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Last updated: Jul 26, 2021
6 min read

Celexa vs. Zoloft: similarities and differences

felix gussonePatricia Weiser PharmD

Medically Reviewed by Felix Gussone, MD

Written by Patricia Weiser, PharmD

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Whether you’re considering starting treatment with an SSRI antidepressant, or if you’ve been taking one for a while, you may be wondering if you’re taking the best drug for you. As you read about the similarities and differences between SSRIs, keep two key things in mind: all SSRIs take several weeks to start working, and individual results can vary. 

Read on to learn more about two SSRIs: Celexa and Zoloft.

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What are Celexa and Zoloft?

Celexa (citalopram) and Zoloft (sertraline; see Important Safety Information) are antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs). They’re only available with a prescription from your healthcare provider.

Our bodies naturally make serotonin, the “feel-good hormone.” Serotonin acts as a chemical messenger that communicates signals from one brain cell to another. These signals play a major role in many brain functions, including mood, appetite, fear, sleep, and sexual behavior (Sahli, 2016). Depression is thought to be associated with low levels of serotonin. 

SSRIs work by blocking the absorption of serotonin into cells, increasing the amount available. Decades of clinical studies show that SSRIs can be an effective part of treating depression and anxiety disorders, especially when used in combination with therapy and lifestyle changes.

The Food and Drug Administration (FDA) has issued a warning that antidepressant medications, including SSRIs, may increase the risk of suicidal thoughts and behaviors, mainly in children, teens, and young adults up to age 25. Because of this, healthcare providers will monitor SSRI treatment in this age group carefully, especially when the drug is first started or after the dose increases (Chu, 2021). 

If you’re starting treatment with Celexa or Zoloft, it’s important to know that neither of these drugs starts working immediately. Taken once a day, it takes at least two weeks before SSRIs begin making a noticeable difference for most people. It can take up to four to six weeks for SSRIs to reach their full level of effectiveness. Because of this, it’s best to take your medication every day, around the same time each day, without skipping doses, as instructed by your healthcare provider (Chu, 2021).

What is Celexa?

Celexa is the brand-name version of the generic drug citalopram. It was FDA-approved in 1998. Celexa comes in two forms: an oral tablet (10 mg, 20 mg, and 40 mg) and an oral liquid solution (10 mg/5 mL) (Allergan, 2019). 

What is Zoloft?

Zoloft is the brand name of the generic drug sertraline, and the FDA originally approved it in 1991. It comes in two forms: an oral tablet (25 mg, 50 mg, and 100 mg) and an oral liquid solution (20 mg/mL). Zoloft is usually taken once a day (Pfizer, 2016).

Conditions treated with Celexa and Zoloft

While Celexa and Zoloft work similarly, the FDA approves them for different conditions.

Celexa

The FDA-approved uses of Celexa in adults include (Allergan, 2019):

Off-label (not FDA-approved) uses for Celexa include (Sharbaf Shoar, 2021):

  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Generalized anxiety disorder (GAD)
  • Social anxiety disorder (SAD)
  • Separation anxiety disorder 
  • Premenstrual dysphoric disorder (PMDD)

Zoloft

Zoloft’s FDA-approved uses in adults (and children when age is specified) include (Pfizer, 2016):

Off-label (not FDA-approved) uses for Zoloft include (Singh, 2020):

Side effects

Like all medications, Celexa or Zoloft can cause mild or severe adverse effects. To minimize the risk of side effects, your healthcare provider may recommend starting with a lower dose of Celexa or Zoloft. Then, after at least one week, it’s common that they’ll increase your dosage. This approach helps your body adjust to taking a new medication (Pfizer, 2016; Allergan, 2019). 

For most people, some common side effects of Celexa and Zoloft, such as nausea, tend to go away on their own after the first few weeks of treatment (Kelly, 2008).

The following section lists the most common side effects of Celexa and Zoloft. These lists do not include all of the possible side effects. Not everyone who takes Celexa or Zoloft develops side effects.

Celexa side effects

The only side effect reported in at least 5 % of participants who took Celexa in clinical studies was ejaculation problems (such as delayed ejaculation) in those assigned male sex at birth (Allergan, 2019).

Other possible side effects of Celexa include (Allergan, 2019):

  • Nausea
  • Sleepiness
  • Weakness
  • Dizziness
  • Nervousness
  • Insomnia
  • Sexual problems (see next section for details)
  • Sweating
  • Shaking
  • Not feeling hungry
  • Dry mouth
  • Constipation
  • Diarrhea
  • Respiratory infections
  • Yawning

Zoloft side effects

The most common side effects of Zoloft include (Pfizer, 2016):

  • Nausea
  • Diarrhea or loose stool
  • Indigestion
  • Reduced hunger
  • Shaking
  • Increased sweating
  • Sexual problems (see next section for details)

Sexual side effects

Sexual side effects can happen with all SSRIs, and some are more common if you take a high dose. If you’re experiencing sexual side effects, it’s important to talk with your healthcare provider. They might adjust your dosage, change your medication, or suggest treatment options such as Viagra (sildenafil) to help you (Jing, 2016).

