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Anxiety

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Zoloft vs. Paxil: What’s the Difference and Which One Should I Take?

Written by Klarity Editorial Team

Published: Sep 12, 2022

Medically Reviewed by Dr. Zoe Russell

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Zoloft and Paxil are both frequently-prescribed medications for depression and anxiety. They belong to the same class of drugs and work similarly in the body, so it can be confusing to decide which one is right for you. 

Both of these medications are SSRIs—selective serotonin reuptake inhibitors—and are FDA-approved. While they’re similar, certain symptoms may make one drug more effective than the other. This comparison guide details the similarities, differences, contraindications, and cost of Zoloft vs. Paxil to help you decide which one you should take. 

If you are diagnosed with generalized anxiety or major depression, or you suspect you have one of these conditions, SSRIs like Zoloft and Paxil could be the solution to relieving your symptoms. Klarity can connect you with a certified healthcare provider in just 48 hours for comprehensive, fast, and affordable online depression and anxiety treatment.

Schedule an appointment today for an evaluation, diagnosis, and individualized treatment for your anxiety or depression symptoms if applicable—all from the comfort and convenience of your home. 

ZoloftPaxil
Drug ClassSelective serotonin reuptake inhibitor (SSRI)Selective serotonin reuptake inhibitor (SSRI)
Brand / Generic StatusBrand name for sertralineBrand name for paroxetine

Form(s) of the Drug• Clear, peppermint-flavored liquid suspension
• Color-coded tablets
• Color-coded tablets
• Time-release tablets
• Orange-colored and flavored liquid suspension
Standard DosageLiquid suspension
• 20 mg of sertraline per dose

Standard tablet dosages:
• Green indicates 25 mg
• Blue indicates 50 mg
• Pinkish-red indicates 100 mg
Time-release tablets:
• 37.5mg of paroxetine

Color-coded tablets:
• Yellow: 10 mg
• Pink: 20 mg
• Blue: 30 mg
• Green: 40 mg

Liquid suspension:
• 5mg of suspension contains 10mg of paroxetine


Conditions TreatedFDA-approved uses:
• Major depression
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Post-traumatic stress (PTS)
• Premenstrual dysphoric disorder (PMDD)
• Social anxiety disorder

Off-label uses:
• Autism (mood stabilizing)
• Alcoholism
• Eating disorders
• Diabetic neuropathy
• Dementia
• Hot flashes
• Generalized anxiety disorder (GAD)
• Fibromyalgia
• Migraines
• Personality disorders
• Tourette syndrome
• Premature ejaculation
FDA-approved uses:
• Major depression

Off-label uses:
• Anxiety
• Panic disorder
• Insomnia
CostGeneric form (sertraline):
• $4 to $25 for 30 days’ worth

Brand-name:
• $215 to $315 for a 30-day supply
Generic form (paroxetine):
• $4 to $25 for a 30-day supply

Brand-name:
• $280 for a 30-day supply
Side-EffectsCommon side effects:
• Nausea or indigestion
• Diarrhea or loose stool
• Tremors or twitching
• Decreased appetite and weight loss
• Bruising and muscle aches
• Decreased libido/trouble orgasming
• Excessive sweating
• Anxiety

Serious side effects:
• Heart arrhythmia
• Bleeding and liver injury
• Confusion and seizures
• Suicidal thoughts
• Changes in behavior
• Serotonin syndrome
Common side effects:
• Changes in vision
• Weakness, drowsiness, or dizziness
• Sweating or shaking
• Anxiety
• Insomnia
• Loss of appetite, nausea, and vomiting
• Diarrhea or constipation
• Dry mouth
• Infections
• Headaches
• Decreased sex drive or impotence
• Abnormal ejaculation or difficulty orgasming

Serious side effects:
• Racing thoughts
• Decreased need for sleep
• Unusual risk-taking behaviors
• Extreme feelings of happiness or sadness
• Being more talkative than usual
• Blurred vision or tunnel vision
• Eye pain, swelling, or seeing halos around lights
• Bone pain, tenderness, swelling, or bruising
• Changes in weight or appetite
• Coughing up blood or bleeding from your nose, mouth, or rectum
• Unusual vaginal bleeding
• Stiff or rigid muscles
• High fever, sweating, tremors, or fainting
• Fast, uneven heartbeat
• Headaches
• Confusion or slurred speech
• Severe weakness, lost coordination, or feeling unsteady

