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Fluoxetine vs Sertraline

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Fluoxetine Details

Sertraline Details

Comparative Analysis

Fluoxetine Prescription Information

Sertraline Prescription Information

Fluoxetine Side Effects

Sertraline Side Effects

Safety and Precautions

Cost Analysis

Market Analysis



For those dealing with major depressive disorder (MDD) or different forms of depression, specific antidepressants capable of modifying the levels of brain chemicals tied to mood - known as neurotransmitters - can assist in managing symptoms and stabilizing depressive lows. Fluoxetine and Sertraline are two such drugs frequently prescribed for treating depression. Both influence varying neurotransmitters within the brain but have a common outcome: mood stabilization in depressed patients. Fluoxetine, commonly marketed under the brand name Prozac, belongs to a class of drugs called selective serotonin-reuptake inhibitors (SSRIs), primarily influencing serotonin levels. On the other hand, Sertraline is also an SSRI that affects serotonin concentrations but has other secondary mechanisms which might impact its effectiveness and side effect profile differently than Fluoxetine.

Fluoxetine vs Sertraline Side By Side

Brand NameProzacZoloft
ContraindicationsShould not be taken with or have recently taken monoamine oxidase inhibitors (MAOIs)Should not be taken with or have recently taken monoamine oxidase inhibitors (MAOIs)
CostApproximately $0.05 to $0.90 per day for generic versionsApproximately $0.28–$1 per day for generic versions
Generic NameFluoxetineSertraline
Most Serious Side EffectWorsening of depression or suicidal thoughts, signs of an allergic reaction, vision changes, fast or irregular heart rate, symptoms of low sodium levels, severe nervous system reaction, symptoms related to serotonin syndromeSigns of an allergic reaction, severe skin reaction, unusual changes in mood or behavior, changes in vision, quickened or irregular heartbeat, symptoms of serotonin syndrome, signs indicating low levels of sodium in the blood
Severe Drug InteractionsMonoamine oxidase inhibitors (MAOIs)Monoamine oxidase inhibitors (MAOIs)
Typical Dose20 mg per day, up to a maximum of 80 mg per day50 mg/day, up to a maximum of 200 mg/day

What is Fluoxetine?

Sertraline (the generic name for Zoloft) is another commonly prescribed drug in the SSRI class of antidepressants that was approved by the FDA in 1991, a few years after Fluoxetine. Like Fluoxetine, Sertraline functions by increasing levels of free serotonin within the brain by inhibiting its reuptake—essentially allowing it to remain active and available for longer periods. This medication is also frequently utilized in treating various forms of depression along with other mental health conditions like obsessive-compulsive disorder and anxiety disorders. Similar to Prozac, Zoloft has a selective impact on serotonin with minimal influence on dopamine and norepinephrine neurotransmitters; hence, it tends to have fewer side effects compared to other antidepressants which exert stronger influences on these two other neurotransmitters. However, every individual reacts differently to medications so consulting your healthcare provider about potential side effects is always recommended.

What conditions is Fluoxetine approved to treat?

Fluoxetine is approved for the treatment of various mood and anxiety disorders, including:

  • Major depressive disorder (MDD), commonly known as unipolar depression
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder with or without agoraphobia
  • Bulimia nervosa
  • Premenstrual dysphoric disorder (PMDD)

Similarly, Sertraline is also prescribed for a wide range of mental health conditions:

  • Major depressive disorder (MDD)
  • Social anxiety disorder
  • Post-traumatic stress disorder (PTSD)
  • Panic Disorder -Premenstrual dysphoric disorder(PMDD) -Obsessive-compulsive Disorder(OCD)

Both Fluoxetine and Sertraline belong to the same class of medication called selective serotonin reuptake inhibitors(SSRIs). They work by increasing levels of a mood-enhancing chemical called serotonin in the brain. However, they might differ slightly in terms of side effects profile and how long it takes them to start working.

How does Fluoxetine help with these illnesses?

