How to switch from Zoloft to Lexapro successfully?
By
Dr Milena Locci de Oliveira (PhD)
Author bio
Dr Milena Locci de Oliveira is a Pharmacist and Doctor of Philosophy in Sciences from the University of São Paulo (USP). She has experience in microbiology, analytical toxicology, and clinical pharmacokinetics. She writes and reviews content on these topics.
Dr Milena’s Highlights:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration in the areas of Pharmacometrics and Population Pharmacokinetics, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
“Science can be translated, and it is essential that everyone has access to quality information to make informed decisions” – Dr Milena Oliveira, PhD.
Professional Experience:
With a decade-long career as a researcher, Dr Milena has amassed extensive experience in conducting research projects in microbiology, analytical toxicology, and clinical pharmacokinetics.
Her expertise also extends to the preparation of technical and scientific reports, literature reviews, data analysis, and scientific communication, both oral and written.
Dr Milena has served as a Clinical Pharmacist, providing expert supervision and guidance to teams during the challenging times of the COVID-19 pandemic, particularly in the ICUs of two reference hospitals for patient hospitalization.
In her most recent role, Dr Milena worked on the implementation of the deliberatives of the São Paulo State Government Pharmaceutical Assistance Coordination. These decisions were aimed at ensuring medication access within the Unified Health System.
A widely multidisciplinary background enabled Dr Milena to become a professional capable of integrating scientific knowledge into private initiatives, education, and healthcare, delivering consistent services in patient safety and population health.
Professional Memberships & Affiliations:
Dr Milena Oliveira is a member of the Regional Council of Pharmacy of the State of São Paulo, Brazil.
Education:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
Relevant Published Work & Citations:
Oliveira ML de, Rocha A, Nardotto GHB, Pippa LF, Simões BP, Lanchote VL. Analysis of daunorubicin and its metabolite daunorubicinol in plasma and urine with application in the evaluation of total, renal and metabolic formation clearances in patients with acute myeloid leukemia. Journal of Pharmaceutical and Biomedical Analysis. Nov 2020. 191:113-124.
Abstracts. CPT: Pharmacometrics & Systems Pharmacology. 2020 Nov; 9 (S1).
Pippa LF, Oliveira ML de, Rocha A, de Andrade JM, Lanchote VL. Total, renal and hepatic clearances of doxorubicin and formation clearance of doxorubicinol in patients with breast cancer: Estimation of doxorubicin hepatic extraction ratio. Journal of Pharmaceutical and Biomedical Analysis. 2020 Jun 5; 185:113-231.
Godoy ALPC, De Jesus C, De Oliveira ML, Rocha A, Pereira MPM, Larangeira DF, Lanchote VL, Barrouin-Melo SM. Determination of Allopurinol and Oxypurinol in Dogs Plasma by High-Performance Liquid Chromatography with an Ultraviolet Detector: Application for Pharmacokinetic Studies. J Chromatogr Sep Tech. 2017; 8 (4).
Clímaco EC, Oliveira ML de, Pitondo-Silva A, Oliveira MG, Medeiros M, Lincopan N, et al. Clonal complexes 104, 109 and 113 playing a major role in the dissemination of OXA-carbapenemase-producing Acinetobacter baumannii in Southeast Brazil. Infection, Genetics and Evolution. 2013 Oct;19:127–33.
Conference Papers:
Oliveira, M. L.; NARDOTTO, G. H. B.; PIPPA, L. F.; ROCHA, A.; SIMOES, B. P.; LANCHOTE, V. L. . Daunorubicin metabolism and urinary excretion in patients with acute myeloid leukemia. In: 84th Annual Meeting of the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT) and the 20th Annual Meeting of the Association of the Clinical Pharmacology Germany (VKliPha), 2018, Göttingen. Naunyn-Schmiedeberg’s Arch Pharmacol, 2018. v. 391. p. S76-S76.
Oliveira, M. L.; NARDOTTO, G. H. B. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . The low contribution of urinary excretion in the elimination of daunorubicin and its metabolite daunorubicinol in patients with acute myeloid leukemia. In: 49th Brazilian Congress of Pharmacology and Experimental Therapeutics., 2017, Ribeirão Preto. Livro de Resumos, 2017. p. 64-64.
Oliveira, M. L.; PIPPA, L. F. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . Quantification of daunorubicin and its metabolite daunorubicinol in human plasma by LC-MS/MS. In: I International Meeting of Environmental Health and Toxicology (IMEHTOX), 2016, Ribeirão Preto. Livro de Resumos, 2016.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. . PFGE typing of Carbapenem-Resistant Acinetobacter baumannii isolated from different University Hospitals. In: V International Postgraduate and Research Symposium, 2012.
Clímaco, E.C. ; SILVA, A. P. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. Relação clonal entre linhagens de Acinetobacter baumannii produtoras de carbapenemases da família OXA em quatro hospitais no Brasil. In: XXI Latin American Congress of Microbiology, 2012, Santos. XXI Latin American Congress of Microbiology, 2012.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Darini A.L.C. . Dissemintion of OXA carbapenemases genes in carbapenem-resistant Acinetobacter baumannii in University Hospital of Juiz de Fora, MG. In: 8th CIFARP – International Congress of Pharmaceutical Sciences, 2011, Ribeirão Preto.
Clímaco, E.C. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Darini A.L.C. . Avaliação do sequenciamento parcial do gene rpoB e de seus flanqueadores para identificação de espécies de Acinetobacter na rotina laroratorial. In: 2° International Symposium on Clinical Microbiology, 2010, Florianópolis.
