Lexapro vs. Zoloft: Which Antidepressant Works Best for Anxiety

Two years on Zoloft. It "took the edge off." His sex drive was gone, the marriage was feeling it, and the plan from his last psychiatrist was to try Lexapro next.

That's the most common version of the Lexapro-vs-Zoloft question I see. It's rarely a pharmacology question. It's a question about why the first SSRI only half-worked, and whether anyone checked the body before reaching for the second one.

STAR*D put a number on the half-working problem. After the first treatment step, 36.8% of patients reached remission on the QIDS-SR (Rush et al., 2006; DOI: 10.1176/ajp.2006.163.11.1905; PMID: 17074942). That was a depression trial, not an anxiety trial. But "better, not well" after the first SSRI is the most common story I hear in anxiety visits too.

If that's where you are, here's what the head-to-head data says, and what I check before I switch anyone.

The fast answer

• For generalized anxiety, escitalopram (Lexapro) has the stronger evidence. Sertraline (Zoloft) also looked effective and well tolerated in the same analysis, but on smaller samples (Slee et al., 2019; DOI: 10.1016/S0140-6736(18)31793-8; PMID: 30712879).
• For panic disorder, PTSD, social anxiety, and OCD, sertraline carries the FDA label indications, and it's often my first pick there.
• For depression, both sit in the better-tolerated group. In the 2018 head-to-head analysis of 21 antidepressants, escitalopram was among the more effective and more tolerable drugs, and sertraline was among the more tolerable (Cipriani et al., 2018; DOI: 10.1016/S0140-6736(17)32802-7; PMID: 29477251).
• The labels give Zoloft more stomach trouble: nausea 26% vs 15%, diarrhea 20% vs 8%. Those are label tables, not a head-to-head trial (DailyMed Zoloft label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7; DailyMed Lexapro label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a).
• Sexual side effects are a class effect. Both labels carry the same warning, and I've never found a reliable way to predict who gets it. If that's why you want to switch, the conversation should include bupropion, not just the other SSRI.
• Neither one treats an overactive thyroid, low iron stores, a B12 deficiency, untreated sleep apnea, or a diagnosis that was never right, and any of those can sit underneath anxiety that isn't responding.
• Switching is a prescriber-run change with monitoring. It isn't a weekend project.

Not every article needs an appointment. Use this page for research. Turn it into a visit when the pattern is affecting a real medication, diagnosis, or daily-function decision.

Turn this into a visit when

• You are changing, stopping, restarting, or adding a psychiatric medication.
• Side effects are shaping the decision more than the original symptom is.
• The medication partly helps, but the diagnosis, sleep, labs, or timing still do not fit.

Bring this pattern

current medication listdose and timingside effectssleep patternprior trials

Available for appropriate patients in California and Arizona.

Quick comparison: Lexapro vs Zoloft

Factor	Lexapro (escitalopram)	Zoloft (sertraline)
Generalized anxiety	More efficacious than placebo with good acceptability in the 2019 GAD network meta-analysis (Slee et al., 2019; DOI: 10.1016/S0140-6736(18)31793-8; PMID: 30712879)	Efficacious and well tolerated in the same analysis, but the finding rested on small samples
Depression	Among the more effective and more tolerable drugs in head-to-head trials (Cipriani et al., 2018; DOI: 10.1016/S0140-6736(17)32802-7; PMID: 29477251)	Among the more tolerable drugs in the same analysis; the 2009 analysis said it might be the best starting choice when cost is weighed (Cipriani et al., 2009; DOI: 10.1016/S0140-6736(09)60046-5; PMID: 19185342)
FDA-labeled uses	Generalized anxiety disorder, major depression	Panic disorder, PTSD, social anxiety disorder, OCD, major depression, PMDD
Nausea	15% in adult depression trials (DailyMed Lexapro label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a)	26% in pooled adult trials (DailyMed Zoloft label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7)
Diarrhea	8% in adult depression trials (DailyMed Lexapro label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a)	20% in pooled adult trials (DailyMed Zoloft label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7)
Insomnia	9% in adult depression trials (DailyMed Lexapro label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a)	20% in pooled adult trials (DailyMed Zoloft label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7)
Sexual side effects	Class warning: decreased libido, delayed or absent orgasm, ejaculatory delay, erectile dysfunction	Same class warning, same list
Drug interactions	Label advises caution with drugs metabolized by CYP2D6; checked against your medication list	Label identifies CYP2D6 inhibition with potentially important interactions; checked against your list
Onset	Early gains in the first couple of weeks are common; the full effect takes longer	Same pattern
Where I reach for it	GAD, polypharmacy, people who could not stomach sertraline	PTSD, OCD, panic, anxious depression with fatigue

