Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
4 drugs selected — Sertraline, Escitalopram, Fluoxetine, Citalopram(click to collapse)
4/4 selected
Sertraline
Zoloft
Selective Serotonin Reuptake Inhibitor
FDA-approved indications
- Major depressive disorder (adults)
- Obsessive-compulsive disorder (adults; pediatric 6–17 years)
- Panic disorder, with or without agoraphobia (adults)
- Posttraumatic stress disorder (adults)
Off-label uses
- Generalized anxiety disorder
- Binge eating disorder
- Body dysmorphic disorder
Half-life26 hours
Escitalopram
Lexapro
Selective Serotonin Reuptake Inhibitor
FDA-approved indications
- Major depressive disorder — acute and maintenance (adults; adolescents 12–17 years)
- Generalized anxiety disorder — acute treatment (adults)
Off-label uses
- Panic disorder
- OCD
- PTSD
Half-life27 to 32 hours
Fluoxetine
Prozac
Selective Serotonin Reuptake Inhibitor
FDA-approved indications
- MDD — acute and maintenance (adults; pediatric 8+)
- OCD — acute and maintenance (adults; pediatric 7+)
- Bulimia nervosa — acute and maintenance (adults)
- Panic disorder — acute treatment (adults)
Off-label uses
- Body dysmorphic disorder
- Selective mutism
- Premature ejaculation
Half-life1 to 3 days (norfluoxetine: 4 to 16 days)
Citalopram
Celexa
Selective Serotonin Reuptake Inhibitor
FDA-approved indications
- Major depressive disorder in adults
Off-label uses
- Generalized anxiety disorder
- Panic disorder
- Social anxiety disorder
Half-life35 hours
Decision GuideWhen to pick each / when to consider an alternative
Sertraline
Consider when
- Cardiac comorbidity or post-ACS depression — only SSRI with prospective trial evidence for cardiac safety (SADHART, ENRICHD)
- Postpartum depression or breastfeeding — lowest infant relative dose among SSRIs; specifically recommended first-line in lactation
- Polypharmacy with CYP2D6 substrates — mild 2D6 inhibition (~30% desipramine AUC increase) vs 300–400% with fluoxetine/paroxetine
- PMDD requiring dosing flexibility — only SSRI with FDA label supporting both continuous and luteal-phase dosing strategies
- +1 more
Consider an alternative when
- Diarrhea-prone or IBS patient — class-top labeled diarrhea 20% vs 10% placebo; OR 2.10 vs escitalopram in Cochrane NMA
- Sexual dysfunction is treatment-limiting — class-top orgasm dysfunction 45.6% (Serretti 2009); higher than escitalopram or fluvoxamine
- Top-tier MDD efficacy is the priority — mid-tier in Cipriani 2018 NMA; below escitalopram, paroxetine, and vortioxetine
- QTc risk factors present — FDA TQT showed mean ΔQTc 10 ms at 2× max dose; pimozide contraindicated
- +1 more
Escitalopram
Consider when
- First-line MDD where efficacy and tolerability both matter — only SSRI ranking top-tier on both axes in Cipriani 2018 NMA
- Generalized anxiety disorder — FDA-approved for both MDD and GAD; citalopram is MDD-only
- Adolescent depression (age 12+) — one of only two SSRIs with FDA-approved pediatric MDD indication (with fluoxetine)
- Polypharmacy with CYP2D6 or CYP3A4 substrates — minimal CYP inhibition; safest SSRI for drug interactions alongside citalopram
- +1 more
Consider an alternative when
- Sexual dysfunction is treatment-limiting — highest-SD SSRI in Reichenpfader 2014 NMA; significant vs bupropion, fluoxetine, mirtazapine
- QTc prolongation risk — dose-dependent QTc increase; max 10 mg in elderly, hepatic impairment, or CYP2C19 PM
- CYP2C19 poor metabolizer — 2× plasma levels in PMs; max 10 mg may limit therapeutic dose optimization
- Cost is primary constraint — marginally more expensive than citalopram or sertraline generics in some formularies
- +1 more
Fluoxetine
Consider when