Warnings For UseContraindicated conditions:
• Pregnancy or breastfeeding
• Liver problems
• Epilepsy and seizure disorders
• Glaucoma
• Bipolar disorder
• Thyroid disease

Drug interactions:
• Monoamine oxidase inhibitors (MAOIs)
• Blood thinners
• Antipsychotic and antiseizure medications
• Alcohol—recreational and alcohol-based medications
Contraindicated conditions:
• Bipolar disorder
• History of suicide attempts
• Liver or kidney problems
• Bleeding problems
• Low sodium in the blood
• Peptic ulcer disease
• Seizure disorders
• Thyroid disease
• Angle-closure type glaucoma
• Pregnancy or breastfeeding

Adverse drug interactions:
• Thioridazine
• Clopidogrel
• NSAIDs
• Warfarin
• Aspirin
• Atomoxetine
• Phenothiazines
• Pimozide,
• Risperidone
• Tamoxifen
• Tetrabenazine
• Antiarrhythmic medications
• TCA antidepressants
• Antihistamines
• Sleep aids
• Muscle relaxants
• Opiate-based pain relievers or cough suppressants
• Water pills (may cause salt imbalance)
• MAOIs may cause a fatal reaction
• Alcohol
• Marijuana

What Is Paxil?

Paxil is the brand name for paroxetine, an FDA-approved SSRI medication available only via prescription. It’s used to treat a wide variety of mood disorders by preventing nerve cells in the brain from reabsorbing serotonin too quickly. This increases the serotonin levels in the brain, which helps stabilize mood, concentration, and sleep.

Paxil Forms and Doses

Paxil comes in three forms: tablets, time-release tablets, and liquid suspensions. Both kinds of pills are color-coded according to dosage. Time-release tablets are usually blue and printed with 37.5, indicating it contains 37.5 mg of medication. 

Regular tablets come in several different colors, with each color corresponding to a specific dosage: 

  • Yellow: 10 mg
  • Pink: 20 mg
  • Blue: 30 mg
  • Green: 40 mg

In liquid form, Paxil is an orange-colored and flavored suspension, with each 5 mg dose containing the equivalent of 10 mg of paroxetine. Liquid medications usually have a clearly marked oral syringe to administer the exact dosage. 

The standard dosage is between 10 mg and 60 mg daily. 

Conditions Paxil Treats

Anxiety

While anxiety is a normal emotion that everyone experiences now and then, chronic, very intense, or frequent acute episodes of anxiety may indicate you have an anxiety disorder. Chemical imbalances sometimes cause these disorders in the brain, which can be addressed with medications like Paxil.

Since Paxil is an SSRI that increases the serotonin in the brain, it helps regulate brain and body functions related to proper serotonin levels. These functions include restoring a sense of calm to a person’s body and mind.

Depression

A lack of available serotonin can also cause depression. Though temporary feelings of depression are normal in some situations—such as the loss of a loved one—frequent or prolonged depressive episodes may indicate a disorder and the need for treatment. 

Paxil is often prescribed to treat depression, and patients typically feel an improvement in their symptoms within 4 to 6 weeks.

Insomnia

Though Paxil isn’t typically prescribed to treat insomnia, those experiencing insomnia as a symptom of anxiety or depression may find that Paxil helps them establish healthy sleeping habits. 

However, one of Paxil’s potential side effects is insomnia, so if you continue or begin to experience disturbed sleep, talk to your healthcare provider right away.

Paxil Costs

Paxil’s generic form, paroxetine, is covered by most insurance, including Medicare Part D. The brand name may cost between $4 and $25 for a 30-day supply. Costs vary depending on your level of insurance coverage and whether you have prescription copays.

