Zoloft vs Prozac: Which is Right for Me?

If you have been diagnosed with depression or other mental health conditions such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or panic disorder, your healthcare provider may prescribe medications called selective serotonin reuptake inhibitors, or SSRIs, to treat your symptoms. 

Two of the most commonly prescribed SSRIs are Zoloft (sertraline) and Prozac (fluoxetine). Continue reading to learn more about how these two medications differ and which may be best to treat your mental health.

What is Prozac?

Prozac (generic drug fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) that is FDA-approved for: 

• Major depressive disorder (MDD) in adults and children 8 years of age and older.

• Obsessive-compulsive disorder (OCD) in adults and children 7 years of age and older. 

• Bulimia nervosa in adults.

• Panic disorder in adults.

What is Zoloft?

Zoloft (generic drug sertraline) is a selective serotonin reuptake inhibitor (SSRI) that is FDA-approved for:

• Major depressive disorder (MDD) in adults.

• Obsessive-compulsive disorder (OCD) in adults and children 6 years of age and older.

• Post-traumatic stress disorder (PTSD) in adults.

• Panic disorder in adults.

• Social anxiety disorder in adults.

• Premenstrual dysphoric disorder (PMDD) in adults.

How Do Prozac And Zoloft Work?

Both Prozac and Zoloft work by increasing serotonin levels in the brain by blocking reabsorption (reuptake). This helps regulate mood, improve sleep, and reduce anxiety. 

SSRIs do not produce more serotonin. They help the brain use what it already has more effectively.

Key Differences: Prozac vs. Zoloft

Here are some of the main differences between Prozac and Zoloft:

Which Is More Effective?

Studies show that Prozac and Zoloft are equally effective in treating depression, anxiety, and sleep disturbances. 

However, some research suggests that more patients discontinued Prozac (fluoxetine) than Zoloft (sertraline) due to no improvement in symptoms, suggesting that Zoloft may be more effective than Prozac. 

Is Zoloft or Prozac Better for Panic Attacks?

According to studies, Zoloft may be better for panic attacks compared to Prozac.

However, the choice of antidepressant for panic disorder depends on other co-occurring conditions. For example, if you also have PTSD or social anxiety, Zoloft may be the preferred therapy because it is approved for these conditions in addition to panic attacks.

Is Zoloft or Prozac Better for Obsessive-Compulsive Disorder (OCD)?

Studies suggest that both Prozac and Zoloft are effective in treating obsessive-compulsive disorder (OCD) in adults. 

Zoloft can be prescribed to children 6 years of age and older, and Prozac to children 7 years of age and older.

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Side Effects of Prozac vs Zoloft

Common side effects of Prozac and Zoloft can include:

• Nervousness, restlessness, or anxiety

• Insomnia

• Gastrointestinal side effects (heartburn, nausea, diarrhea)

• Loss of appetite 

• Weight changes

• Dry mouth

• Excessive sweating

• Weakness 

• Unusual dreams

• Sexual problems in men and women

• Cognitive side effects such as confusion, difficulty concentrating, or memory problems

In rare cases, more serious side effects of Prozac and Zoloft can occur. Seek emergency medical care if you experience the following: 

• Skin rash, hives, itching, peeling, or blistering skin

• Swelling of the face, eyes, lips, tongue, throat, hands, lower legs, ankles, or feet

• Changes in heartbeat (fast, slow, or irregular)

• Shortness of breath

• Difficulty breathing or swallowing

• Confusion, agitation, or hallucinations 

• Severe muscle stiffness or muscle twitching

• Dizziness or fainting

• Seizures

• Abnormal bleeding or bruising

What Are The Risks of Taking Antidepressants?

Suicidal Thoughts

SSRIs carry an FDA black-box warning for the risk of increased suicidal thoughts and behavior in people under 25 years old. This risk is especially high during the first few weeks of therapy and after dosage adjustments.

If you or a loved one experiences worsening depressive symptoms or has an increase in thoughts of self-harm, please contact the doctor immediately or get emergency help. 

Pregnancy and Breastfeeding

Tell your doctor if you are pregnant or breastfeeding before starting an antidepressant medicine. Prozac and Zoloft can affect newborn babies if they are taken during the last few months of pregnancy. 

Withdrawal Symptoms

Stopping antidepressants suddenly can cause withdrawal symptoms, such as a return of depression and anxiety, mood swings, dizziness, trouble sleeping, flu-like symptoms, and digestive issues. 

Do not stop taking the medication without discussing the risks and the benefits with your doctor first. Your healthcare provider can tell you how to lower the dose slowly.

Weight Gain on Prozac Vs Zoloft

Both Zoloft and Prozac may lead to weight changes, including weight loss and weight gain. Studies suggest that people gain slightly more weight on Zoloft compared to Prozac over time. 

Is Zoloft Sedating or Energizing?

Sleepiness and fatigue are common side effects of both medications. However, low energy is a common symptom of major depression, and by treating depression, Zoloft and other antidepressants can have an energizing effect. 

You should start to feel more energetic once your body adjusts to the antidepressant drug.

Dosage Guidelines

Prozac

The starting dose of Prozac in adults with major depressive disorder or obsessive-compulsive disorder is 20 mg once daily in the morning. The maximum dose of Prozac is 80 mg per day.

Zoloft 

The starting dose of Zoloft in adults with major depressive disorder, obsessive-compulsive disorder, and premenstrual dysphoric disorder is 50 mg once daily. 

The initial dose of Zoloft for adults with panic disorder, PTSD, and social anxiety disorder is 25 mg once daily.

The therapeutic maintenance dose range of Zoloft is between 50 mg and 200 mg per day.

Drug Interactions

Both Zoloft and Prozac can interact with various medications. Some examples include:

• Monoamine oxidase inhibitors (MAOIs)

• Migraine medications

• Antipsychotics

• St John’s Wort

• Other SSRIs or SNRIs (Selective Serotonin and Norepinephrine Reuptake Inhibitors)

• Tricyclic Antidepressants (TCAs)

These interactions can lead to serotonin syndrome, a potentially life-threatening condition due to too much serotonin in your body. Signs and symptoms of serotonin syndrome may include agitation, fever, excessive sweating, tremors, confusion, rapid heart rate, and significant fluctuation in blood pressure. You should seek emergency medical care if you experience any of these symptoms.