Both Zoloft and Xanax are prescribed to treat anxiety and major depressive disorder, but there are some major differences between the two medications.
In this article, we will compare Zoloft and Xanax, including their differences, what they treat, side effects, costs, and more.
Plus, we’ll cover how you should know when to see a doctor for signs of anxiety or depression.
Differences
The primary difference between Zoloft and Xanax is that they are in different drug classes because they work differently in the brain.
Zoloft (the brand name for sertraline) is a selective serotonin reuptake inhibitor (SSRI).
It increases levels of the neurotransmitter serotonin by blocking its reuptake (or removal).
This produces a calming effect on the brain. Zoloft is not a controlled substance. It comes in tablets and liquid forms.
Xanax (the brand name for alprazolam) is a benzodiazepine.
It increases activity receptors in the central nervous system, affecting the neurotransmitter gamma-aminobutyric acid (GABA).
This also has a calming effect on the brain.
Xanax is a controlled substance because it has a greater potential for abuse or dependence.
It comes in tablet forms as immediate-release and extended-release. It is also available as an oral solution.
Primary Differences Between Zoloft and Xanax
Xanax | Zoloft | |
Drug class | Benzodiazepine | Selective serotonin reuptake inhibitor (SSRI) |
Generic drug name | Alprazolam | Sertraline |
Forms | Immediate-release tablet, extended-release tablet, oral solution | Tablet, liquid |
Standard dosage | Adults: 0.25-1 milligrams (mg) taken 1-3 times daily | Adults: 50-200 mg daily |
Does discontinuation require tapering? | Yes | Yes |
Who it is prescribed for | Adults | Adults; adolescents in some cases |
Length of treatment | Short-term use; occasionally long-term use under close healthcare provider supervision | Months or years |
How quickly does each take to work?
Because Zoloft and Xanax work differently in the brain, their effects are noticed at different times.
Xanax: Benefits are typically felt within an hour.
Zoloft: Benefits may start being noticeable within two weeks, but full improvements may take 6-8 weeks.
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Conditions Treated
Zoloft is an SSRI that is FDA-approved for the treatment of:
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Premenstrual dysphoric disorder (PMDD)
Zoloft may also be used off-label for generalized anxiety disorder and other related conditions.
Xanax is FDA-approved for the short-term treatment of:
Anxiety
Panic disorder
Agoraphobia
Xanax is sometimes used off-label for depression and other anxiety disorders.
Condition | Xanax | Zoloft |
Major depressive disorder | Off-label | Yes |
Anxiety disorders | Yes | Yes |
Post-traumatic stress disorder (PTSD) | Off-label | Yes |
Obsessive-compulsive disorder (OCD) | Off-label | Yes |
Short-term anxiety relief with or without depression symptoms | Yes | No |
Panic disorder | Yes | Yes |
Social anxiety disorder | Off-label | Yes |
Premenstrual dysphoric disorder (PMDD) | No | Yes |
Side Effects
Zoloft and Xanax may cause some common side effects.
In rare cases, they may lead to serious reactions.
Common side effects
Side effects that may commonly occur while taking Zoloft include:
Xanax side effects are dose-dependent, with higher doses likely causing more noticeable side effects.
These may include:
Drowsiness, fatigue, or sedation
Weakness
Confusion or memory problems
Depression
Diarrhea
Side Effect | Xanax | Zoloft |
Nausea | Yes | Yes |
Diarrhea | Yes | Yes |
Dry mouth | Yes | Yes |
Sleepiness | Yes | Yes (less common) |
Insomnia | Yes | Yes |
Headache | Yes | Yes |
Yes | Yes | |
Weakness | Yes (less common) | No |
Ejaculation disorder or sexual problems | Yes (less common) | Yes (less common) |
More serious side effects
In rarer cases, both Zoloft and Xanax may cause serious side effects.
Xanax may worsen sleep apnea or obstructive pulmonary disease.
Both Zoloft and Xanax carry black box warnings, including an increased risk for suicidal thoughts or attempts.
Withdrawal symptoms
Both Xanax and Zoloft can cause withdrawal symptoms.
Xanax: It is possible to become dependent on Xanax even if you only take it for several days. Work with your doctor to discontinue Xanax use. Your medical provider will likely provide a tapered dose to help ease symptoms. If you have been taking Xanax long-term or multiple times a day, do not suddenly stop taking Xanax, as withdrawal symptoms can include serious effects such as seizures.
