Sertraline (Zoloft) vs. Venlafaxine (Effexor): Uses, Side Effects

Sertraline (Zoloft) vs. Venlafaxine (Effexor): What’s the difference?

• Sertraline (Zoloft) and venlafaxine (Effexor) are antidepressants used to treat depression, social anxiety disorder, and panic disorder.
• Sertraline is also used to treat obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).
• Sertraline and venlafaxine belong to different classes of antidepressants. Sertraline is a selective serotonin reuptake inhibitor (SSRI) and venlafaxine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI).
• Side effects of sertraline and venlafaxine that are similar include drowsiness/sleepiness, sleep problems (insomnia), dizziness, nausea, loss of appetite, headache, abnormal ejaculation, dry mouth, increased sweating, and weight loss.
• Side effects of sertraline that are different from venlafaxine include nervousness, tremor, skin rash, constipation, upset stomach, diarrhea, and decreased interest in sexual activity.
• Side effects of venlafaxine that are different from sertraline include anxiety and increased blood pressure.
• Do not stop using sertraline suddenly, or you could have unpleasant withdrawal symptoms.

What are sertraline and venlafaxine?

Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat depression, panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). Other SSRIs include fluoxetine (Prozac, Sarafem), citalopram (Celexa), paroxetine (Brisdelle, Paxil, Paxil CR, Pexeva), and fluvoxamine (Luvox CR). Experts believe depression may be caused by disturbances in the balance between neurotransmitters in the brain. Sertraline is thought to restore the chemical balance among neurotransmitters in the brain. Selective serotonin reuptake inhibitors block the reuptake of serotonin, changing the level of serotonin in the brain. A serotonin balance is reached between attachment to the nearby nerves and reuptake.

Venlafaxine (Effexor) is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant used to treat depression, depression with associated symptoms of anxiety, generalized anxiety disorder, social anxiety disorder, and panic disorder. Other SNRIs include milnacipran (Savella), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). Venlafaxine prevents the reuptake of the neurotransmitters serotonin and epinephrine by nerves after they have been released. Since uptake is an important mechanism for removing released neurotransmitters and terminating their actions on adjacent nerves, the reduced uptake caused by venlafaxine increases the effect of serotonin and norepinephrine in the brain.

What are the side effects of sertraline and venlafaxine?

Sertraline

WARNING

• As demonstrated in short-term studies, antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of sertraline or any other antidepressant in a child or adolescent must balance this risk with the clinical need for the antidepressant. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

The most common side effects of sertraline are:

• Sleepiness
• Nervousness
• Insomnia
• Dizziness
• Nausea
• Tremor
• Skin rash
• Constipation
• Upset stomach
• Loss of appetite
• Headache
• Diarrhea
• Abnormal ejaculation
• Decreased interest in sexual activity
• Dry mouth
• Increase in sweating, known as diaphoresis
• Weight loss

Possible serious side effects of sertraline include:

• Irregular heartbeats
• Serious allergic reactions
• Worsening of depression
• Serotonin syndrome
• Hyponatremia
• Abnormal bleeding
• Priapism (prolonged erection)
• Decreased liver function
• Suicidality
• Activation of mania in patients with bipolar disorder

Important side effects are irregular heartbeats, allergic reactions and activation of mania in patients with bipolar disorder.

If sertraline is discontinued abruptly, some patients experience side effects such as:

• Abdominal cramps
• Fatigue
• Nausea
• Vomiting
• Diarrhea
• Headaches
• Lightheadedness
• Dizziness
• Diminished appetite
• Flu-like symptoms
• Sweating
• Chills
• Sleep disturbances
• Memory impairment

A gradual dose reduction of sertraline is recommended when therapy is discontinued.

Venlafaxine

WARNING

• Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in short-term studies in children, adolescents, and young adults with depression and other psychiatric disorders. Anyone considering the use of venlafaxine or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.

Venlafaxine, like most antidepressants, can cause:

• Nausea
• Headaches
• Anxiety
• Insomnia
• Drowsiness
• Loss of appetite

Other side effects that can occur are:

• Dizziness
• Ejaculation disorder
• Sweating
• Dry mouth
• Weight loss

Increased blood pressure can occur, and blood pressure should be monitored.

Seizures have been reported.

