IRFANA PARVEEN
By Irfana Parveen

B.Sc (Psychiatry Ward)

25 November 2021
Medically reviewed by
Sumayya Salam
Pharm D
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Table of Contents

Every year, about 7% of Americans have a major depressive episode, and many receive antidepressant prescriptions to address their symptoms. It can be challenging to decide which medication to use to treat your depression, as there are several options for treating the condition. Even selecting between well-known drugs like Prozac and Zoloft can be very difficult.

Zoloft and Prozac are widely used antidepressants for treating mental health problems such as depression and panic attacks. These two drugs are selective serotonin reuptake inhibitors (SSRI), which stop neurons from reabsorbing serotonin and raise serotonin levels in the brain. As the amount of serotonin in the brain increases, the symptoms of anxiety and depression improve.

Although Prozac and Zoloft are quite similar, they have some differences that can make one a better option than the other for each person. But which of them is more effective- Zoloft or Prozac? Let us know more about it.

What is Zoloft (Sertraline)?

Zoloft is a member of the drug group known as Selective Serotonin Reuptake Inhibitors (SSRI). It treats various mental health problems suffered by an individual, such as depression and anxiety disorders.  

Sertraline is the generic name of Zoloft. It is an SSRI, FDA-approved for treating OCD in children and adolescents ages 6 to 12, individuals over 18, and adults with depression. Both the brand-name and generic versions are available with a prescription. It was approved in 1991, and since it has been used widely for managing mental health problems.

Use Of Zoloft

As discussed earlier, Zoloft is an SSRI (Antidepressant) that works in treating mental health problems. It is primarily prescribed for the medication of major depressive disorder. It is also used to treat panic disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).

Zoloft can also be used as a combination therapy. It also acts as a medication for premenstrual dysphoric disorder in women. 

Other Off label uses of Zoloft include binge-eating disorder, bulimia nervosa, and generalized anxiety disorder (GAD).

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What is Prozac?

Prozac is also a member of the drug class Selective Serotonin Reuptake inhibitors (SSRI) and is used to treat mental health issues. It is generically known as Fluoxetine. Prozac was approved in the year 1987. It is used as an effective medicine for the treatment of depression and other mental problems. (Sohel AJ, Shutter MC, Molla M)

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Use of Prozac:

Prozac is an antidepressant drug. It helps treat major depression, panic disorder, and social anxiety problems. Prozac is significantly used to treat Bulimia Nervosa. 

It is an eating disorder in which a person follows binge eating patterns and consumes food in large quantities. Prozac can also be used along with Zyprexa during the treatment of Bipolar Disorder to reduce manic depression

How Does Zoloft Work?

Sertraline is the active ingredient present in Zoloft. It works as a treatment for depression by increasing the level of certain natural substances in the brain called Serotonin. They accomplish this by preventing the recycling of released serotonin back into the nerve terminals. 

Serotonin, often known as "5HT," is a neurotransmitter that occurs naturally and plays a significant role in the parts of the brain that regulate mood and thought. Serotonin helps the brain to maintain a proper balance of mental health. It helps in reducing overthinking and the urge to do repetitive tasks 

How Does Prozac Work?

Prozac has Fluoxetine as its active ingredient present. It acts against depression and mental health issues by affecting the chemical messengers called neurotransmitters which send signals to brain cells. It helps to improve mood and increases appetite, energy level, and sleep, which distracts people from mental problems. It provides rest to the brain by discontinuing the signals sent to it.

Fluoxetine is a phenylpropylamine that blocks serotonin reuptake in neurons, which probably directly affects its antidepressant effects. It has the power to improve mood and get rid of anxiety and stress. It has no sedative properties. It is preferable to use fluoxetine when the side effects of other antidepressants, such as sedation, hypotension, and anticholinergic effects, are detrimental to the patient's health.

No, you cannot take Zoloft and Prozac together. Since they are both SSRIs, taking them together can cause dangerously high amounts of serotonin to accumulate in your body. It can lead to the potentially fatal condition known as serotonin syndrome.
Prozac and Zoloft are not available over the counter. You will require a consultation with your doctor and a prescription before you can buy Zoloft or Prozac.
It can take up to 4 to 6 weeks of consistent doses for Zoloft (sertraline) to fully treat depression. The initial effects may start within the first one to two weeks of medication. Certain patients may need more time.

Dosages Of Zoloft And Prozac 

Medication is only effective when it reaches its site of action. There are some cases where only a particular route of administration is possible, hence the pharmaceutical dosage forms are crucial in treating various ailments. Therefore, different routes of drug administration and dosage forms are used according to the treatment. 