Sertraline, like fluoxetine (Prozac), is a selective serotonin reuptake inhibitor (SSRI) and works to manage depression by increasing the amount of serotonin in the brain's synapses. It achieves this by preventing the neurotransmitter from being taken up again by nerve cells, thus enabling it to remain active for longer periods. Serotonin, an important neurotransmitter that transmits signals between neurons, plays a vital role in regulating mood, memory function, sleep patterns, appetite and body temperature among other things. In people with depression, levels of serotonin are often found to be lower than normal. By boosting serotonin levels in the brain's neural pathways using sertraline or fluoxetine can help mitigate depressive symptoms and stabilize mood effectively.

What is Sertraline?

Sertraline, marketed under the brand name Zoloft among others, is a selective serotonin reuptake inhibitor (SSRI), which means it increases levels of serotonin in the brain by reducing its reabsorption. It also has a minimal effect on norepinephrine and dopamine reuptake. First approved by the FDA in 1991, sertraline differs from other SSRIs like fluoxetine (Prozac) due to its pharmacodynamic properties.

While both drugs are effective for treating depression and anxiety disorders, their side-effect profiles differ slightly. Unlike fluoxetine, sertraline is less likely to cause agitation or insomnia due to its mild sedative effects and is generally better tolerated with fewer drug interactions.

The effectiveness of Sertraline can be beneficial for individuals suffering from major depressive disorder as well as other mood disorders such as obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder and premenstrual dysphoric disorder.

What conditions is Sertraline approved to treat?

Sertraline is recognized by the FDA for its effectiveness in treating a range of conditions, including:

  • Major depressive disorder (MDD)
  • Obsessive-compulsive disorder (OCD)
  • Panic Disorder
  • Social anxiety disorder
  • Post-traumatic stress disorder (PTSD) Additionally, sertraline is also prescribed to manage premenstrual dysphoric disorders.

How does Sertraline help with these illnesses?

Serotonin is a neurotransmitter that plays a key role in regulating mood, sleep and appetite. Low levels of serotonin have been linked to depression. Sertraline works by increasing the levels of serotonin available in the brain, thereby helping to alleviate symptoms of depression and anxiety. Its specific action on only serotonin makes it an SSRI (Selective Serotonin Reuptake Inhibitor), which typically results in fewer side effects than older types of antidepressants. While fluoxetine also acts on serotonin, sertraline has shown to be more effective for certain conditions like panic disorder and social anxiety disorder, leading many doctors to prefer prescribing it when patients do not respond well or are expected not to respond well based on their specific condition or symptom profile.

How effective are both Fluoxetine and Sertraline?

Both fluoxetine (Prozac) and sertraline (Zoloft) are selective serotonin reuptake inhibitors (SSRIs), with a proven track record in treating depression. The FDA approved them within four years of each other, and they exert their effects by increasing the levels of serotonin in the brain. Direct comparisons between these two drugs have shown that both have similar efficacy in alleviating symptoms of depression as well as comparable safety profiles. In several studies, there were no significant differences observed when measuring various metrics to gauge the effectiveness of treatment for patients on either drug.

A 2002 meta-analysis demonstrated that fluoxetine is effective at relieving symptoms of depression from the first week onward, has a favorable side effect profile compared to many other antidepressants, and is well-tolerated among different patient groups including older individuals and pregnant women. It also highlighted that fluoxetine was one of the most widely prescribed antidepressant medications worldwide at the time due to its early development among SSRIs and extensive research backing up its usage.

On the other hand, a systematic review conducted in 2010 indicated that sertraline had similar or slightly superior efficacy than placebo in treating depressive disorders while sharing an almost identical efficacy level with other common SSRIs like fluoxetine. However, it's noteworthy that some patients may prefer sertraline due to fewer withdrawal reactions after discontinuation compared to certain SSRIs such as paroxetine or venlafaxine.

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At what dose is Fluoxetine typically prescribed?

