Paxil (Paroxetine) vs. Zoloft (Sertraline): How Do They Compare?

Medically reviewed by Femi Aremu, PharmD

Paxil, also known as paroxetine, is a medication that can be used to treat certain mental health conditions, such as general anxiety disorder (GAD), post-traumatic stress disorder (PTSD), or major depressive disorder (MDD).

Zoloft, also known as sertraline, is a different medication that can treat similar conditions, including panic disorder, PTSD, or MDD.

These medicines are part of a drug class called selective serotonin reuptake inhibitors (SSRIs). SSRIs work in the body by allowing the neurotransmitter serotonin to stay in certain parts of the brain longer, which helps improve mood over time.

Differences between Paxil and Zoloft can be found when comparing side effects. Paxil can come with more side effects than those found with Zoloft. However, which medicine you use may depend on several factors.

This article will discuss the similarities and differences between Paxil and Zoloft, including its uses, side effects, dosing, and more.

Uses of Paxil vs Zoloft

The U.S. Food and Drug Administration (FDA) approved Paxil to treat:

• Major depressive disorder (MDD)

• Premenstrual dysphoric disorder (PMDD)

• Obsessive compulsive disorder (OCD)

• Panic disorder

• Social anxiety disorder (SAD)

• Generalized anxiety disorder (GAD)

• Post-traumatic stress disorder (PTSD)

Zoloft is approved to treat some of the same conditions as Paxil, but not all of them.

It is FDA-approved for:

• PMDD

• MDD

• OCD

• Panic disorder

• PTSD

• SAD
  

Which Is More Effective?

Paxil and Zoloft are both effective at treating certain conditions. Some studies show no difference in their effectiveness in treating GAD. The results showed that people taking Paxil or Zoloft had similar improvements in their mental health conditions.

In the treatment of PTSD, both Paxil and Zoloft worked just as well in reducing symptoms. Alongside SSRIs, some healthcare providers may recommend behavioral therapies as a means to help further reduce PTSD-related symptoms.

Similarly, Paxil and Zoloft are both equally effective in treating panic disorder, according to one clinical study.

Off-label treatment means that although the medication is not FDA-approved for a particular condition, studies have shown that the medication may benefit it.

Related: Prozac (Fluoxetine) vs. Zoloft (Sertraline): Which Is Right For You?

Dosages and Dosage Forms

It is important to follow your healthcare provider's recommendation on how to take your medication. Oftentimes, your dose will start lower and slowly increase. Never change the dosing alone or without talking to your provider first.

Below is a list of common dosing amounts in milligrams (mg) used when starting each medication and their maximum doses.

What Are the Side Effects?

Similar side effects can occur with both Paxil and Zoloft, which include:

• Agitation

• Constipation

• Diarrhea

• Drowsiness

• Dry mouth

• Excessive sweating

• Nausea

• Sexual dysfunction

• Tremors

• Worsening of liver damage

Although weight gain can be seen with all medications in the SSRI class, Paxil can cause more weight gain than others, including Zoloft.

Additionally, Zoloft is considered to be better tolerated than Paxil. It is also associated with fewer side effects when tapering (gradually lowering the dose) than Paxil.

Warnings and Precautions

Safety precautions are important when taking any medicine.

The following are complications that can occur with both Zoloft and Paxil:

• Seizures: If you are prone to epilepsy or seizures, contact your healthcare provider before starting any type of SSRI, as they can lead to an increased risk of seizures.

• Increased risk of bleeding: All SSRIs can potentially cause an increase in bleeding.

• Mania/hypomania: If you have been diagnosed with schizophrenia, talk to your healthcare provider before starting Paxil or Zoloft. SSRIs can potentially cause an episode of mania.

• Angle-closure glaucoma: SSRIs can sometimes trigger angle closure attacks in people who have eyes with untreated narrow angles.

Taking Paxil while pregnant can harm the fetus. Therefore, discuss appropriate interventions with your healthcare provider if you are pregnant or plan to become pregnant while starting treatment for a mental health condition.

Taking Zoloft during the third trimester of pregnancy can increase the risks of problems associated with the fetus' heart and lungs.

Abruptly stopping your medicine is not advised. With Paxil, stopping it too suddenly can cause serious withdrawal symptoms such as nausea, irritability, dizziness, and prickling sensations. Your healthcare provider must provide a dosing schedule to gradually lower your dose if you need to stop taking it.

Interactions

Both Paxil and Zoloft have similar interactions, which include:

• Monoamine oxidase inhibitors (MAOIs): Do not take SSRIs within 14 days of taking an MAOI and vice versa. Some common MAOIs still in use include Nardil (phenelzine), Parnate (tranylcypromine), Emsam (selegiline transdermal patch), or Marplan (isocarboxazid), which are sometimes prescribed to help treat depression.

• Pimozide: Pimozide is a medication used to help treat vocal tics. You should not take Paxil or Zoloft at the same time as pimozide.

• Melaril (thioridazine): Paxil and Zoloft can interact with thioridazine, a treatment for schizophrenia. Taking Paxil with this medicine can increase the risk of QT prolongation. When taken together, Zoloft can increase the risk of exposure to thioridazine.

• Other drugs that boost serotonin: Taking other serotonergic drugs, such as tramadol or other types of antidepressants, with SSRIs can raise the risk of serotonin syndrome.

• Warfarin: Taking Paxil or Zoloft with warfarin can increase the risk of side effects.

• Blood thinners: These medicines, which include aspirin and Plavix (clopidogrel), can heighten the risk of bleeding.
  

Other drugs that can interact with Paxil are:

• Tamoxifen

Other drugs that can interact with Zoloft are:

• Drugs that increase the risk of QTc prolongation, such as certain antipsychotics (e.g., ziprasidone) and antibiotics (e.g., erythromycin)

• Dilantin (phenytoin)

Which Is Right for Me?

Both medications are similarly effective for what they treat. When choosing the right treatment, your healthcare provider will consider many factors, including your medical history, pregnancy status, and age. You may also want to take side effects into account, as not everyone will react the same way to a medication.

Whether you choose Paxil or Zoloft, it is always important to take the medication as prescribed by your healthcare provider, making sure to take it for the recommended duration. These medications will not work immediately. It may take days to weeks for your mood or symptoms to change.

With Paxil, it is especially important not to stop the medication randomly or abruptly, as it can cause serious withdrawal symptoms.

Summary

Both Paxil and Zoloft are medications that can be used to treat several mental health conditions, including PTSD, panic disorder, OCD, and more.

However, both vary in their side effect profile and safety for use during pregnancy. It is always important to talk to your healthcare provider before starting either of these medications, as they can cause unwanted side effects if taken improperly.

Read the original article on Verywell Health.