the public record, side by side

Celexa (citalopram) vs Zoloft (sertraline)

Celexa and Zoloft, compared on what the public record actually supports: side effects by rate from each FDA label, what the largest trial comparison found, who takes each one, who pays, what the labels warn, and what the litigation record holds. Sources on every number.

the short answer

is Celexa or Zoloft more effective? in the largest comparison of antidepressant trials (522 trials, 116,477 people, Lancet 2018), both beat placebo on response at about 8 weeks: citalopram odds ratio 1.52 (95% CrI 1.33 to 1.74), sertraline 1.67 (1.49 to 1.87). the authors called the differences between drugs mostly modest, with wide intervals. the two direct trials, both 24 weeks (Ekselius 1997, 400 primary-care patients; Stahl 2000, 323 patients with a placebo arm), found no difference in response at the end, with citalopram improving earlier in one of them and sertraline causing more stomach upset; the one label difference that changes everyday use is citalopram’s 40 mg cap for QT prolongation, where sertraline’s label has a caution but no cap below its 200 mg maximum.
which has fewer side effects? the labels say their trials “cannot be directly compared”, because each drug was tested in different people under different rules. what each label prints: Celexa (citalopram): 16% stopped for an adverse reaction vs 8% on placebo (Celexa label, Revised: 10/2023). Zoloft (sertraline): 12% stopped for an adverse reaction vs 4% on placebo (Zoloft label, Revised: 8/2023). the reactions both labels list, side by side, are in the table below. in the 2018 network, all-cause dropout against placebo was 0.94 for citalopram and 0.96 for sertraline.
which should i take? not a question this page answers. the odds ratios are averages across thousands of strangers; your history, other medications and what you can live with are not in them. the questions for your prescriber below are built from what is on this page.

What this page will not do is rank them. For most same-class pairs, head-to-head efficacy differences are smaller than the rankings look — the largest network meta-analysis ever run (21 antidepressants, 522 trials) found every drug beat placebo and the gaps between drugs mostly modest and uncertain. Which one fits you turns on your history, your other medications, and side-effect trade-offs — a prescriber conversation. This page arms that conversation; here are the questions worth taking into it →

what the 522-trial comparison found for citalopram and sertraline

the 2018 Lancet network meta-analysis pooled 522 trials comprising 116 477 participants, the median duration of the acute treatment was 8 weeks (iqr 6–8), and compared 21 antidepressants against placebo and against each other on two outcomes: response (at least a 50% fall on the depression scale) and all-cause dropout, its stand-in for acceptability. odds ratios are against placebo. an odds ratio above 1 on response favours the drug; below 1 on dropout means fewer people stopped than on placebo.

drug	response vs placebo, OR (95% CrI)	dropout vs placebo, OR (95% CrI)
Celexa (citalopram)	1.52 (1.33 to 1.74)	0.94 (0.80 to 1.09)
Zoloft (sertraline)	1.67 (1.49 to 1.87)	0.96 (0.85 to 1.08)

citalopram: among the more tolerable (fewer dropouts) in head-to-head trials.
sertraline: among the more tolerable (fewer dropouts) in head-to-head trials.

the other direction, in the authors' words. “the certainty of evidence was moderate to very low”; “The random-effects summary SMD for all antidepressants was 0·30 (95% CrI 0·26–0·34)”, a modest average effect; “positive results need to be taken with great caution, because the trials in this network meta-analysis were of short duration”. 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low. 409 (78%) of 522 studies were funded by pharmaceutical companies. the trials excluded people with psychotic, treatment-resistant or bipolar depression, and the paper says it cannot guide the next choice after a first drug fails. a difference between two odds ratios in the table above is not a difference between the drugs unless the direct comparison shows one.

Cipriani A, Furukawa TA, Salanti G, et al. 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. Lancet 2018; doi:10.1016/S0140-6736(17)32802-7. funding of the analysis: National Institute for Health Research Oxford Health Biomedical Research Centre and the Japan Society for the Promotion of Science. The funder of this study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit for publication. read 2026-10-11 at PMC.

the two trials that compared these two directly, and the dose cap that separates their labels

who paid: the Cochrane review is academic (University of Verona and collaborators) and calls its 59 included studies "mostly of low quality". the two direct trials: Ekselius 1997 and Stahl 2000. neither abstract names its funder, and the Cochrane review’s companion citalopram volume (2012) closes with the same warning as its others: "the potential for overestimation of treatment effect due to sponsorship bias and publication bias should be borne in mind."