You can view some of Dr Milena’s work below and links to her professional profile.
Linkedin: https://www.linkedin.com/in/dra-milena-locci-de-oliveira-28986042/?locale=en_US
ResearchGate: https://www.researchgate.net/profile/Milena-Oliveira-6
Escavador: https://www.escavador.com/sobre/5394254/milena-locci-de-oliveira
Lattes: https://buscatextual.cnpq.br/buscatextual/busca.do
Scopus: https://www.scopus.com/authid/detail.uri?authorId=57199779361
Scholar: https://scholar.google.com/citations?view_op=list_works&hl=pt-BR&user=1YUBDIQAAAAJ
How to switch from Zoloft to Lexapro successfully?
You can successfully switch from Zoloft to Lexapro by following your doctor’s directions. The best switching strategy can be patient-specific because each individual is unique in terms of symptoms and overall body physiology.
The cause of Zoloft discontinuation is also different, as some people may suffer from side effects and that’s why they shift to Lexapro, whereas some people don’t benefit much from Zoloft and may need to try another antidepressant for better therapeutic effects.
Either way, your doctor will most likely suggest one of the following switching strategies (1,2):
- Direct switch
- Taper off Zoloft while starting Lexapro from the lowest effective dose.
Direct switch
A direct switching strategy can be applied in this case because both Zoloft and Lexapro belong to the same class of antidepressants – Selective serotonin reuptake inhibitors (SSRIs) (3,4).
Antidepressants belonging to one class are very similar, especially in the way they work. This is why your doctor may stop Zoloft and start Lexapro right away. This is the simplest way of switching antidepressants, but it may not be applicable in every case.
Taper off Zoloft while starting Lexapro from the lowest effective dose
People who are more sensitive to the effects of Zoloft may experience disturbing withdrawal symptoms after directly switching to the antidepressant.
In such cases, it’s best to first taper off Zoloft gradually, while starting Lexapro from the lowest effective dose at the same time. This way, the dose of Zoloft keeps decreasing until the drug is stopped and Lexapro takes its place.
This way, the sudden discontinuation of Zoloft doesn’t affect you or cause disturbing withdrawal symptoms. Make sure you don’t try switching your antidepressant on your own.
Common reasons leading to Zoloft discontinuation
Some common reasons leading to Zoloft discontinuation include:
Persistent side effects
Some individuals may experience side effects while taking Zoloft, such as nausea, headache, dizziness, or sexual dysfunction. If these side effects become bothersome or affect daily life, it’s preferable to switch to another antidepressant.
Reduced effectiveness
Zoloft may not work as effectively as expected for everyone. If a person does not experience the desired improvement in their symptoms or feels that the medication is not helping them sufficiently, they may decide to stop taking it.
However, your doctor may try dose escalation first. If you are taking a low dose of Zoloft, such as 25 mg – your doctor may increase it to 50 mg and monitor your response. If it does work, you may not need to switch to another medication.
Some people may begin their treatment with a dose lower than 25 mg, such as 12.5 mg. If your initial Zoloft dose is not working, it doesn’t necessarily mean that the drug is ineffective. It’s the dosage strength which is not adequate enough to make a difference.
In some cases, doctors may recommend increasing 50 mg of Zoloft to 75 mg, or 75 mg to 100 mg, if it fails to deliver promising results. The dose of Zoloft can be increased up to 200 mg per day.
Availability of a better treatment option
Some individuals may have a preference for alternative treatment methods or want to explore non-pharmacological options for their condition. People with mild depression often choose not to take antidepressants and seek help from psychiatric therapy sessions.
Completion of therapy
In some cases, Zoloft is prescribed for a specific duration to treat a particular condition. Once the treatment period is completed and the person’s symptoms have improved, their healthcare provider may advise discontinuing the medication.
What to expect when you switch from Zoloft to Lexapro?
Lexapro, although it belongs to the same class of antidepressants as Zoloft, may take some time to start working. You can’t expect to see a difference in your symptoms overnight.
Lexapro may also cause some early side effects and you may struggle a week or two. However, when Lexapro kicks in, you will start to see a positive change in your symptoms.
Antidepressant switching is common among depressed individuals, as it can take years to try out antidepressants and end up with the one that works out for the best.
Zoloft can also be switched to other SSRIs like Prozac (Fluoxetine). Some SNRIs like Effexor may also be more suitable for certain individuals, as compared to Zoloft.
Furthermore, Zoloft can be successfully used in combination with other antidepressants, like Mirtazapine, Trazodone, etc if antidepressant-monotherapy does not work. Just make sure you closely follow your doctor’s directions.
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References
1.-
National Prescribing Service Limited. Guidelines for switching antidepressants. [Internet]. NPS MedicineWise; 2010. Available from: https://www.nps.org.au/assets/Products/Guidelines-switching-antidepressants_A3.pdf
2.-
Keks N, Hope J, Keogh S. Switching and stopping antidepressants. Aust Prescr. 2016 Jun;39(3):76-83. doi: 10.18773/austprescr.2016.039. Epub 2016 Jun 1. PMID: 27346915; PMCID: PMC4919171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919171/
3.-
PubChem [Internet]. Bethesda (MD): National Library of Medicine (US), National Center for Biotechnology Information; 2004-. PubChem Compound Summary for CID 68617, Sertraline; [cited 2023 June 26]. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/Sertraline
4.-
PubChem [Internet]. Bethesda (MD): National Library of Medicine (US), National Center for Biotechnology Information; 2004-. PubChem Compound Summary for CID 146570, Escitalopram; [cited 2023 June 26]. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/Escitalopram
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