Comparing Sertraline and Escitalopram

Prescribers weigh several things at once, and the reasoning below is illustrative, not a rule.

If a person has difficulty swallowing tablets, or needs a form that can be measured out, a doctor may consider that sertraline is supplied as a concentrate (liquid) as well as a tablet (MedlinePlus, undated). If a person's symptoms follow a monthly pattern, a doctor may take into account that sertraline has a labeled dosing pattern for premenstrual dysphoric disorder, taken either every day of the month or on certain days (MedlinePlus, undated).

If a person is an adolescent, a doctor may look at what each product's label covers: escitalopram capsules are indicated for major depressive disorder in adults younger than 65 and in pediatric patients 12 years of age and older (U.S. Food and Drug Administration, 2025). Separately, sertraline may decrease appetite and cause weight loss in children, and parents are advised to talk to the child's doctor about concerns regarding growth or weight (MedlinePlus, undated). Either way, medications in this class may increase the risk of suicidal thoughts and actions in children, teenagers and young adults under 24, with the risk more likely in the first few months of treatment and when the dose is increased (MedlinePlus, undated) — which is why close follow-up is part of the plan.

If a person takes a monoamine oxidase inhibitor, has taken one within the past 14 days, or takes pimozide, the escitalopram capsule label treats those combinations as contraindicated (U.S. Food and Drug Administration, 2025). If a person takes NSAIDs, aspirin, other antiplatelet drugs, warfarin or other anticoagulants, the same label notes an increased bleeding risk — serotonin is involved in platelet function, so blocking its reuptake can add to the effect of medicines that already reduce clotting (U.S. Food and Drug Administration, 2025). Bring your full medicine and supplement list to the appointment rather than deciding for yourself what interacts.

Serotonin syndrome most often occurs when two or more medicines that affect serotonin levels are taken together; both escitalopram and sertraline are listed among SSRIs that can contribute (MedlinePlus Medical Encyclopedia, undated). Neither drug is exempt from that consideration.

• Both drugs — increased sweating. Reported with sertraline (MedlinePlus, undated) and recorded in the escitalopram capsule label's adverse reaction table at 5% versus 2% on placebo (U.S. Food and Drug Administration, 2025).
• Both drugs — sexual side effects. With sertraline these include decreased sex drive, difficulty getting or keeping an erection, delayed or absent ejaculation, and delayed or absent orgasm (MedlinePlus, undated). Report these rather than stopping the medicine on your own.
• Sertraline — digestive effects. Nausea, diarrhea, heartburn and loss of appetite are listed (MedlinePlus, undated).
• Escitalopram — dry mouth. Reported in 6% of treated patients versus 5% on placebo in the capsule label (U.S. Food and Drug Administration, 2025).
• Sertraline — uncontrollable shaking of a part of the body (MedlinePlus, undated). Tell your doctor if this appears or worsens.
• Sertraline — drowsiness. Do not drive or operate machinery until you know how it affects you (MedlinePlus, undated).
• Both drugs — alcohol. Alcohol can make sertraline's side effects worse; ask your doctor about safe use of alcoholic beverages while taking either medicine (MedlinePlus, undated).
• Both drugs — low sodium, bleeding, heart rhythm changes and serotonin syndrome are listed among escitalopram's possible effects (Cleveland Clinic, undated), and serotonin syndrome is associated with SSRIs including sertraline (MedlinePlus Medical Encyclopedia, undated). Call your doctor promptly about unusual bruising or bleeding, confusion or marked weakness. Get emergency care for agitation with fever, muscle stiffness or a racing heartbeat, or for fainting.
• Sertraline — angle-closure glaucoma, in which fluid is suddenly blocked from leaving the eye, raising eye pressure quickly and possibly leading to vision loss (MedlinePlus, undated). Sudden eye pain or change in vision is also listed for escitalopram (Cleveland Clinic, undated). Treat sudden eye pain or vision change as a reason to seek emergency care.
• Both drugs — allergic reactions. Rash, itching, hives and swelling of the face, lips, tongue or throat are listed for escitalopram (Cleveland Clinic, undated). Swelling of the face, lips, tongue or throat, or trouble breathing, is an emergency.
• Both drugs — new or worsening thoughts of suicide or self-harm (MedlinePlus, undated; Cleveland Clinic, undated). Seek emergency care for thoughts of acting on self-harm; contact your prescriber the same day for new or worsening thoughts without immediate danger.

Serious side effects can be reported by you or your doctor to the FDA's MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088 (MedlinePlus, undated).