the 2010 Cochrane review of sertraline (searched to July 2008; 59 trials) pooled the two trials against citalopram and reports, for sertraline relative to citalopram: failure to respond at 6 to 12 weeks OR 0.93 (95% CI 0.61 to 1.42; 1 trial, 400 participants), at 16 to 24 weeks OR 1.38 (0.86 to 2.23); stopping for any cause OR 1.30 (0.77 to 2.19; 2 trials, 615 participants); stopping for side effects 1.46 (0.90 to 2.36); at least one side effect 1.71 (1.00 to 2.94). an odds ratio above 1 here counts against sertraline. none of the intervals excludes 1, so the review reports no sertraline–citalopram finding in its text.
in the other direction, the same review found sertraline ahead of fluoxetine on efficacy and better accepted than amitriptyline, imipramine, paroxetine and mirtazapine, "generally associated with a higher rate of participants experiencing diarrhoea" (significant against escitalopram, OR 2.10, and paroxetine, OR 2.51; against citalopram 1.54, 0.92 to 2.56, not significant). the 2012 Cochrane review of citalopram (37 trials) reports no sertraline result in its abstract; its findings are that citalopram was less effective than escitalopram and more effective than paroxetine and reboxetine.
Ekselius 1997 (400 general-practice patients in Sweden, 24 weeks, sertraline 50 to 150 mg against citalopram 20 to 60 mg, flexible dose): intention-to-treat response 76% on sertraline and 81% on citalopram, "no statistically significant differences"; completer response 90% and 93%; final mean doses 82 mg and 34 mg; both "considered to be well tolerated".
Stahl 2000 (323 patients, 24 weeks, citalopram 20 to 60 mg, sertraline 50 to 150 mg, or placebo): both drugs beat placebo on the Hamilton and Montgomery-Åsberg scales; "significant improvement was observed at earlier timepoints in the citalopram group than the sertraline group"; sertraline "was associated with increased gastrointestinal side effects and a tendency toward early discontinuation", and once early dropouts were excluded the two drugs showed "similar acute efficacy". on the Hamilton anxiety scale citalopram separated from placebo and sertraline did not.
the labels, read on 2026-10-21 (citalopram tablets, DailyMed set 625a78b2, version 5, effective 27 August 2026; sertraline tablets, set 1afd0016, version 3, effective 27 August 2026). citalopram: "dosages above 40 mg once daily are not recommended due to the risk of QT prolongation"; the maximum is 20 mg for people over 60, with hepatic impairment or who are CYP2C19 poor metabolizers; avoid in congenital long QT syndrome, bradycardia, low potassium or magnesium, recent heart attack or uncompensated heart failure, and stop if QTc stays above 500 ms. sertraline: maximum 200 mg a day for depression; its QTc item (5.10) says post-marketing cases of QTc prolongation and torsade de pointes have been reported and the drug "should be used with caution in patients with risk factors for QTc prolongation", with no dose cap attached.
what each label prints for the stomach, against its own placebo: sertraline nausea 26% vs 12%, diarrhoea or loose stools 20% vs 10% (3,066 adults across its indications); citalopram nausea 21% vs 14%, diarrhoea 8% vs 5%, somnolence 18% vs 10%, dry mouth 20% vs 14% (1,063 depressed adults). different trials, different people; read each column against its own placebo.

limits: two trials, 615 people between them, both flexible-dose, published in 1997 and 2000; the Cochrane review pooled them under "mostly of low quality". the sertraline odds ratios above are against citalopram as the reference, so the intervals that touch 1 (at least one side effect, 1.00 to 2.94) are borderline, not findings. the 2018 Lancet network, which pooled far more trials, gives both drugs overlapping intervals against placebo (sertraline 1.67, 1.49 to 1.87; citalopram 1.52, 1.33 to 1.74), names both among the more tolerable drugs in its head-to-head analysis and neither among the more effective. the QT cap is about doses above 40 mg and about specific groups; it is not a finding about an everyday 20 mg dose. none of this is a verdict about you.