The FDA suggests if antidepressants are discontinued abruptly, symptoms may occur such as dizziness, headache, nausea, changes in mood, or changes in the sense of smell, taste, etc. (Such symptoms even may occur when even a few doses of antidepressant are missed.) Therefore, it is generally recommended that the dose of antidepressant be reduced gradually when therapy is discontinued.

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What is the dosage of sertraline vs. venlafaxine?

Sertraline

The recommended dose of sertraline is 25 to 200 mg once daily. Treatment of depression, OCD, panic disorder, PTSD, and social anxiety disorder is initiated at 25 to 50 mg once daily. Doses are increased at weekly intervals until the desired response is seen.

The recommended dose for PMDD is 50 to 150 mg every day of the menstrual cycle or for 14 days before menstruation.

Sertraline may be taken with or without food.

Venlafaxine

Venlafaxine should be taken with food at doses specifically directed by a physician. Individual doses vary greatly among individuals. The antidepressant effects are not maximal for 1 to 2 weeks. If discontinued, the dose of venlafaxine should gradually be reduced under the direction of a physician. For patients with difficulty swallowing tablets or capsules, capsules of Effexor XR can be opened and the contents sprinkled on a spoonful of applesauce, but removal from the capsule allows immediate release of the drug so it is no longer an extended release drug.

The dose for treatment of depression using the immediate release formulation is 75 to 375 mg daily divided in 2 or 3 doses and given every 8 or 12 hours. The extended release dose is 37.5 mg to 225 mg once daily. Dosing is usually begun with low initial concentrations and adjusted as needed by the treating doctor.

Generalized anxiety disorder and panic disorder are treated with 37.5 mg to 225 mg once daily using the extended release formulation. Social anxiety is treated with 75 mg daily using the extended release formulation.

Depression is a(n) __________ .
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What drugs interact with sertraline and venlafaxine?

Sertraline

All SSRIs, including sertraline, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example

• isocarboxazid (Marplan),
• phenelzine (Nardil),
• tranylcypromine (Parnate),
• selegiline (Eldepryl, Emsam, Elazar), and
• procarbazine (Matulane).

Other drugs that inhibit monoamine oxidase include

• linezolid (Zyvox) and
• intravenous methylene blue.

Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. (A period of 14 days without treatment should lapse when switching between sertraline and MAOIs.) Similar reactions occur when sertraline is combined with other drugs — for example, tryptophan, St. John's wort, meperidine (Demerol, Meperitab), tramadol (ConZip, Synapryn FusePaq, Ultram) — that increase serotonin in the brain.

Cimetidine (Cimetidine Acid Reducer, Tagamet HB ) may increase the levels in blood of sertraline by reducing the elimination of sertraline by the liver. Increased levels of sertraline may lead to more side effects.

Sertraline increases the blood level of pimozide (Orap) by 40%. High levels of pimozide can affect electrical conduction in the heart and lead to sudden death. Therefore, patients should not receive treatment with both pimozide and sertraline.

Through unknown mechanisms, sertraline may increase the blood thinning action of warfarin (Coumadin, Jantoven). The effect of warfarin should be monitored when sertraline is started or stopped.

Venlafaxine

Venlafaxine should not be used in combination with a monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl), or within 14 days of discontinuing the MAOI. At least 5 days should be allowed after stopping venlafaxine before starting an MAOI. Combinations of SNRIs and MAOIs may lead to serious, sometimes fatal, reactions including very high body temperature, muscle rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium, and coma. Similar reactions may occur if venlafaxine is combined with antipsychotics, tricyclic antidepressants or other drugs that affect serotonin in the brain. Examples include tryptophan, sumatriptan (Imitrex), lithium, linezolid (Zyvox), tramadol (Ultram), and St. John's wort.

Combining venlafaxine with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin), or other drugs that are associated with bleeding may increase the risk of bleeding, because venlafaxine is associated with bleeding.

Most medications affecting the brain such as venlafaxine have the potential to slow reflexes or impair judgment. Therefore, caution is advised especially early in the course of treatment.

Safety has not been established in children below the age of 18 years.

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Are sertraline and venlafaxine safe to use while pregnant or breastfeeding?

Sertraline

• Use of sertraline during the third trimester of pregnancy may lead to adverse effects in the newborn.
• Use of sertraline by nursing mothers has not been adequately evaluated.

Venlafaxine

• The effects of venlafaxine on the fetus during pregnancy are unknown.
• It is not known if venlafaxine is secreted in breast milk and, therefore, if it may have an effect on nursing infants.