Zoloft: Do not stop taking Zoloft suddenly. Unless your healthcare provider tapers your dose, you may experience withdrawal symptoms. These range from nausea and vomiting to headaches, nightmares, dizziness, and tingling nerve pain.
Drug Interactions
Both Xanax and Zoloft can have some serious drug interactions.
Speak to your medical provider and pharmacist about other medications, over-the-counter drugs, or supplements you are taking.
This can prevent complications.
Drug Class | Drugs | Interacts with Xanax? | Interacts with Zoloft? |
MAOIs | Phenelzine Selegiline Rasagiline Others | No | Do not take within 14 days of each other. |
Triptans | Zolmitriptan Rizatriptan | Yes | Yes |
Tricyclic antidepressants | Amitriptyline Nortriptyline Others | Yes | Yes |
SSRI antidepressants | Citalopram Escitalopram Fluoxetine Paroxetine Others | Yes | Yes |
SNRI antidepressants | Venlafaxine Duloxetine Others | Yes | Yes |
NSAIDs | AspirinIbuprofen Others | No | Yes |
Anticoagulants | Warfarin | Yes | Yes |
Opioid painkillers | Codeine Hydrocodone Methodone Morphine Tramadol Others | Yes | Yes |
Alcohol | All types | Yes | Yes |
Sedating antihistamines | Diphenhydramine | Yes | Yes |
Anticonvulsants | Carbamazepine Gabapentin Lamotrigine Phenobarbital Pregabalin Others | Yes | Yes |
Herbal supplements | St. John’s Wort | Yes | Yes |
Muscle relaxants | Baclofen Cyclobenzaprine Metaxalone Others | Yes | Yes |
Macrolide antibiotics | Azithromycin Erythromycin Others | Yes | Yes |
Azole antifungals | Itraconazole | Yes | Yes |
Contraceptives | Any | Yes | Yes |
Coverage and Costs
Both Zoloft and Xanax have similar insurance and Medicare coverage.
Coverage for each typically includes:
Most private insurance
Medicare Part D
Generic may be covered, brand name may not
Out-of-pocket costs for brand names and generics can differ significantly. Sertraline (generic Zoloft) may cost around $85 out of pocket.
A typical Medicare Part D copay for sertraline is between $0-13. Xanax generic (alprazolam) may cost $40 out of pocket or between $0-33 for a Medicare Part D copay.
Xanax | Zoloft | |
Covered by insurance? | Yes (generic) | Yes (generic) |
Covered by Medicare Part D? | Yes (generic) | Yes (generic) |
Typical Medicare Part D copay | $0-33 (generic) | $0-13 (generic) |
Standard dosage | 60 tablets of 0.5 mg | 30 tablets of 100 mg |
Warnings
Zoloft and Xanax can be effective treatments, but when used improperly or in certain populations, they come with serious warnings.
Zoloft
Zoloft carries a black box warning.
This is the most serious warning that the Food and Drug Administration (FDA) issues.
This means that this medication, particularly in younger adults, may carry a higher risk of causing suicidal thoughts and behavior.
Other warnings for Zoloft include increased risk of:
Serotonin syndrome
Agitation
Seizures
Electrolyte imbalance (hyponatremia)
Bleeding
Worsened episodes in patients with bipolar disorder
Additionally, individuals who are pregnant or breastfeeding should not take Zoloft unless a healthcare provider deems the benefits greater than the risk.
Xanax
Xanax also carries a black box warning because it may increase the risk of suicidal thoughts or behavior.
Xanax may also worsen:
Sleep apnea or COPD
Seizure disorders
Liver problems
Xanax may become habit-forming if used incorrectly or long-term.
Do not take Xanax with opioids due to risk of sedation, coma, or death.
Do not take Xanax if you are pregnant.
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When to See a Doctor
See a medical provider if symptoms of anxiety or depression affect your quality of life and functioning on a daily basis.
They can recommend appropriate medication as well as other treatments such as therapy and lifestyle changes.
If you already take Zoloft, Xanax, or other medication, let your healthcare provider know if your symptoms worsen, change, or you want to stop or change your regimen.
How K Health Can Help
Think you might need a prescription for Zoloft (sertraline)?
K Health has clinicians standing by 24/7 to evaluate your symptoms and determine if Zoloft is right for you.
Get started with our free assessment, which will tell you in minutes if treatment could be a good fit. If yes, we’ll connect you right to a clinician who can prescribe medication and have it shipped right to your door.
K Health does not prescribe controlled substances such as xanax.