Paxil Side Effects

Just as with most prescription medications, Paxil may cause side effects in some people. Common side effects include: 

  • Changes in vision
  • Weakness, drowsiness, or dizziness
  • Sweating or shaking
  • Anxiety
  • Insomnia
  • Loss of appetite, nausea, and vomiting
  • Diarrhea or constipation
  • Dry mouth
  • Infections 
  • Headaches
  • Decreased sex drive or impotence
  • Abnormal ejaculation or difficulty orgasming

If these side effects persist or become unmanageable, contact your healthcare provider immediately. Additionally, seek medical attention right away if you experience any of the following severe side effects: 

  • Racing thoughts
  • Decreased need for sleep
  • Unusual risk-taking behaviors
  • Extreme feelings of happiness or sadness
  • Being more talkative than usual
  • Blurred vision or tunnel vision 
  • Eye pain, swelling, or seeing halos around lights
  • Bone pain, tenderness, swelling, or bruising
  • Changes in weight or appetite
  • Coughing up blood or bleeding from your nose, mouth, or rectum
  • Unusual vaginal bleeding
  • Stiff or rigid muscles
  • High fever, sweating, tremors, or fainting
  • Fast, uneven heartbeat
  • Headaches
  • Confusion or slurred speech
  • Severe weakness, lost coordination, or feeling unsteady

Paxil Warnings for Use

Tell your healthcare provider about any allergies you have before taking Paxil. Even if you’re not allergic to the medication itself, you may be allergic to one or more of the inactive ingredients. 

Additionally, it’s important to share if you or your family has a history of any of the following conditions: 

  • Bipolar disorder
  • History of suicide attempts
  • Liver or kidney problems
  • Bleeding problems
  • Low sodium in the blood
  • Peptic ulcer disease
  • Seizure disorders
  • Thyroid disease
  • Angle-closure type glaucoma

Older adults and children may both be more sensitive to some of Paxil’s side effects. Seniors may experience bleeding or loss of coordination, while children may experience loss of appetite and weight loss. Additionally, Paxil is not recommended for those who are nursing or may be pregnant.

Paxil Interactions

Paxil may interact with other substances or medications in ways that inhibit their intended effects or cause health issues. Before taking Paxil, tell your healthcare provider about every medication and substance you use regularly. 

Contraindicated medications include: 

  • Thioridazine
  • Clopidogrel
  • NSAIDs (e.g., Ibuprofen)
  • Warfarin
  • Aspirin
  • Atomoxetine
  • Phenothiazines
  • Pimozide, 
  • Risperidone
  • Tamoxifen
  • Tetrabenazine
  • Antiarrhythmic medications
  • TCA antidepressants
  • Antihistamines
  • Sleep aids
  • Muscle relaxants
  • Opiate-based pain relievers or cough suppressants
  • Water pills (may cause salt imbalance)
  • MAOIs may cause a fatal reaction

Other contraindicated substances include: 

  • Alcohol
  • Marijuana

Your healthcare provider will discuss your symptoms, your medical history, your current medications, and other important information before prescribing any drug for your anxiety or depression. 

Discover the right anxiety medication and treatment
with an appointment in as little as 24 hours.

What Is Zoloft?

Zoloft is the brand name for sertraline. Like Paxil, Zoloft is an FDA-approved SSRI medication available via prescription only. Zoloft helps stabilize an individual’s mood, attention span, and behaviors by preventing nerve cells in the brain from reabsorbing serotonin too quickly. This increases serotonin levels in the brain and helps restore serotonin levels in the body to optimum levels.

Zoloft Forms and Doses

Zoloft comes in two forms: tablets and a solution. Like Paxil, Zoloft tablets are color-coded depending on the dosage they contain. There are three available dosages in the following colors: 

  • Green: 25 mg
  • Blue: 50 mg
  • Yellow/Off-white: 100 mg

In liquid form, Zoloft comes as a colorless, odorless solution in a 60 ml bottle. Each dose of oral solution contains the equivalent of 20 mg of medication. The solution must be properly prepared before you take it, so be sure to get instructions from your pharmacist.  

Conditions Zoloft Treats

Anxiety

Though Zoloft isn’t FDA-approved to treat generalized anxiety disorder (GAD), it is indicated to treat social anxiety disorder and is sometimes prescribed off-label for GAD. 

Like Paxil, Zoloft is an SSRI that helps restore healthy serotonin levels to the brain. Low serotonin can cause chronic or frequent acute episodes of anxiety that include racing thoughts, social anxiety, overwhelming feelings of dread, and panic attacks. 