Oral dosages of Fluoxetine (Prozac) typically start from 20 mg per day, and research has shown this to be an effective dosage for treating major depressive disorder in the majority of people. For children and adolescents starting on this medication, the recommended dose is often lower at 10 mg per day. If there's no response after a few weeks, the dosage can be increased under medical supervision. However, it's crucial that the maximum dosage does not exceed 80 mg per day.

Similarly, Sertraline (Zoloft), another selective serotonin reuptake inhibitor (SSRI) used to treat depression and other mood disorders starts with a common initial dose for adults at 50 mg/day. For children aged six years or older dealing with obsessive-compulsive disorder (OCD), an initial dose could range between 25–50mg/day; however, every individual varies so always consult your healthcare provider before changing doses. It should also be noted that regardless of age or condition being treated with Sertraline, one must never exceed a daily dose of 200 mg.

At what dose is Sertraline typically prescribed?

Sertraline treatment is typically initiated at a dose of 50 mg/day. Depending on the patient's response and tolerability, the dose can then be increased to a maximum of 200 mg/day, taken as a single daily dose in either the morning or evening. It should be noted that dosage adjustments should occur at intervals of no less than one week since the full effects of Sertraline are not seen until after several weeks of therapy. If there is no significant improvement in symptoms after several weeks at this higher dosage, further consultation with your healthcare provider may be necessary for additional treatment strategies.

What are the most common side effects for Fluoxetine?

Common side effects of sertraline can include:

  • Nervousness and anxiety
  • Insomnia or somnolence (sleepiness, drowsiness)
  • Tremor (unintentional trembling or shaking)
  • Decreased appetite
  • Nausea and dyspepsia (burning sensation, discomfort, or pain in the upper abdomen)
  • Diarrhea
  • Dry mouth
  • Sweating more than usual
  • Decreased libido (sex drive) and other sexual problems such as delayed ejaculation and inability to reach orgasm
  • Rash
  • Feeling tired or fatigued Uncommon but possible effects may also include abnormal dreams. If you experience symptoms like these for a prolonged period, it's essential to seek medical attention.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Fluoxetine?

While both Fluoxetine and Sertraline are selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety, they can have different side effects. With Sertraline, it's important to watch out for:

  • Worsening of depression or suicidal thoughts
  • Signs of an allergic reaction: hives; difficult breathing; swelling in your face, lips, tongue, or throat
  • vision changes such as seeing rainbows around lights at night
  • Fast or irregular heart rate, feeling light-headed
  • Symptoms associated with low sodium levels - headache, confusion, severe weakness, vomiting, loss of coordination
  • Severe nervous system reaction - rigid muscles, high fever sweating confusion rapid heartbeat
  • Symptoms related to serotonin syndrome which may include restlessness hallucinations fever fast heartbeat muscle stiffness twitching loss of coordination nausea vomiting diarrhea

If you experience any of these symptoms while on Sertraline treatment it is essential that you seek immediate medical attention.

What are the most common side effects for Sertraline?

The side effects of Sertraline might include:

  • Dry mouth or increased salivation
  • Upset stomach, diarrhea, or mild nausea
  • Sleep problems (insomnia), drowsiness
  • Sweating and a feeling of nervousness or restlessness
  • Weight changes
  • Mild tremor
  • Delayed ejaculation, decreased libido
  • Headache, dizziness -Muscle pain.

It's important to remember that not all patients experience these side effects and they often lessen over time as the body adjusts to the medication. Always discuss potential side effects with your healthcare provider before starting a new medication.

Are there any potential serious side effects for Sertraline?

While Sertraline is generally well-tolerated, it can in rare instances lead to serious side effects. If you notice any of the following symptoms while on Sertraline, seek immediate medical attention:

  • Signs of an allergic reaction including hives; difficulty breathing; swelling of your face, lips, tongue or throat
  • Any signs indicative of a severe skin reaction such as fever, sore throat, burning eyes, skin pain or a red/purple rash that spreads and causes blistering/peeling
  • Unusual changes in mood or behavior
  • Changes in vision like blurred vision and seeing halos around lights
  • Quickened heart rate or irregular heartbeat
  • Symptoms suggestive of serotonin syndrome: agitation, hallucinations (seeing things), coordination problems (overactive reflexes), rapid heart rate, increased body temperature
    Remember to also watch for signs indicating low levels of sodium in the blood which includes headache confusion memory issues weakness instability leading to falls.

