoms include: 

• Dizziness or light-headedness 
• Vertigo 
• Fatigue
• Headache 
• Nausea, vomiting, diarrhea 
• Tremor or visual disturbances 
• Irregular sensations, including an “electric-shock” sensation throughout your body
• Increased anxiety or agitation 
• Confusion or irritability 
• Insomnia 

Zoloft drug interactions

Whenever starting a new medication, it’s important to disclose all of the medications you’re currently taking, including over-the-counter medications and supplements. Zoloft interacts with a number of commonly prescribed medications. 

Some common drug interactions associated with Zoloft include: 

• Serotonin syndrome: increased risk with other medications that increase serotonin, with the most common including:
  • Recreational drugs, such as Methylenedioxymethamphetamine (MDMA) or ecstasy 
  • ADHD medications, such as Adderall, increase the risk of serotonin syndrome.
  • Antipsychotic medications 
  • Tricyclic antidepressants
  • Buspar
  • Some migraine medications, including sumatriptan, rizatriptan, tramadol 
  • Lithium 
  • St. John’s Wort
• MAO inhibitors, including linezolid or methylene blue. These medications must be stopped 14 days before starting an SSRI  
• Antiplatelet or anticoagulant medications, which increase the risk of bleeding 
• Specific antibiotics and antifungal medications
• Opioids, including methadone 
• Some antinausea medications, such as ondansetron or Zofran 
• Thiazide diuretics: increase risk of hyponatremia 

What is Celexa?

Similar to Zoloft, Celexa or citalopram is an SSRI medication that works by increasing serotonin levels in the brain. Celexa is commonly prescribed for the treatment of depression by improving mood and decreasing symptoms of anxiety. 

Compared to Zoloft, Celexa has been shown to have fewer side effects and drug interactions. Although Celexa is found to be highly effective in treating anxiety and depression, it’s not the best choice for those who have chronic heart or liver issues. 

Forms and doses of Celexa 

Celexa is available in capsule, tablet, and oral solution forms. Tablets are most commonly used for adults. 

The initial starting dose of Celexa is typically 10 milligrams daily and can be increased in 10 milligrams increments on a weekly basis, as needed. The maximum dose is 40 milligrams per day, and in patients over 60 years of age, the maximum dose is 20 milligrams per day due to cardiac concerns in this population. 

Celexa is available in tablet form in the following doses: 

• 10 milligrams
• 20 milligrams 
• 40 milligrams

Celexa capsules are available in 30 milligrams dosing only. 

Oral solution of Celexa is available in 10 milligrams/5 millileters dosing only. 

Conditions that Celexa treats

Celexa or citalopram is commonly used in the treatment of a variety of depressive and anxiety disorders. The FDA has only formally approved the medication for major depressive disorder (MDD), but there are a number of off-label uses that are listed below.  

Symptoms of anxiety Celexa is used to treat

There are a variety of anxiety symptoms that are treated with Celexa. Although these are all considered off-label uses, they have been found to be effective in treating the following anxiety symptoms: 

• Sleep quality
• Anxious or racing thoughts 
• The anxiety or stress associated with eating disorders, including bulimia or binge eating disorder 
• Thought processing and urges associated with performing repetitive tasks in OCD 
• The number or severity of panic attacks in those who have PTSD, panic disorder, or social anxiety

Symptoms of depression Celexa can treat

Celexa is FDA-approved for the treatment of depressive symptoms and can potentially improve the quality of life of the patient. 

Common symptoms of depression treated with Celexa include: 

• Depressed mood
• Inability to enjoy regular activities 
• Sleep disturbances 
• Changes in appetite 

Off-label uses for Celexa

The term off-label is used for any use of a medication that isn’t FDA approved for the medication. There are a number of off-label uses for Celexa, including:

• OCD
• Binge eating disorder 
• Alcohol use disorder 
• Generalized anxiety disorder 
• Panic disorder
• PTSD
• Premenstrual dysphoric disorder 
• Postmenopausal flushing 
• Premature ejaculation 

Celexa costs

Brand-name Celexa costs from roughly $965 to $1,049 for a one-month supply of oral tablets according to drugs.com. Citalopram, the generic form, costs about from$12 to $19 for a one-month supply. Those costs are without coupons or insurance. Celexa and citalopram are typically covered by insurance plans, and prescription coupon codes are widely available at major pharmacies and online at sites like GoodRx, Drugs.com, SingleCare, and others.

Side effects from Celexa 

There are potential side effects from starting or increasing the dose of any drug. Compared to Zoloft, there tend to be fewer side effects with Celexa, although everyone reacts differently to medications. 

Some common side effects of Celexa include: 

• Nausea or GI upset
• Dry mouth 
• Changes in appetite 
• Drowsiness or fatigue 
• Increased sweating 
• Blurred vision 

Celexa warnings for use

There are a few rare but serious warnings with the use of Celexa, and should be carefully considered when discussing treatment options with your healthcare provider.  