Zoloft replenishes serotonin levels to help alleviate these symptoms. Individuals taking Zoloft often feel calmer, better able to concentrate, and have an increased ability to process or ignore intrusive thoughts.

Major Depressive Disorder (MDD)

Anxiety disorders and depression often go hand-in-hand, with low serotonin levels causing individuals to swing from feeling panicked to having no energy or interest in life. Since Zoloft makes serotonin more available in the brain, those taking it often experience fewer symptoms of major depressive disorder (MDD).

Obsessive-Compulsive Disorder (OCD)

OCD has a high comorbidity rate with both depression and anxiety. By limiting the reuptake of serotonin, Zoloft can improve your mood and reduce many of the fears, anxieties, obsessions, and compulsions related to OCD.   

Zoloft Costs

Zoloft’s generic form, sertraline, is covered by most insurance, including Medicare Part D. The brand name may cost between $7 and $35 for a 30-day supply. The cost of your prescription will vary depending on whether your insurance covers it or if there’s a copay. 

Zoloft Side Effects

Those taking Zoloft may experience side effects ranging from mild to severe. If your side effects last for an extended period or become too overwhelming to manage, contact your healthcare provider immediately. 

Common side effects of Zoloft include: 

  • Drowsiness or tiredness
  • Feeling agitated or anxious
  • Indigestion, nausea, diarrhea, or loss of appetite
  • Sweating, tremors, or shaking
  • Insomnia
  • Decreased sex drive
  • Impotence or difficulty orgasming

Zoloft may also cause severe side effects in some people. If you experience any of the following, seek medical attention right away: 

  • Seizures or convulsions
  • Blurred vision or tunnel vision
  • Eye pain or swelling
  • Headache
  • Confusion or memory problems
  • Severe weakness or feeling unsteady
  • Racing thoughts or increased energy
  • Unusual risk-taking behavior
  • Extreme happiness
  • Irritability or unusually talkative

Zoloft Warnings for Use

Be sure to tell your healthcare provider about your allergies before taking Zoloft. Even if you’re not allergic to the medication itself, you may be allergic to one or more of the inactive ingredients. 

Additionally, it’s important to disclose if you or your family has a history of any of the following conditions: 

  • Bipolar disorder
  • Bleeding problems
  • Liver disease
  • Seizure disorders
  • Thyroid disease
  • Angle-closure type glaucoma

Further, make certain you don’t have a potassium or magnesium deficiency before starting Zoloft, as this raises your chance of developing an arrhythmic heart condition.

Zoloft Interactions

Zoloft may interact with other medications, substances, or supplements in a way that inhibits its effectiveness or causes health issues. Make sure to disclose all medications and supplements to your healthcare provider before taking Zoloft. 

Contraindicated medications include: 

  • Pimozide
  • Clopidogrel
  • Ibuprofen, naproxen, and all other NSAIDs
  • Warfarin and dabigatran
  • Aspirin
  • Other SSRIs or SNRIs
  • Sleep aids
  • Antihistamines
  • Opiate-based painkillers or cough suppressants
  • Monoamine oxidase inhibitors (MAOIs) may cause a fatal interaction

Contraindicated supplements include: 

  • St. John’s wort
  • Tryptophan

Other contraindicated substances include: 

  • Alcohol
  • Marijuana
  • MDMA (ecstasy)

Before prescribing Zoloft, your healthcare provider will discuss your medical history, your current medications, and any other considerations that may impact the drug’s ability to help you. 

Zoloft vs. Paxil: Which Medication Should I Take?

Zoloft and Paxil are very similar medications that overlap in the conditions they treat. Which medication your healthcare provider recommends will be based on specific factors such as: 

  • Other prescription medications you may be taking
  • Whether you’re allergic to inactive ingredients in either Paxil or Zoloft
  • Whether one of these medications is contraindicated for a health condition you have
  • Insurance coverage

Additionally, how you metabolize each medication could determine which one is right for you. Some individuals may start taking one medication and discover it’s not very effective, and switch to the other simply because it works better for them.