Contraindications for Fluoxetine and Sertraline?

Both fluoxetine and sertraline, like most other selective serotonin reuptake inhibitor (SSRI) antidepressants, may exacerbate symptoms of depression in some individuals. If you observe an intensification of your depression, or a rise in suicidal thoughts or behaviors, it is crucial to seek immediate medical attention.

Neither fluoxetine nor sertraline should be taken if you are currently using, or have recently used monoamine oxidase inhibitors (MAOIs). It's vital to always inform your doctor about any medications you're taking; MAOIs will require a washout period of approximately 5 weeks to eliminate from the system before starting treatment with either fluoxetine or sertraline to avoid potentially dangerous drug interactions.

How much do Fluoxetine and Sertraline cost?

For the brand-name versions of these drugs:

  • The price for 30 tablets of Zoloft (50 mg), which contains sertraline, averages around $320. This works out to approximately $10-$20/day, depending on your dose.
  • On the other hand, a package of 30 capsules of Prozac (20 mg) is priced at about $570. Thus, this medication comes down to roughly $19/day.

If you are in the higher dosage range for Zoloft (i.e., 200 mg/day or more), then brand-name Prozac might be less expensive on a per-day treatment basis. However, cost should not be the main factor when deciding between these two medications.

As for generic versions:

  • Sertraline can be purchased in packs starting from 30 tablets and up with costs ranging from approximately $0.28–$1 per day if dosages vary between 50mg/day and upwards to as much as 200mg/day.

  • Fluoxetine is available in packages that start from small counts like 15 all the way up to larger counts such as1000 capsules (each capsule containing about 20 mg). If you purchase larger amounts upfront your daily cost could begin as low as $0.05 and go up till nearly just under a dollar ($0.90).

Popularity of Fluoxetine and Sertraline

Sertraline, commonly recognized by its brand name Zoloft, was estimated to have been prescribed to nearly 40 million people in the US in 2020. Sertraline accounted for nearly 28% of SSRI prescriptions and just over 14% of overall antidepressant prescriptions in the United States. This makes sertraline one of the most frequently prescribed selective serotonin reuptake inhibitors (SSRIs) in the country.

Fluoxetine, including brand versions such as Prozac, was administered to roughly 4.7 million individuals in America throughout that same year. In terms of SSRIs specifically within the US, fluoxetine represents slightly less than a fifth at approximately 20%, and roughly under a tenth or about 10% when it comes to total antidepressant prescriptions across all classes. Over the past decade leading up until now, fluoxetine's prevalence has remained relatively steady with no drastic shifts.


Both Fluoxetine (Prozac) and Sertraline (Zoloft) are widely used in managing depression, with numerous clinical studies supporting their effectiveness over placebo treatments. They can be combined under certain circumstances, but this requires careful evaluation by a healthcare provider as they may interact with each other. The primary mechanism of action for both drugs is similar - they inhibit the reuptake of serotonin into presynaptic cells, increasing the amount of serotonin available to bind to the postsynaptic receptor.

Fluoxetine is often a first-line treatment option due to its long-standing use and extensive research base. Sertraline might also be considered as an initial treatment or in patients who did not respond well to fluoxetine or have specific needs like managing anxiety symptoms along with depression.

Both medications are available in generic form which provides significant cost savings especially for patients paying out-of-pocket. There may be an adjustment period required when starting these medications during which effects might not become apparent immediately.

While side effect profiles are somewhat similar between these two SSRIs; nausea, diarrhea, sleep problems and sexual dysfunction being common ones; sertraline tends to cause less trouble sleeping than fluoxetine. Patients must closely monitor their moods while on these medications especially when commencing therapy and should seek medical help promptly if experiencing worsening depression or suicidal thoughts.