What the research supports is narrower than most articles admit. For generalized anxiety specifically, escitalopram has the better evidence. For depression, both are good starting drugs and sertraline may be the better value when cost is on the table. Individual response still varies, and a medical contributor can sit underneath anxiety that isn't responding to either one.

When comparing stops being enough

If you are deciding between Lexapro and Zoloft because one caused nausea, one flattened your emotions, one helped anxiety but killed your sex drive, or neither worked long enough to matter, that is a medication review. The question isn't which SSRI wins in the abstract. The question is what your pattern says.

A real review looks at diagnosis, dose, duration, side effects, missed-dose symptoms, sleep, alcohol or cannabis use, stimulant exposure, pregnancy or hormone context when relevant, prior medication trials, and the medical factors that can be part of why an SSRI isn't working.

Read how medication management works, or request a medication review if you're deciding whether to switch.

Before you keep searching

If this answer changes what you might do next, pick the next clinical question now.

Care path Turn this into a medication review Bring your current list. Dose, timing, side effects, interactions, and the labs nobody ordered — reviewed in one visit. Side effects or safety question Sort expected activation from dose, timing, blood pressure, sleep, or stop-and-call symptoms. Dose or formulation question Compare 150mg, 300mg, XL, SR, timing, seizure risk, and what to check before increasing.

Or read how medication management works

What to bring to a medication review

Bring the history in order. The timeline usually explains more than the medication name.

• Current medication list with doses and timing
• Prior Lexapro, Zoloft, SSRI, SNRI, Wellbutrin, stimulant, benzodiazepine, and sleep-medication trials
• Why each medication started, changed, or stopped
• Side effects, especially GI symptoms, sleep changes, sexual side effects, emotional flattening, activation, or weight change
• Anxiety pattern: panic, rumination, physical tension, avoidance, social fear, trauma symptoms, or shutdown
• Alcohol, cannabis, caffeine, supplements, and stimulant exposure
• Recent labs if available, especially thyroid, ferritin, B12, vitamin D, A1c, and metabolic markers

What the head-to-head research actually shows

Depression: two Lancet analyses, a decade apart

The 2009 Lancet analysis pooled 117 randomized trials and 25,928 participants and found clinically meaningful advantages for both escitalopram and sertraline in major depression (Cipriani et al., 2009; DOI: 10.1016/S0140-6736(09)60046-5; PMID: 19185342). The authors' interpretation, which gets misquoted constantly, was that sertraline might be the best starting choice for moderate-to-severe depression once benefit, acceptability, and price were weighed together. It didn't crown escitalopram.

The same group came back in 2018 with 522 trials and 116,477 participants across 21 drugs. In head-to-head trials, escitalopram was among the antidepressants that were more effective than the others, and both escitalopram and sertraline were among the more tolerable (Cipriani et al., 2018; DOI: 10.1016/S0140-6736(17)32802-7; PMID: 29477251). The authors also rated the certainty of evidence as moderate to very low, which I take seriously. These are good drugs with modest differences, not a clear winner and a loser.

Generalized anxiety: escitalopram leads, with a catch

The 2019 Lancet network meta-analysis of GAD treatments found escitalopram more efficacious than placebo, with a Hamilton Anxiety Scale mean difference of -2.45 and a 95% credible interval of -3.27 to -1.63, alongside relatively good acceptability (Slee et al., 2019; DOI: 10.1016/S0140-6736(18)31793-8; PMID: 30712879). Sertraline was described as efficacious and well tolerated too, but the sertraline findings rested on small sample sizes. So I don't quote a clean "Lexapro response rate versus Zoloft response rate" for anxiety. It doesn't exist in this data.