Cipriani A, La Ferla T, Furukawa TA, et al. Sertraline versus other antidepressive agents for depression. Cochrane Database of Systematic Reviews 2010; doi: 10.1002/14651858.CD006117.pub4. read 2026-10-21.

side effects by rate: what each label prints, not a head-to-head trial

the labels' own warning, first: “Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in clinical practice.” the two columns below come from different trials, in different people, under different inclusion rules. read each against its own placebo column, not against the other drug.

reaction	CELEXA (N=1,063) vs Placebo (N=446)	ZOLOFT (N=3066) vs Placebo (N=2293)
nausea	21% vs 14%	26% vs 12%
dry mouth	20% vs 14%	14% vs 9%
diarrhea	8% vs 5%	20% vs 10%
insomnia	15% vs 14%	20% vs 13%
somnolence	18% vs 10%	11% vs 6%
fatigue	5% vs 3%	12% vs 8%
tremor	8% vs 6%	9% vs 2%
sweating	11% vs 9%	7% vs 3%
decreased appetite	4% vs 2%	7% vs 2%
agitation	3% vs 1%	8% vs 5%
vomiting	4% vs 3%	4% vs 1%
dyspepsia	5% vs 4%	8% vs 4%
libido decreased	2% vs <1%	6% vs 2%
ejaculation disorder	6% vs 1%	3% vs 0%
erectile dysfunction	3% vs <1%	4% vs 1%

Celexa (citalopram): 16% stopped for an adverse reaction vs 8% on placebo (Celexa label, Revised: 10/2023).
Zoloft (sertraline): 12% stopped for an adverse reaction vs 4% on placebo (Zoloft label, Revised: 8/2023).

what makes each table, in the labels' words

Celexa (citalopram), Revised: 10/2023, 6 ADVERSE REACTIONS / 6.1 Clinical Trials Experience. inclusion rule: “Adverse reactions reported by at least 2% of patients treated with CELEXA are reported, except for the following adverse reactions which had an incidence on placebo ≥ CELEXA: headache, asthenia, dizziness, constipation, palpitation, vision abnormal, sleep disorder, nervousness, pharyngitis, micturition disorder, back pain.” trials: “Table 3 enumerates the incidence of adverse reactions that occurred among 1,063 patients with MDD who received CELEXA at doses ranging from 10 mg to 80 mg once daily in placebo-controlled trials of up to 6 weeks duration.” DailyMed
Zoloft (sertraline), Revised: 8/2023, 6 ADVERSE REACTIONS / 6.1 Clinical Trials Experience. inclusion rule: “Adverse reactions that occurred greater than 2% in ZOLOFT-treated patients and at least 2% greater in ZOLOFT-treated patients than placebo-treated patients.” trials: “The data described below are from randomized, double-blind, placebo-controlled trials of ZOLOFT (mostly 50 mg to 200 mg per day) in 3066 adults diagnosed with MDD, OCD, PD, PTSD, SAD, and PMDD. These 3066 patients exposed to ZOLOFT for 8 to12 weeks [sic — spacing as printed] represent 568 patient-years of exposure. The mean age was 40 years; 57% were females and 43% were males.” DailyMed

every row above was transcribed from the current FDA label on 2026-09-08; the full tables, including the reactions only one label lists, are on side-effect rates, drug vs placebo. the sexual side-effect rows carry each label's own underreporting caveat on the SSRI sexual side effects page.

citalopram (Celexa)

SSRI antidepressant

FDA approval: 1998 · full approval journey →
Who takes it (US, 2024): 2,876,646 patients · 12,504,000 prescriptions (AHRQ MEPS)2014 → 2024: 29,737,922 → 12,504,000 prescriptions, down 58%Correction (29 September 2026): An earlier version of this section took its numbers from ClinCalc DrugStats, a third-party site that republishes this survey; we now compute them from AHRQ’s public-use files ourselves. It showed 2,876,645 people and 12,500,214 prescriptions for 2024; the file gives 2,876,646 and 12,504,000.
Who pays (2024): Medicare: 6,743,311 claims · 1,422,360 beneficiariesMedicaid: ≥2,096,752 prescriptionsCommercial claims: not published in any public dataset — a real absence, not a zero.
Boxed warning: Yes — on the current FDA label. read it in context →
Adverse-event reports (FAERS): Caveat first: FAERS counts unverified REPORTS, not patients or rates — no denominator, and attention inflates reporting. Never compare these counts head-to-head; a longer-marketed, more-prescribed drug accumulates more reports by exposure alone. how to read FAERS →106,559 all-time reports; most-reported terms: fatigue, nausea, drug ineffective
Legal & safety record: the full litigation & recall record →

sertraline (Zoloft)