While Paxil can effectively treat depression and anxiety, its side effects may be less favorable compared to other similar medications. Paxil can enhance a person’s mood and help them relax. Zoloft is also effective for treating depression and anxiety, but it can interact with more medications, so users must be mindful.

When deciding between these two drugs, you should always speak to a medical professional about your symptoms, medical history, and other medications you are currently on. You should never attempt to self-medicate, as you could be putting yourself at risk for harmful reactions. 

Get Anxiety and Depression Treatment Today With Help From Klarity

If you need a trusted healthcare provider who can prescribe medications like Zoloft or Paxil to treat your anxiety or depression, Klarity can help. We’ll match you with a licensed medical professional in your state for online anxiety or depression treatment, including a personalized treatment plan based on your symptoms. 

Find a provider today and within 48 hours you could begin treatment and receive a prescription if your provider determines it to be right for you. 

Zoloft and Paxil Frequently Asked Questions

Here are some of the questions people often ask when considering whether to take Zoloft or Paxil. You should discuss these issues with your healthcare provider, who will work with you to develop your treatment plan and get you the medication you need to get relief from anxiety or depression.

Does Zoloft or Paxil Make You Gain More Weight?

Weight gain is a possible side effect of both Zoloft and Paxil, although it doesn’t affect everyone who takes these medications. Clinical studies have reported instances of weight gain associated with both drugs, but the extent and likelihood of weight gain can vary among individuals. 

These medications may impact factors such as appetite regulation, metabolism, and energy balance, leading to weight gain in some cases. If you have concerns about weight gain while taking Zoloft or Paxil, it’s best to discuss them with your healthcare provider, who can offer advice on managing weight or explore alternative medication options if needed.

Are Zoloft, Paxil, and other SSRIs the same drug?

Though SSRIs like Paxil and Zoloft have the same effect on the human body—increasing serotonin levels—they’re not all the same drug. Each SSRI medication has a slightly different molecular structure, meaning they each have a unique active ingredient and pharmacological characteristics. 

These varying molecular structures explain why different SSRIs have slightly different side effects, contraindications, and dosage recommendations and why everyone reacts to them differently. 

Why is Zoloft an off-label treatment for anxiety?

The term “off-label” means the FDA has not yet approved a specific medication for a particular use because they haven’t reviewed enough data on its effectiveness and safety for that specific condition.

This is the case with Zoloft. Though it’s been FDA-approved for social anxiety and panic disorders, it’s not yet been officially approved for generalized anxiety disorder; however, healthcare providers may prescribe Zoloft in some cases because it’s shown to be an effective treatment. 

What’s better for anxiety—Zoloft or Paxil?

Though studies have shown that Zoloft may cause fewer side effects in some patients, and in most patients, it’s easier to wean off of the drug (when indicated by a healthcare provider), Paxil and Zoloft are both effective anxiety treatments. 

Ultimately, which drug you take will be up to you and your healthcare provider and will depend on factors like your medical history and other medications you’re taking. 

What’s better for depression? Zoloft or Paxil?

Double-blind studies have shown Paxil and Zoloft to be equally effective in treating major depression, with some taking Zoloft experiencing slightly fewer side effects. Patients in each drug group reported enjoying a better quality of life overall. 

As stated above, which medication is right for you depends on your medical history, your medications, and your healthcare provider’s recommendations.

Can I drink alcohol when taking Zoloft or Paxil?

Healthcare providers typically strongly recommend that you avoid drinking when taking Zoloft, Paxil, or other antianxiety or antidepressant medications. Alcohol is a depressant that can cause drowsiness and inhibited coordination—also side effects of Zoloft and Paxil. Alcohol can exacerbate these side effects, increasing feelings of intoxication, which could lead to dangerous situations. 

Additionally, alcohol may counteract these medications’ positive effects and worsen your anxiety or depression.

Does it matter what time of day I take Zoloft or Paxil?

It’s best to take Zoloft or Paxil at the same time each day to experience the full benefits of either medication. Choosing a specific time to take them also prevents any feelings of withdrawal that may worsen the symptoms of your depression or anxiety. Your healthcare provider will tell you when to take your medication each day.

Your healthcare provider will work with you to determine the best medication for your anxiety or depression. 

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