Switching from zoloft to Lexapro (Best switching strategies)

In this blog, we will talk about switching from zoloft to lexapro. We will also shed some light on reasons which lead to the change of antidepressant and best ways to switch safely. We will also compare the safety profiles of zoloft and lexapro.

Is it okay to switch from zoloft to lexapro?

For people who can not tolerate zoloft well, it is better to switch to a safer antidepressant, like lexapro. Your healthcare provider will determine the initial dose for lexapro and a suitable taper schedule for zoloft. 

Note: It is not advised to change your antidepressant without your doctor’s approval. 

3 things to know when you switch from zoloft to lexapro 

There are few things you need to understand before you switch from zoloft to lexapro. These include:

Your new antidepressant might take a few weeks to work

The new drug will not start working overnight. Your body will take its time to adapt to lexapro. Be patient. Don’t lose hope or think that no antidepressant is working for you. Just give it a few weeks, be consistent and maintain a healthy lifestyle. 

You may suffer from side effects 

Lexapro may produce some unwanted side effects at first, but as your body gets used to it, they will begin to subside. So don’t think that your new med doesn’t suit you, it’s just your body adapting to it. Hang in there! 

You may experience withdrawal symptoms

In case of completely washing out the zoloft, you might face withdrawal symptoms. The best way is to taper down zoloft slowly while starting lexapro from the lowest effective dose.

Common antidepressant switching strategies 

Antidepressants need a proper switching strategy to prevent the complications related to withdrawal syndrome (if you take away the med too quickly) or serotonin syndrome (if you start the next one too early). Let’s take a look at four antidepressant switching strategies: 

Direct switch 

Here, you stop one antidepressant and directly switch to another. This strategy is only applicable if you’re switching to a drug which belongs to the same class of antidepressants. You can also switch from SSRI to SNRI (Serotonin-norepinephrine reuptake inhibitors) through this strategy. 

Cross taper 

Here, you taper off one antidepressant while gradually increasing the dose of the next one, over a few weeks period. This is the preferred method when you switch to a drug that’s in a different antidepressant class.

Taper and switch right away

Here, you gradually taper off your current drug. As soon as you have completely stopped the first drug, you start taking the next one. 

Taper and switch, after washing out the first drug completely 

Here, you gradually taper off the first drug and wait a couple of weeks, usually 1-6 weeks, for your body to completely wash out the drug from your system, even traces. This strategy is most commonly used in case of Monoaminoxidase inhibitors (MAOI), to prevent serotonin syndrome. 

Is Lexapro safer than zoloft? 

One study suggests that escitalopram (Lexapro) has a better efficacy and tolerability profile, as compared to sertraline (zoloft) and paroxetine (Paxil). It is better tolerated by people and is often considered the safest SSRI. 

Side effects of lexapro

Common side effects of Lexapro include:

• Anorexia 
• Constipation or diarrhoea
• Sexual issues
• Difficulty in falling asleep
• Vertigo 
• Decreased salivation or dry mouth
• Sweating
• Anxiety 
• Infections caused by decreased immunity
• Nausea
• Shaking
• Weakness
• Sleepiness and fatigue

Some serious and rare side effects include:

• Angle-closure glaucoma causes symptoms like eye pain, vision changes, or swelling or redness in your eyes.
• It could cause low sodium levels which can result in psychological symptoms like confusion, agitation, inability to understand surroundings, memory loss etc.
• It can cause elongation of QT interval, causing increased heartbeat or arrhythmia
• Teeth grinding
• It may also put you at an increased risk for dangerous bleeding, especially when taken with medications such as nonsteroidal anti-inflammatories (NSAIDs), warfarin (an anticoagulant medication), or other anticoagulants. 

Dosage Forms

Lexapro (escitalopram) is available in tablet and liquid forms:

Lexapro tablet

Table is available in following strengths:

• 5 mg
• 10 mg
• 20 mg

Lexapro liquid

• 1 mg/ml

The starting dose for lexapro is 10mg, taken once a day, as recommended by your healthcare provider. Deciding an appropriate dose is necessary to achieve therapeutic response of the drug. If your dose is too low, your med will not provide enough support. 

If your dose is too high, your med will produce unwanted effects and might make you even more restless. It is extremely important to match your dose with the severity of your symptoms, in order to avoid therapeutic failure.

Overdose

Following are the symptoms of escitalopram overdose:

• Seizures 
• Unconsciousness or coma
• Vertigo 
• Drowsiness/sleepiness
• Hypotension (low blood pressure)
• Insomnia or poor quality of sleep
• Arrhythmia or irregular heartbeat 
• Nausea and vomiting 

It is important to monitor your dose closely. Do not deviate from the prescribed dose. Do not drink alcohol while you’re on antidepressants. The combination can make your symptoms or your side effects even worse. Cut back as much as you can. 

Recommended dose of lexapro

According to guidelines, following are the recommended doses of lexapro:

For Major Depressive Disorder

10 mg, once a day, is recommended for major depressive disorder. The dose may increase to 20 mg/day after 1 week. 

For Generalised Anxiety Disorder

10 mg, once a day, is recommended. The dose may increase to 20 mg/day after 1 week. It’s best to maintain therapy at the lowest effective dose. 