Zoloft

Zoloft is an oral medication and is available in the form of tablets and liquids. It can be taken with or without food once in the morning or the evening.

The starting dose of Zoloft for adults should be 50 mg for MDD, OCD, and PMDD in women, while 25 mg is the ideal starting dose for PTSD and SAD.

Depending upon the response and tolerability, it can range up to 50-200 mg as the treatment proceeds. 

For children below 12, the dosage amount is 25 mg, while for the age group 13-17, it can be 50 mg. 

A proper dose-measuring device should be used for Zoloft liquid and should be diluted first with any liquid such as water, ginger ale, and orange juice before use.  

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Prozac

Prozac is also an oral medication that is available as tablets, capsules, and liquids for consumption. 

The initial dosage of Prozac for adults should be 20 mg per day.

It can be changed to a 20 mg dose once or twice a daily, depending upon the improvement and response. 

The maximum daily consumption of Prozac should not be greater than 80 mg.

The initial dosage for children can be 10 mg per day, increasing to 20 mg daily after several weeks. 

For the treatment of Bulimia, 60 mg per day is the ideal dosage. 

Who Should Not Take it:

Zoloft

One should not take Zoloft if:

1. Allergic to Sertraline

2. Using MAO inhibitor 

3. Liver or kidney disorders

4. Bleeding problems

5. Seizures

6. Herbal medicines

7. Bipolar disorder

8. Asthma

9. Using NSAIDs

10. Women in their last three months of pregnancy 

11. Breastfeeding women

Prozac

One should not take Prozac if:

1. Taking any other antidepressants

2. Having asthma and heart problems

3. Consuming narcolepsy medicine

4. Having MAO inhibitors

5. Allergic to Fluoxetine       

6. Liver problems

7. Problems in urination

8. Diabetes

9. Glaucoma

10. Below the age of 18

11. Women in their last three months of pregnancy

12. Breastfeeding women

Pregnant women can take Zoloft and Prozac only when needed and prescribed by the doctor. 

One should inform the doctor about his entire medical history and allergies before taking the medicines to eliminate the risk of adverse effects.

Which is More Effective?

Zoloft and Prozac are both antidepressants and work for the exact cause. It can take a few weeks for both Prozac and Zoloft to make a difference in your depression symptoms. They help individuals deal with their mental health problems and maintain an optimal mental balance. 

Prozac and Zoloft are equally effective at treating the signs and symptoms of depression. Compared to a placebo, both Zoloft and Prozac relieve symptoms and improve quality of life.

Studies related to Zoloft and Prozac Use

A study by E.Aguglia Et al. evaluated the efficacy of Zoloft and Prozac in treating major depression in a total of 88 patients. Forty-eight people received a 72 mg dosage of Zoloft, while the remaining 40 received a 28 mg dosage of Prozac.

Significant improvement was seen in both drug groups, and there was no major difference. The incidence of adverse events was about 40.4% in the Zoloft group and 39.3% in the Prozac group. Prozac group participants faced adverse effects at a higher intensity compared to the Zoloft group. But both the medicine groups were equally effective and showed similar results.

Most of the side effects and drug interactions associated with both these drugs are common. According to a study in the Journal of Clinical Medicine 2016, long-term use of Zoloft can result in a substantial increase in weight than that of Prozac. The study found that patients using Prozac for two years gained an average of 4.6 pounds. However, over the same two-year period, persons taking Zoloft put on an average of 10.5 pounds.

Prozac has an advantage over Zoloft as it can also be used as a medication for Bulimia. Still, on the other side, Zoloft can be used as a combination therapy, unlike Prozac.

Prescription of Zoloft and Prozac depends upon the doctor and how your body will react to them. But both Zoloft and Prozac are equally effective antidepressants. One should consult the doctor and convey the medical history to the proper selection of medicine between Zoloft and Prozac.

Side Effects

These are undesired side effects that may be associated with a drug. The severity of side effects might range from mild discomforts like a runny nose to potentially fatal situations like a heart attack or liver damage.

Age, the use of additional medications, vitamins, or dietary supplements, as well as other underlying diseases or disorders, can all affect whether a patient experiences side effects when taking a medication.