A 2020 network meta-analysis that looked at remission rather than symptom scores adds the catch. Across 32 double-blind trials and 13,338 people with GAD, escitalopram beat placebo on remission with an odds ratio of 2.03 and a 95% CI of 1.48 to 2.78. But its tolerability was worse than placebo, while sertraline's tolerability was comparable to placebo (Kong et al., 2020; DOI: 10.3389/fphar.2020.580858; PMID: 33343351). Better remission, more dropouts. That trade-off is exactly what I see in clinic, and it's why the choice depends on the person sitting in front of me rather than the ranking.

Onset

Both drugs can show early improvement inside the first couple of weeks, and both need considerably longer for the full effect. The mistake I see most is a trial abandoned at week three because "nothing happened yet." I don't call an SSRI trial failed until it has had a real dose for a real stretch of time.

Side effects: the numbers that matter

Stomach

The labels are the cleanest source we have. Nausea: 15% for escitalopram in adult depression trials versus 26% for sertraline in pooled adult trials. Diarrhea: 8% versus 20% (DailyMed Lexapro label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a; DailyMed Zoloft label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7).

Those percentages come from different trial populations, so they're not a head-to-head comparison. Still, if sertraline sent you running to the bathroom, escitalopram is a reasonable next SSRI and the label numbers point the same direction as my experience.

Sexual function

Both labels carry the SSRI sexual-dysfunction warning: decreased libido, delayed or absent orgasm, ejaculatory delay, erectile dysfunction. I've never found a reliable way to predict who gets it. It is dose-related more often than people expect, and it's the most common reason my patients quietly stop taking an SSRI without telling anyone. Tell me. There are options.

Sleep

Insomnia: 9% for escitalopram in adult depression trials and 20% for sertraline in pooled adult trials (DailyMed Lexapro label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a; DailyMed Zoloft label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7). Sertraline runs more activating in my experience, so I usually have people take it in the morning.

Weight

Weight change varies by person with both drugs, and the labels don't rank the two against each other on weight. Some people lose weight because nausea kills appetite. Others gain because depression lifted and food tastes good again.

Heart rhythm

The escitalopram label reports QT-interval prolongation findings and, separately, recommends 10 mg a day for most older adults; the sertraline label carries a QTc-prolongation warning of its own (DailyMed Lexapro label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a; DailyMed Zoloft label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7). I check an ECG when there are other risk factors or other QT-prolonging drugs on the list. That monitoring habit came from nineteen years of watching cardiac monitors, and I haven't dropped it.

What I check before switching anyone

Here is where most of the value in this article lives, and the step most prescribers skip.

Thyroid

Hyperthyroidism mimics panic disorder almost perfectly: racing heart, tremor, sweating, agitation, heat intolerance, weight loss with a good appetite. A suppressed TSH with those symptoms needs to be evaluated and treated as a thyroid problem first; anxiety can coexist, but an SSRI isn't the treatment for hyperthyroidism. On the other side, sluggish thyroid function can drag mood and energy down. I order TSH with reflex free T4 on everyone with new or treatment-resistant anxiety, and I add free T3 and antibodies when the TSH is borderline.

Iron

Low ferritin travels with fatigue, restless legs that wreck sleep, poor concentration, and an anxious, wired-but-tired feeling. I treat it as context, not as a stand-alone explanation for every mood symptom. But a man with anxiety, fatigue, and a ferritin of 18 ng/mL is not someone I switch from Zoloft to Lexapro and send home without addressing the iron; it's context for the decision, not proof of the cause. Standard ferritin ranges are broad; I read the number next to symptoms, iron saturation, inflammation, bleeding history, sleep, and diet. The long version is in the ferritin article.

Vitamin D

A 2020 meta-analysis pooled 25 trials with 7,534 participants and found a moderate effect of vitamin D supplementation on negative emotion, Hedges' g of -0.50, with the benefit concentrated in people with major depression and in people whose 25(OH)D was at or below 50 nmol/L, which is 20 ng/mL (Cheng et al., 2020; DOI: 10.1002/da.23025; PMID: 32365423). The benefit looked concentrated in deficient people, with substantial uncertainty across trials, so I check the level and talk it through before anyone starts it.

Vitamin B12

Neuropsychiatric symptoms of B12 deficiency can show up before anemia does, and the "normal" range starts low. The authors of a 2020 review concluded that early B12 supplementation may delay depression onset and improve antidepressant response when used alongside antidepressants; that is their conclusion from the studies they reviewed, not settled prevention efficacy (Sangle et al., 2020; DOI: 10.7759/cureus.11169; PMID: 33251075). When a B12 comes back low-normal in someone with brain fog and mood symptoms, I add methylmalonic acid and homocysteine before deciding it's fine.