For Obsessive-Compulsive Disorder (Off-label)

10 mg, once a day. The dose may increase to 20 mg/day after 1 week. It’s best to maintain the lowest effective dose. 

For Vasomotor Symptoms Associated with Menopause (Off-label)

10 mg, once a day. The dose may increase to 20 mg once daily, after 4 weeks of treatment, if 10mg fails to provide adequate therapeutic response. 

Common reasons for switching antidepressants

It is not easy to switch antidepressants. Infact, they should be switched only when necessary. Your doctor might recommend another antidepressant for one of the following reasons:

Inadequate therapeutic response 

If your antidepressant is not living up to the expectations and it fails to provide relief from depression symptoms, your doctor might think of increasing the dose of the same antidepressant, as it’s not wise to blame the drug right away and jump to conclusions. 

Sometimes, it’s the dose that’s not working out for you. If the med fails to give an adequate therapeutic response even at high doses (even highest), now it’s time to switch. Your doctor will prescribe another antidepressant and follow proper switching strategy. 

Drug interactions

If your antidepressant is interfering with the effects or metabolism of some other medicines that you are taking along with it, it’s best to switch to another antidepressant that’s safe to use with your other prescribed medications. 

Side effects 

If your antidepressant is producing side effects which are not going away, even after 3 to 4 weeks of your treatment, you might need to change it. Your antidepressant should be well tolerated as you have to live with it everyday, for several months or even longer. 

Which antidepressant is best for you?

Finding the perfect antidepressant is one hell of a task. Some meds just don’t work for you. No matter how many times you try to increase the dose or take it in the best possible way, they just don’t work for you. This process takes a while. 

When you start an antidepressant, you need to give it a few weeks because these meds don’t work overnight, like analgesics which provide pain relief in an hour or two. Antidepressants usually take 3 – 4 weeks to start making changes in your system. 

They require proper adherence, or else they might not work the way you want them to. The medication itself is not solely responsible, as your body’s reaction to it plays a major role as well. 

So yes, there’s only one way to find the perfect antidepressant. You’ve got to try them! There’s no way to set a standard here, as your perfect antidepressant might not be so perfect for someone else. Stick to the one your doctor recommends.

Conclusion 

Zoloft and lexapro are both selective serotonin reuptake inhibitors. They both increase the availability of serotonin in synaptic cleft to enhance mood, cognition, reward, learning etc. 

Your doctor may recommend switching to another antidepressant, if the current one doesn’t work best for you. It usually takes a few trials to determine which antidepressant works best for you. Just stick to your doctor’s advice and do not deviate from it. 

Note: Don’t start, switch or stop any antidepressant on your own. 

FAQs: Switching from zoloft to lexapro

Can you switch directly from Zoloft to Lexapro?

In order to go from zoloft to lexapro, it’s best to taper off zoloft while gradually increasing the dose of the lexapro, over a few weeks period. 

Can you switch antidepressants without tapering?

One of the switching strategies includes direct switching. Here, you stop one antidepressant and directly switch to another. This strategy is only applicable if you’re switching to a drug which belongs to the same class of antidepressants. You can also switch from SSRI to SNRI (Serotonin-norepinephrine reuptake inhibitors) through this strategy. 

Which has less side effects Zoloft or Lexapro?

As, zoloft and lexapro belong to the same class of antidepressants, there’s not much of a difference in side effects, but lexapro has a better tolerability profile and is considered safer than other SSRIs. 

Is Lexapro good for anxiety?

Yes, Lexapro is good for anxiety and depression. It is well tolerated. 

Does Lexapro or Zoloft cause more weight gain?

Antidepressant associated weight gain and weight loss vary from person to person. If the drug decreases your appetite, you’re more likely to lose weight. If it spikes up your sugar cravings and makes you eat more, you end up gaining weight. 

Should I take 10mg or 20mg of Lexapro?

The recommended dose of lexapro is 10mg, once a day. Your healthcare professional suggests an appropriate dose for you, based on your symptoms and tolerability. Do not start, switch or stop antidepressants without your doctor’s approval. 

References 

• Antidepressant switching guidelines (1998) https://www.nps.org.au/assets/Products/Guidelines-switching-antidepressants_A3.pdf 
• Nicholas Keks, Director and Adjunct professor, Judy Hope, Deputy director and Senior lecturer, and Simone Keogh, Psychiatrist and senior fellow – Switching and stopping antidepressants https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919171/
• K. Outhoff – Switching antidepressants : review https://journals.co.za/doi/10.10520/EJC170556
• Strategies and Solutions for Switching Antidepressant Medications https://www.psychiatrictimes.com/view/strategies-and-solutions-switching-antidepressant-medications
• Overview – Antidepressants https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/overview/#:~:text=Antidepressants%20usually%20need%20to%20be,effects%20usually%20wear%20off%20quickly.
• Antidepressants: Selecting one that’s right for you https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273
• Escitalopram (Oral Route) https://www.mayoclinic.org/drugs-supplements/escitalopram-oral-route/side-effects/drg-20063707
• Connie Sanchez, Elin H. Reines and Stuart A. Montgomery (2014) – A comparative review of escitalopram, paroxetine, and sertraline: are they all alike? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047306/