Celexa vs. Zoloft: Similarities & Differences

Medically reviewed by Mary Choy, PharmD

As Americans face rising challenges regarding maintaining their mental health, some prescription drug options may offer varying benefits to manage symptoms of depression or anxiety.

Celexa (citalopram) and Zoloft (sertraline) are first-line, brand-name selective serotonin reuptake inhibitors (SSRIs) that treat mental health conditions. They are used to treat mood disorders.

Celexa is approved by the Food and Drug Administration (FDA) for depression, while Zoloft is FDA-approved for multiple conditions, such as major depressive disorder (MDD), various anxiety disorders, and post-traumatic stress disorder (PTSD).

Celexa and Zoloft are taken by mouth and are available in tablet and liquid forms. They increase serotonin hormone levels in the brain to improve symptoms of depression and anxiety.

However, despite being viewed as generally similar by the healthcare community, Celexa and Zoloft differ in their active ingredients, dosing regimens among different populations, and some FDA-approved uses.

This article will highlight the differences and similarities between Celexa and Zoloft.

Understanding Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are first-line antidepressant medicines for chronic psychiatric conditions, including MDD, panic disorder (PD), and generalized anxiety disorder (GAD).

How SSRIs Work

SSRIs work by inhibiting serotonin reuptake (a natural chemical in the brain that helps maintain balance), thereby increasing serotonin activity.

Off-Label Uses

SSRIs can be used for off-label purposes (using a drug for a purpose it was never FDA-approved for).

Such off-label uses include the treatment of fibromyalgia, SAD, and sexual dysfunction in males.

Modes of Administration

SSRIs are commonly given as immediate-release (IR) tablets, extended-release (ER) capsules, or liquid suspension/solutions.

Some commonly available SSRIs include Lexapro (escitalopram), Prozac (fluoxetine), Luvox (fluvoxamine), and Paxil (paroxetine).

Significance of Panic Disorder (PD)

PD is a condition marked by repeated episodes of intense fear accompanied by physical symptoms that include angina (chest pain), cardiac arrhythmia (irregular heartbeats), shortness of breath, or dizziness.

PD can occur suddenly and is not typically associated with any specific fear or stressor.

An estimated 4.7% of American adults will experience PD at some time in their lives.

Significance of Depression

In general‚ one out of every six adults will experience depression at some point in their lifetime.

Throughout the United States, it affects about 16 million adults annually.

Significance of Post-Traumatic Stress Disorder (PTSD)

PTSD is a chronic mental disorder that occurs after exposure to traumatic events.

About six out of every 100 people in the United States will experience PTSD at some point in their lives.

In 2020, about 13 million Americans had PTSD.

What Is Celexa?

Celexa is an orally administered, brand-name SSRI containing the active ingredient citalopram. It is FDA-approved for the treatment of MDD in adults 18 and older.

Celexa carries a boxed warning that concerns a potential increased risk of suicidal thoughts and behavior in young adults who take it.

Forms of Administration

Brand-name Celexa and its generic versions are available for administration as a tablet, liquid solution, or film-coated tablet.

Off-label Uses

At times, Celexa may be used off-label to treat:

• Obsessive-compulsive disorder (OCD, a mental health condition causing obsessive thoughts and compulsive behavior)

• Eating disorders

• Alcoholism

• PD

• Premenstrual dysphoric disorder (PMDD, physical and emotional symptoms that occur periods)

• Social anxiety disorder (SAD, extreme fear of interacting with others)

• PTSD
  

• Tingling in the hands and feet caused by diabetes

• Sexual impotence in males
  

What Is Zoloft?

Zoloft is an orally administered, brand-name SSRI containing the active ingredient sertraline.

It is FDA-approved for use in adults and children 6–17 years old.

Like Celexa, Zoloft carries a boxed warning regarding an increased risk of suicidal thoughts and behavior in young adults who take it.

Zoloft is FDA-approved for the treatment of:

• MDD

• OCD

• PD

• PTSD

• SAD

• PMDD

Forms of Administration

Brand-name Zoloft and its generic versions can administered as a film-coated tablet or liquid solution.

Off-label Uses

Zoloft is sometimes used off-label to treat:

• Headache

• Sexual dysfunction in males

Dosing Guidelines

The following will outline basic dosing guidelines for using Celexa versus Zoloft.