Magnesium

An open-label randomized trial with no placebo arm, using 248 mg of elemental magnesium a day, found improvement in mild-to-moderate depressive symptoms within two weeks (Tarleton et al., 2017; DOI: 10.1371/journal.pone.0180067; PMID: 28654669). Unblinded, so read it as a signal. Adjunctive support, not a diagnosis; serum magnesium is a limited marker, so I read it with diet, medications, kidney function, and alcohol in mind.

One rule for all of these: don't start, combine, or change iron, vitamin D, B12, or magnesium on your own. They interact with other medications and with kidney function, and the level should be checked first by the clinician who knows your history.

Sleep, alcohol, and stimulants

Untreated sleep apnea can look like anxious depression, and it needs its own evaluation and treatment as part of the plan. Nightly alcohol produces rebound anxiety the next morning that gets blamed on the medication. Caffeine and stimulants stack on top. I ask about all three before I change a dose.

The lab panel I order

Tier 1 (everyone):

• TSH with reflex free T4
• CBC with differential
• Comprehensive metabolic panel
• Vitamin B12
• Vitamin D (25-OH)
• HbA1c

Tier 2 (based on the picture):

• Ferritin and iron panel when fatigue is prominent
• Free T3 and anti-TPO antibodies when TSH is borderline
• Methylmalonic acid and homocysteine when B12 is low-normal
• RBC magnesium when available
• CRP when the case is treatment-resistant or there is chronic medical illness

Lexapro: when I reach for it

• Generalized anxiety disorder, where the evidence is strongest
• People on several other medications, once the list has been checked; the label still advises caution with drugs metabolized by CYP2D6
• Anyone who couldn't tolerate sertraline's stomach effects
• Simple once-daily dosing, morning or evening

Label dosing: 10 mg once daily to start, 10 to 20 mg as the usual range, and 10 mg a day recommended for most older adults (DailyMed Lexapro label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a).

Zoloft: when I reach for it

• PTSD, OCD, panic disorder, and social anxiety, where it carries the label indications
• Anxious depression with fatigue, where a slightly activating drug helps
• Someone who tolerated it well before and stopped for a reason unrelated to side effects
• Cost-sensitive situations, since it's cheap and widely covered

Label dosing: 25 to 50 mg once daily to start depending on the indication, with 50 to 200 mg as the usual range (DailyMed Zoloft label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7). I usually have people take it in the morning.

Switching without making a mess

You can switch in either direction, and people do it all the time. How it's done is a prescriber decision made for your dose, your history, and how you're doing, with monitoring along the way.

There are three ways to move from one antidepressant to another: taper the first drug and wait before starting the second, switch directly, or cross-taper with both on board briefly. Which one fits depends on the two drugs, the dose, how long you've been on it, and how sick you are. A 2016 review of switching strategies lays out the logic and the risks, including serotonin syndrome from combinations handled badly and withdrawal symptoms from stopping abruptly (Keks et al., 2016; DOI: 10.18773/austprescr.2016.039; PMID: 27346915).

I'm not going to print a week-by-week schedule here. The right one depends on your dose and your history, and I've seen too many people improvise from a blog post and end up with dizziness, brain zaps, and a flu-like week they didn't need. Let the prescriber write the schedule.

The harder part is the reason for the switch, because the reason decides whether Lexapro is even the right next move.

• Stomach or sleep. If sertraline wrecked your stomach or kept you up, escitalopram is a reasonable next SSRI to discuss. The label numbers point the same direction as my experience.
• Sex drive. Sexual side effects are a class effect, so a second SSRI can bring the same problem. That conversation should include adding or switching to bupropion, since that's often the better move.
• It never really worked. Confirm the first drug had a real dose for a real duration, check adherence, and run the labs above before declaring it a failure. A switch built on a half-done trial just restarts the clock.

That's the conversation the man in the opening needed before anyone reached for Lexapro.

If neither one worked

Two adequate SSRI trials without benefit is a diagnostic signal, not a reason for a third SSRI. Here is the order I work in.