- Bulimia nervosa — only antidepressant with FDA approval for this indication (at 60 mg/day)
- Pediatric depression (age 8+) — one of only two SSRIs with FDA-approved pediatric MDD indication
- Adherence or discontinuation risk — longest SSRI half-life means missed doses and taper are forgiving
- Bipolar depression or treatment-resistant depression — available as olanzapine-fluoxetine combination (Symbyax)
Consider an alternative when
- Patient on CYP2D6 substrates — potent CYP2D6 inhibition persists 5 weeks after discontinuation
- Anxiety or insomnia is prominent — most activating SSRI (insomnia 19%, nervousness 13%); start low in panic disorder
- MAOI anticipated in treatment plan — long half-life requires 5-week washout before starting an MAOI (longest delay of any SSRI)
- Elderly patient — most activating SSRI with longest half-life; higher rates of insomnia, nervousness, and prolonged drug accumulation in older adults
Citalopram
Consider when
- Patient previously responded well to citalopram — no clinical rationale to switch to escitalopram if effective and tolerated
- Cost is a primary constraint — long-established generic at lowest price tier among SSRIs
- Minimal CYP drug interactions needed — among cleanest interaction profiles alongside escitalopram and sertraline
- Switching off paroxetine for tolerability — no anticholinergic burden, less weight gain, milder discontinuation syndrome
- +1 more
Consider an alternative when
- QTc risk factors present — dose-dependent QTc prolongation with boxed warning; max 20 mg in elderly, hepatic impairment, or CYP2C19 PM
- Efficacy is the top priority — not in Cipriani 2018 top tier for MDD; escitalopram preferred for most new prescriptions
- Pimozide co-prescribed — contraindicated; only citalopram and escitalopram carry this CI among SSRIs
- Sexual dysfunction is treatment-limiting — orgasm dysfunction OR 4.60 (Serretti 2009); ejaculation disorder 6% vs 1% placebo
- +1 more
Drug-Drug Interactions5 contraindicated1 major
Educational reference only. Interactions are extracted from FDA prescribing information and DDInter 2.0. Always verify with institutional pharmacy systems before clinical decisions.
Efficacy & Acceptability (9 axes)— NMA efficacy & discontinuation data (not side effects)
| Axis | Sertraline | Escitalopram | Fluoxetine | Citalopram |
|---|---|---|---|---|
| 📊 Efficacy (response rates) | ||||
MDDEfficacy | ||||
GADEfficacy | ||||
OCDEfficacy | ||||
PTSDEfficacy | — | — | ||
Panic DisorderEfficacy | — | |||
PMDDEfficacy | — | — | ||
| 🛡️ Acceptability (all-cause discontinuation) | ||||
MDDAcceptability | ||||
GADAcceptability | ||||
Panic DisorderAcceptability | — | — | ||
| Axis | Sertraline SSRI | Escitalopram SSRI | Fluoxetine SSRI | Citalopram SSRI |
|---|---|---|---|---|
| Boxed Warnings | ||||
Suicidality (boxed warning) | ||||
Mania / hypomania induction | ||||
| CNS | ||||
Sedation / somnolence | ||||
Activation / insomnia | ||||
Emotional blunting | ||||
Seizure risk | ||||
| Metabolic | ||||
Weight gain | — | — | ||
Weight loss | — | — | ||
| Autonomic | ||||
Anticholinergic burden | ||||
Orthostatic hypotension | — | — | — | |
Sweating | ||||
Angle-closure glaucoma | ||||
| Cardiac | ||||
QTc prolongation | ||||
| GI | ||||
Nausea / GI (general) | ||||
| Electrolytes | ||||
Hyponatremia / SIADH | ||||
| Sexual | ||||
Sexual dysfunction | ||||
| Discontinuation | ||||
Withdrawal / discontinuation | ||||
| Interactions | ||||
Serotonin syndrome risk | ||||
CYP interactions / DDI profile | ||||
| Safety | ||||
Bleeding risk | ||||
Overdose toxicity | — | — | — | |
| Pregnancy | ||||
Teratogenicity | — | — | — | |
Lactation / breastfeeding safety | — | |||