Celexa

Celexa tablets are available in strengths of 10-, 20-, and 40-milligrams (mg), as follows:

Zoloft

Zoloft tablets are available in 25-, 50-, and 100-mg strengths, as follows:

*The luteal phase is the days of the menstrual cycle after ovulation and the start of the next period.

Safe Use Guidance

The following offers best practices when taking Celexa or Zoloft:

Celexa and Zoloft

• Take Celexa and Zoloft daily (in the morning or the evening), with or without food.

• Take Celexa and Zoloft around the same time every day.

• Your healthcare provider will start Celexa and Zoloft on a smaller dose and gradually increase the dose once weekly as required.

• Do not stop taking Celexa or Zoloft without asking your healthcare provider, even if you feel well. Sudden discontinuation of these drugs can lead to withdrawal symptoms. Your healthcare provider will slowly reduce the dose before stopping it altogether

• People under 25 years old taking Celexa or Zoloft should be continually assessed for suicidal ideation and other unusual behaviors, as per their boxed warning

• Celexa and Zoloft may cause drowsiness. Do not drive or operate the machinery unless you know how these drugs affect you.

• Be mindful while drinking alcohol with these drugs.

Zoloft-Specific Guidance

The following guidance applies specifically to the use of Zoloft:

• Dilute Zoloft concentrate immediately before taking it, using the provided dropper to measure the dose.

• Dilute Zoloft oral solution only with water, ginger ale, lemon-lime soda, lemonade, or orange juice.

• Consume Zoloft immediately after mixing.

Efficacy

Although minor differences may exist between them, both Celexa and Zoloft are equally effective SSRIs.

One study established that drugs within this class when taken at higher doses, can lead to symptom improvement of mood disorders.

In comparison, an earlier study comparing the efficacy of Celexa versus Zoloft found Celexa to have a significantly higher onset than Zoloft during the early weeks of treatment and a better efficacy in overall treatment.

Both drugs were considered adequate and well-tolerated.

Side Effects and Precautions

Like all drugs, Celexa and Zoloft have the potential for side effects of varying severity.

SSRIs like Celexa and Zoloft both carry a boxed warning alerting users and their parents of the risk of increased suicidal thinking and behavior in children, adolescents, and young adults (typically those under 25 years old).

When taking Celexa or Zoloft, monitor yourself or a loved one closely for the emergence of side effects that worsen or fail to dissipate over time.

If this occurs, your healthcare provider may reevaluate your prescription.

Side effects associated with the use of Celexa and Zoloft are listed below.

Common Side Effects

Shared, typical side effects associated with the use of Celexa and Zoloft include:

• Constipation

• Diarrhea

• Dizziness

• Headache

• Dry mouth

• Lethargy

• Heartburn
  

• Loss of appetite

• Nausea

• Sexual dysfunction in males

• Tremors

• Vomiting
  

Severe Side Effects

Rarer, though more severe side effects associated with the use of Celexa and Zoloft include:

• Seizures

• Abnormal bleeding or bruising

• Symptoms of withdrawal, such as hallucinations, fever, sweating, tachycardia (rapid heartbeat), shivering, severe muscle stiffness, nausea, vomiting, or diarrhea
  

• Confusion

• Rash

• Urticaria (hives)

• Shortness of breath

Summary

Celexa and Zoloft are effective SSRIs and are used as first-line therapies in the treatment of depression and related disorders.

However, while generally viewed as similar, they differ in their active ingredients and FDA-approved uses, among other differences.

Celexa is approved to treat major depressive disorder in adults, while Zoloft is used for the treatment of MDD, OCD, PD, PTSD, SAD, and the symptoms of PMDD.

Celexa is approved for adults, while Zoloft is approved for use in adults and children 6 years and older.

SSRIs like Celexa and Zoloft carry a boxed warning regarding the risk of increased suicidal thinking and behavior in children, adolescents, and young adults.

Do not take these drugs more often or at higher doses than prescribed.

Continue taking even if you feel better, and don't discontinue without asking your healthcare provider—sudden discontinuation may cause life-threatening withdrawal symptoms.

Frequently Asked Questions

How do I store Celexa or Zoloft?

Store all forms of Celexa and Zoloft in a dry, secure place (away from children and pets) and at room temperature (68–77 degrees F).

Keep these drugs away from areas of high moisture and direct light.

How quickly does Celexa vs. Zoloft begin working?

Celexa and Zoloft usually take a few weeks to show benefits and improve symptoms after taking the initial dose.

Read the original article on Verywell Health.