1. Verify the trials were real. Therapeutic dose, adequate duration, taken consistently.
2. Run the medical workup in the panel above and treat what turns up, under supervision. Thyroid, iron, B12, vitamin D, and sleep apnea can change the plan, sometimes more than a new antidepressant would.
3. Consider augmentation before another switch: bupropion for energy and sexual side effects, buspirone for residual anxiety, or other options depending on the pattern.
4. Reassess the diagnosis. ADHD presents as anxiety constantly. Bipolar spectrum illness gets worse on antidepressants. PTSD needs a different plan. Medical anxiety from thyroid, cardiac, or hormonal causes needs the cause treated.

My read

Escitalopram is often the cleaner choice for generalized anxiety and for stomachs that hate sertraline. Sertraline has broader label indications and might be the better starting drug when cost counts. Those are real differences, and they are small.

The usual response to a half-working SSRI is the next drug in the same class, without asking why the first one underperformed. I don't switch anyone until I know what the thyroid, the iron, the B12, the sleep, and the alcohol are doing.

Common Questions

Is Lexapro better than Zoloft for anxiety?

For generalized anxiety disorder, escitalopram has the stronger network-meta-analysis evidence, and I usually start there. For panic disorder, PTSD, social anxiety, and OCD, sertraline carries the FDA label indications and is often my first pick. "Better" depends on which anxiety you have, what you've tolerated before, and what else you take.

What is the difference between Lexapro and Zoloft?

Both are SSRIs and work the same basic way. Lexapro shows less nausea, diarrhea, and insomnia in its label tables. Zoloft has more labeled uses, including PTSD, OCD, and panic disorder, and in my experience runs more activating, so I usually dose it in the morning. Both labels carry CYP2D6 interaction cautions, so both get checked against your medication list. Sexual side effects are a class effect and show up with both.

Does Lexapro cause fewer sexual side effects than Zoloft?

I can't promise that. Both labels carry the same warning: decreased libido, delayed or absent orgasm, ejaculatory delay, erectile dysfunction. I've never found a reliable way to predict who gets it, and it's dose-related more often than people expect. If this is why you want to switch, ask about bupropion, added or instead of the SSRI. And say it out loud. It's the most common reason my patients quietly stop an SSRI without telling anyone.

Is Lexapro 10 mg the same as Zoloft 50 mg?

No. Each is a common starting dose, so they sit at a similar spot on their own drug's range, but the milligrams don't translate from one drug to the other and starting doses depend on the indication. Lexapro's labeled range is 10 to 20 mg (DailyMed Lexapro label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a); Zoloft's is 50 to 200 mg (DailyMed Zoloft label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7).

Can I switch from Zoloft to Lexapro?

Yes, and it's a common switch when sertraline's stomach effects or activation are the problem. How it's done, a taper, a direct switch, or a cross-taper, is your prescriber's call for your dose and history, with monitoring, and never an abrupt stop, because both drugs can cause withdrawal symptoms if dropped suddenly. If the reason is sex drive or a drug that never worked, the better move may not be another SSRI at all.

What should be checked before switching from Zoloft to Lexapro?

First, whether the trial was real: therapeutic dose, adequate duration, taken consistently. Then the possible medical contributors that need their own assessment. For every anxiety workup, I order TSH with reflex free T4, CBC with differential, a comprehensive metabolic panel, vitamin B12, vitamin D (25-OH), and HbA1c, and I add ferritin and an iron panel when fatigue is prominent. I also ask about sleep apnea, nightly alcohol, caffeine, and stimulants before I change a dose.

Wellbutrin vs Zoloft for anxiety: which is better?

Wellbutrin isn't an SSRI and isn't a first-line anxiety drug, but it fits a specific pattern: tired, unmotivated, anxious depression, or an SSRI that worked but wrecked sex drive or energy. Wired, panicky anxiety usually does better with an SSRI. I wrote a separate guide on Wellbutrin vs SSRIs for anxiety.

Which one causes more weight gain?

Weight change varies by person with both drugs, and the labels don't rank the two against each other on weight: some people lose weight because nausea kills appetite, and others gain because they feel better and food tastes good again. If weight is your main concern, that conversation should include the alternatives, not just these two.