As with most SSRIs, it is important to note that there have been reported incidences of worsening depression and increased suicidal ideation. If you’re having thoughts of suicide or self-harm behaviors, contact your healthcare provider immediately or go to the nearest emergency department. 

The national suicide hotline is available 24x7by dialing 988.

Serotonin syndrome is an uncommon but serious condition that is caused by elevated levels of serotonin in the brain. This is most commonly seen in patients who are taking multiple medications that work by increasing serotonin. 

It’s important to contact your healthcare provider or seek medical care if you begin to experience the following side effects: 

• Rapid heart rate and high blood pressure 
• High fever, resulting in increased sweating, shivering, or goosebumps 
• Irregular heartbeat or palpitations 
• Agitation or restlessness
• Loss of muscle coordination or uncontrollable muscle twitching or rigidity 
• Diarrhea 
• Headache 
• Dilated pupils 
• Confusion or altered consciousness

Another important consideration with any SSRI is the potential for withdrawal syndrome. When considering discontinuing or decreasing the dose of your medication, it’s important to discuss this plan with your healthcare provider so that they can guide the process and slowly titrate (reduce) the medication. 

Known Celexa drug interactions

As with any medication, there are a number of associated drug interactions that may occur. Overall, there appear to be fewer drug interactions than with Zoloft. It’s still important to disclose all medications you’re currently taking with your healthcare provider, including over-the-counter medications and supplements. 

Some medications that interact with Celexa include: 

• Medications that increase the risk for serotonin syndrome:
  • Recreational drugs like MDMA or ecstasy 
  • St. John’s Wort 
  • ADHD medications, such as Adderall 
  • Antipsychotic medications 
  • Tricyclic antidepressants
  • Buspar 
  • Some migraine medications, including sumatriptan, rizatriptan, tramadol 
  • Lithium 
• Antiplatelet and anticoagulant medications will increase the risk of bleeding
• MAO inhibitors including linezolid, metaxalone, and methylene blue, to name a few. These medications should be discontinued two weeks prior to starting an SSRI
• Drugs that affect heart rhythm, including amiodarone, procainamide, and sotalol 

Frequently asked questions about Zoloft vs Celexa

With so many different medications that belong to the SSRI medication classification, understanding the differences between medications can be difficult. To help, here are some commonly asked questions about Celexa and Zoloft.

Does Zoloft make you gain weight? Does Celexa?

Weight gain is a common concern for anyone starting on an SSRI medication. The simple answer is that either Zoloft or Celexa may result in a small weight gain of 1 to 5 pounds when starting either medication. 

If this is a major concern for you or you develop serious weight gain when starting either medication, your healthcare provider can offer alternative treatment options. 

Is Zoloft or Celexa better for anxiety?

Unlike Celexa, Zoloft is FDA approved for the treatment of anxiety and has been shown to be one of the most effective SSRIs for various anxiety disorders. Although, Celexa is better tolerated in some patients and has shown to be effective in treating anxiety as well. 

Can I replace Zoloft with Celexa?

Since both medications belong to the same drug class, they can be interchanged with one another under the supervision and direction of your healthcare provider. 

Depending on how you tolerate either medication and the side effects you experience, changing SSRIs to find the best treatment option for you is a fairly common practice. Your healthcare provider will adjust your dose based on your current symptoms and side effects. 

Is Zoloft energizing or sedating? What about Celexa?

While comparing the two medications, Celexa tends to be more sedating, while Zoloft has been found to be more energizing. Although, everyone reacts differently to each medication.

Does Zoloft cause brain fog? Does Celexa?

Brain fog is a common symptom of depression but can be a side effect associated with the use of SSRIs. When comparing the two medications, Zoloft was shown to have more side effects of reported brain fog than Celexa. 

Can I drink alcohol on Celexa? On Zoloft?

You should avoid drinking alcohol while taking either Celexa or Zoloft. Even drinking a small amount of alcohol while on these medications can cause unwanted side effects. Plus, overall, drinking alcohol has been associated with worsening anxiety and depression. 

Can I drink caffeine when I’m on Celexa? How about Zoloft?

It’s typically safe to consume caffeine on both Celexa and Zoloft, with no increased incidence of side effects reported. 

What is better for depression — Celexa or Zoloft?

Although both medications have been found to be highly effective at treating depression, studies have shown that Celexa may provide relief of depressive symptoms more quickly than Zoloft. 

How Klarity helps you discover the right medication 

If you’re living with symptoms of anxiety or depression and are unsure which medication is right for you, schedule an appointment with a healthcare provider on Klarity today. Klarity lets you find a healthcare provider in your state who specializes in the evaluation and treatment of anxiety and depression. And you can have your first telehealth visit in as little as 48 hours. 

Klarity offers access to quality mental health care at your convenience. No more long waitlists or inconvenient commutes to an office. Schedule an appointment on Klarity today.