Zoloft

Following are the common and serious side effects observed after the medication of Zoloft:

Common

Serious

Nausea

Seizures

Indigestion

Allergic reactions like itching, rash

Sweating

Difficulty in breathing

Loss of interest in sex

Changes in vision

Tremores

Problems in memory

Tiredness

Increased energy

Headache

Hallucination

Prozac 

Following are some of the common and serious side effects of taking Prozac:

Common

Serious

Headaches

Suicidal thoughts

Sleep problems

Allergic skin reactions

Pain and weakness

Constant mood changes

Loss of appetite

Hyperactivity

Decreased sex interest

Trouble breathing

Dry mouth

Shivering

Diarrhea

Loss of coordination

Restlessness

Irregular heart rate

Precautions To be Taken 

These are preventive steps for medications to avoid undesired events. Precautions are  necessary for the safe use of drugs. When using prescription medicine, it is essential to take the advised safety precautions to prevent abuse.

Zoloft

  • Take Zoloft as directed by your doctor. The dosage of Zoloft may need to be adjusted by your doctor until it is suitable for you.
  • You can take Zoloft with or without food.
  • Zoloft may impair your ability to concentrate, think clearly, respond fast or cause drowsiness. Driving, using machinery, or engaging in other risky activities should be avoided until you know how Zoloft affects you.
  • Avoid drinking alcohol while taking Zoloft.
  • Do not take an extra dose in case of a missed dose.
  • Your infant could experience withdrawal symptoms after birth or could be more likely to have a significant lung issue at birth. When taking Zoloft during pregnancy, discuss the advantages and disadvantages with your healthcare professional.
  • If you are currently breastfeeding or intend to do so, let your doctor know. Zoloft can pass into your breast milk in small amounts.

Prozac

  • Do not abruptly stop taking fluoxetine unless your doctor instructs you.
  • Take Prozac as prescribed by your physician.
  • Tell your doctor if you are taking any other medicines, including any that you buy without a prescription, before starting Prozac.
  • Till you can do it safely, avoid operating machinery, driving, or doing anything else that requires alertness.
  • Avoid drinking alcohol when you are on Prozac.
  • In the event of a missed dose of Prozac, do not take an extra pill.
  • If you are planning a pregnancy or are nursing a baby, talk to your doctor before taking  Prozac. Only if the advantages outweigh the potential pregnancy should they be used.

Drug Interactions 

Drug interactions could alter how your medications work or raise the possibility of side effects. Keep a list of all drugs you use, including herbal products, prescription, and over-the-counter medications, and provide it to your doctor and pharmacist.

Interactions of Zoloft vs Prozac

  • Avoid taking SSRIs with monoamine oxidase inhibitors or within two weeks of taking them. It can have possible fatal consequences.
  • Concomitant use of sertraline with other drugs that raise serotonin levels, such as some antidepressants, so-called "triptans" for migraines, some painkillers, and the antibiotic linezolid may result in an increased risk of serotonin syndrome.
  • Avoid the use of Pimozide with sertraline.
  • Sertraline may intensify the effects of other drugs like aspirin, warfarin, and ibuprofen which can lead to bleeding.
  • Disulfiram and sertraline should not be used together because the concentrate contains alcohol.

Bottom Line From Practical Anxiety Solutions

Zoloft (sertraline) and Prozac (fluoxetine) are SSRIs authorized to treat the major depressive disorder. They are commonly used to treat generalized anxiety disorder off-label as well.

There are a few significant distinctions between Prozac and Zoloft, including the illnesses they treat, the age restrictions, the adverse effects, and whether they are brand-name or generic drugs.

Both Prozac and Zoloft appear to be equally helpful in treating a variety of mental health issues, and they have comparable side effects. Although Prozac and Zoloft are safe and effective, patients should check in with their doctor periodically to discuss their symptoms and side effects.

  • McRae, Aimee L., and Kathleen T. Brady. "Review of sertraline and its clinical applications in psychiatric disorders." Expert Opinion on Pharmacotherapy 2.5 (2001): 883-892. From https://doi.org/10.1517/14656566.2.5.883  Obtained on 21/11/2022
  • Wong, David T., Kenneth W. Perry, and Frank P. Bymaster. "The discovery of fluoxetine hydrochloride (Prozac)." Nature reviews Drug discovery 4.9 (2005): 764-774. From  https://doi.org/10.1038/nrd1821 Obtained on 21/11/2022
  • Singh HK, Saadabadi A. Sertraline. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022. PMID: 31613469. Obtained on 21/11/2022
  • Andersen, Jacob, et al. "Molecular basis for selective serotonin reuptake inhibition by the antidepressant agent fluoxetine (Prozac)." Molecular pharmacology 85.5 (2014): 703-714. From https://doi.org/10.1124/mol.113.091249 Obtained on 21/11/2022
  • (2014). Fish on Prozac (and Zoloft): Ten years later. Aquatic Toxicology, 151, 61-67. From  https://doi.org/10.1016/j.aquatox.2014.01.007 Obtained on 21/11/2022
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