Get the pattern reviewed

If you've tried Lexapro, Zoloft, or both without getting well, the next step isn't another SSRI. It's a review of the diagnosis, the dose history, the side effects, and the labs.

What to expect:

• A 75-90 minute initial evaluation that goes through the whole medication and medical history
• Labs when the picture calls for them
• A plan built on what the review and any labs found, which sometimes means a different medication, sometimes an adjustment, and sometimes something other than a medication change

Cost: self-pay is $400 for the initial evaluation and $150 for 30-minute follow-ups. If you're using insurance, you pay your plan's copay or coinsurance; benefits verification is not a payment guarantee.

Where: in person at the Gilbert, Arizona office or the Rancho Palos Verdes, California office, with telehealth for California and Arizona residents when appropriate.

Request a medication review →

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References

• Rush, A.J., Trivedi, M.H., Wisniewski, S.R., et al. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D report. American Journal of Psychiatry, 163(11), 1905-1917. DOI: 10.1176/ajp.2006.163.11.1905. PMID: 17074942

• Cipriani, A., Furukawa, T.A., Salanti, G., et al. (2009). Comparative efficacy and acceptability of 12 new-generation antidepressants: A multiple-treatments meta-analysis. The Lancet, 373(9665), 746-758. DOI: 10.1016/S0140-6736(09)60046-5. PMID: 19185342

• Cipriani, A., Furukawa, T.A., Salanti, G., et al. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391(10128), 1357-1366. DOI: 10.1016/S0140-6736(17)32802-7. PMID: 29477251

• Slee, A., Nazareth, I., Bondaronek, P., et al. (2019). Pharmacological treatments for generalised anxiety disorder: A systematic review and network meta-analysis. The Lancet, 393(10173), 768-777. DOI: 10.1016/S0140-6736(18)31793-8. PMID: 30712879

• Kong, W., Deng, H., Wan, J., et al. (2020). Comparative remission rates and tolerability of drugs for generalised anxiety disorder: A systematic review and network meta-analysis of double-blind randomized controlled trials. Frontiers in Pharmacology, 11, 580858. DOI: 10.3389/fphar.2020.580858. PMID: 33343351

• Cheng, Y.C., Huang, Y.C., Huang, W.L. (2020). The effect of vitamin D supplement on negative emotions: A systematic review and meta-analysis. Depression and Anxiety, 37(6), 549-564. DOI: 10.1002/da.23025. PMID: 32365423

• Sangle, P., Sandhu, O., Aftab, Z., et al. (2020). Vitamin B12 supplementation: Preventing onset and improving prognosis of depression. Cureus, 12(10), e11169. DOI: 10.7759/cureus.11169. PMID: 33251075

• Tarleton, E.K., Littenberg, B., MacLean, C.D., et al. (2017). Role of magnesium supplementation in the treatment of depression: A randomized clinical trial. PLoS ONE, 12(6), e0180067. DOI: 10.1371/journal.pone.0180067. PMID: 28654669

• Keks, N., Hope, J., Keogh, S. (2016). Switching and stopping antidepressants. Australian Prescriber, 39(3), 76-83. DOI: 10.18773/austprescr.2016.039. PMID: 27346915

• DailyMed. Lexapro (escitalopram) prescribing information. Set ID: 13bb8267-1cab-43e5-acae-55a4d957630a. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a

• DailyMed. Zoloft (sertraline hydrochloride) prescribing information. Set ID: fda754f6-d0f3-4dce-a17a-927d64f912f7. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7

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Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Antidepressant medications, and the supplements discussed here (iron, vitamin D, B12, magnesium), should only be started, adjusted, combined, tapered, switched, or stopped under the supervision of a qualified healthcare provider who knows your medical history, medications, and kidney function. If you are having suicidal thoughts, thoughts of self-harm, severe worsening anxiety or depression, signs of mania or psychosis, severe agitation, or a mental health crisis, call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room. If you have chest pain, severe shortness of breath, fainting, allergic reaction symptoms, or another medical emergency, call 911.

About the Author: Canybec Sulayman, PMHNP-BC, brings 19 years of ICU nursing experience across seven specialties at Cedars-Sinai and USC Keck to psychiatric care. Board-certified as a Psychiatric-Mental Health Nurse Practitioner, he specializes in diagnostic psychiatry—investigating medical causes of psychiatric symptoms before attributing them to primary mental illness.