Sexual side effects that are most common with Celexa include (Allergan, 2019):

Zoloft’s most common sexual side effects are (Pfizer, 2016):

  • Failure to ejaculate
  • Decreased sex drive

Withdrawal symptoms

If you and your healthcare provider decide that you should stop taking Celexa or Zoloft, they’ll instruct you on how to gradually reduce your dose before stopping. Suddenly stopping these medications can cause side effects known as withdrawal symptoms.

The most common withdrawal symptoms include nausea, vomiting, diarrhea, headache, light-headedness, dizziness, loss of appetite, sweating, drowsiness, chills, shaking, lack of energy, and trouble sleeping (Sharbaf Shoar, 2021). 

Potential drug interactions

Some medications can interact with SSRIs. If you’re taking Celexa or Zoloft, it’s essential to consult your pharmacist or healthcare provider before taking any new medications, including over-the-counter drugs or dietary supplements.

Bleeding risk

The combination of SSRIs with certain medications can increase the risk of bleeding. This can cause bruising easily, excessive nosebleeds, injuries that take a long time to stop bleeding, or severe stomach ulcers or bleeding. To avoid this, it’s best to avoid medications known to make blood thinner while taking SSRIs. Some examples to avoid include:

  • Aspirin
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
  • Anticoagulant drugs, commonly called blood-thinners, such as warfarin (Coumadin)
  • Antiplatelet drugs, such as clopidogrel (Plavix)

Serotonin syndrome

Serotonin syndrome is a rare but serious risk that comes with SSRIs, but combining certain drugs can further increase this risk. SSRIs work by increasing the availability of serotonin in your brain. However, if serotonin levels become too high, you could develop serotonin syndrome, ranging from mild to life-threatening. Symptoms of serotonin syndrome include nausea, vomiting, excess sweating, dizziness, changes in heart rate or blood pressure, increased body temperature, tremor, muscle stiffness, or seizures. 

Several types of medications increase the risk of serotonin syndrome and should generally be avoided with SSRIs, such as (Pfizer, 2016):

  • Other types of antidepressants, including tricyclic antidepressants such as amitriptyline (Elavil)
  • Buspirone (Buspar)
  • Amphetamines, such as Adderall
  • Triptans, such as sumatriptan (Imitrex) 
  • Fentanyl (Duragesic)
  • Lithium
  • Tramadol (Ultram)
  • St. John’s Wort, an herbal remedy that’s advertised to support mental health
  • Monoamine oxidase inhibitors (MAOIs), such as linezolid (Zyvox). You must wait at least 14 days after stopping an MAOI to start any SSRI (and vice-versa).

Heart arrhythmias

When certain drugs are combined, they increase the risk of a rare but serious heart rhythm problem known as QT-prolongation. All SSRIs carry a risk of affecting the electrical activity in your heart, but this risk is higher with Celexa. Because of this risk, certain drugs shouldn’t be combined with Celexa, particularly if you are taking a high dose (20 mg or more per day). Some examples include (Allergan, 2019):

  • Certain heart medications, such as amiodarone (Cordarone) and sotalol (Betapace)
  • Antipsychotic drugs, such as pimozide (Orap)
  • Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) and moxifloxacin (Avelox)
  • Methadone (Dolophine)

If your healthcare provider deems it medically necessary for you to take any of these medications with Celexa, they’ll monitor your heart more carefully. Be sure to let your healthcare provider know right away if you develop dizziness, light-headedness, or heart palpitations. 

Similarities and differences of Celexa vs. Zoloft

We’ve given you a lot of information regarding the differences and similarities between these two SSRIs medications. Here is a summary:

References

  1. Allergan. (2019). Celexa (citalopram) tablets. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020822s051lbl.pdf
  2. Chu, A. & Wadhwa, R. (2021). Selective serotonin reuptake inhibitors. [Updated May 10, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554406/
  3. Jing, E. & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. The Mental Health Clinician, 6(4), 191–196. doi: 10.9740/mhc.2016.07.191. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007725/
  4. Kelly, K., Posternak, M., & Alpert, J. E. (2008). Toward achieving optimal response: understanding and managing antidepressant side effects. Dialogues in Clinical Neuroscience, 10(4), 409–418. doi: 10.31887/DCNS.2008.10.4/kkelly. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181894/
  5. Pfizer. (2016). Zoloft (sertraline hydrochloride) tablets, for oral use. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839S74S86S87_20990S35S44S45lbl.pdf
  6. Sahli, Z. T., Banerjee, P., & Tarazi, F. I. (2016). The preclinical and clinical effects of vilazodone for the treatment of major depressive disorder. Expert Opinion on Drug Discovery, 11(5), 515–523. doi: 10.1517/17460441.2016.1160051. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841022/
  7. Sharbaf Shoar, N., Fariba, K., & Padhy, R. K. (2021). Citalopram. [Updated Feb 19, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482222/
  8. Singh, H. K. & Saadabadi, A. (2020). Sertraline. [Updated Nov 22. 2020]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547689/