SSRI antidepressant

FDA approval: 1991 · full approval journey →
Who takes it (US, 2024): 10,233,569 patients · 44,634,056 prescriptions (AHRQ MEPS)2014 → 2024: 37,723,879 → 44,634,056 prescriptions; the change is within the survey’s margin of errorCorrection (29 September 2026): An earlier version of this section took its numbers from ClinCalc DrugStats, a third-party site that republishes this survey; we now compute them from AHRQ’s public-use files ourselves. It said prescriptions were up 18% since 2014; that change is within the survey’s margin of error, so we no longer state a direction.
Who pays (2024): Medicare: 16,155,695 claims · 3,200,756 beneficiariesMedicaid: ≥9,178,192 prescriptionsCommercial claims: not published in any public dataset — a real absence, not a zero.
Boxed warning: Yes — on the current FDA label. read it in context →
Adverse-event reports (FAERS): Caveat first: FAERS counts unverified REPORTS, not patients or rates — no denominator, and attention inflates reporting. Never compare these counts head-to-head; a longer-marketed, more-prescribed drug accumulates more reports by exposure alone. how to read FAERS →218,320 all-time reports; most-reported terms: nausea, drug ineffective, fatigue
Legal & safety record: the full litigation & recall record →

questions for your prescriber, built from this page

this page does not tell you to start, stop or switch anything. it arms the conversation where that decision belongs. take these in:

which of Celexa and Zoloft did you have in mind first, and what in my history points that way?
the trials put these two close together on average. what, for me specifically, breaks the tie: another medication i take, a side effect i can't live with, sleep, weight, sexual function?
the label lists these reactions above placebo for the one you're suggesting. which of them should i expect in the first weeks, and which would make you want to hear from me the same day?
how long were the approval trials, and what do we know past that point?
how will we judge whether it is working, by when, and what is the plan if it isn't?
if i ever want to come off it, how is that done, and over how long?
is there a cheaper generic or a formulation that changes the dosing, and does my insurance prefer one of these two?

the longer checklist, for any antidepressant, is questions to ask before starting antidepressants. if you are already on one and it feels like it stopped working, that has its own page.

What the warnings mean, drug by drug

Each explainer reads one drug's current FDA label and the studies in our library, in both directions: the boxed warnings with the label's own numbers, the trials behind the approval and how long they ran, side effects by rate, and the research since.

Questions people search

Is Celexa or Zoloft better?

No honest page can answer that in one line. Head-to-head differences between comparable psychiatric medications are usually smaller than rankings suggest, and which fits you depends on your history, other medications, and side-effect trade-offs, a prescriber conversation. What can be compared is the public record (usage, payers, label warnings, approval history, litigation), which is what this page does, with sources.

Is Celexa the same as citalopram, and Zoloft the same as sertraline?

Celexa is a brand name for citalopram. Zoloft is a brand name for sertraline. citalopram is a SSRI antidepressant; sertraline is a SSRI antidepressant. This page uses the generic names because the federal datasets do.

Which has fewer side effects, Celexa or Zoloft?

The two FDA labels cannot be compared head to head, in their own words, because each drug's trials ran in different people under different rules. What each label prints: Celexa (citalopram): 16% stopped for an adverse reaction vs 8% on placebo (Celexa label, Revised: 10/2023). Zoloft (sertraline): 12% stopped for an adverse reaction vs 4% on placebo (Zoloft label, Revised: 8/2023). The page shows the reactions both labels list, each against its own placebo column. In the 2018 Lancet network meta-analysis, all-cause dropout against placebo was 0.94 for citalopram and 0.96 for sertraline.

Is Celexa or Zoloft more effective for depression?

In the 2018 Lancet network meta-analysis of 522 trials and 116,477 adults with major depressive disorder, both beat placebo on response at about 8 weeks: citalopram odds ratio 1.52 (95% CrI 1.33 to 1.74), sertraline 1.67 (1.49 to 1.87). The authors described the differences between drugs as mostly modest, with wide intervals. The two direct trials, both 24 weeks (Ekselius 1997, 400 primary-care patients; Stahl 2000, 323 patients with a placebo arm), found no difference in response at the end, with citalopram improving earlier in one of them and sertraline causing more stomach upset; the one label difference that changes everyday use is citalopram’s 40 mg cap for QT prolongation, where sertraline’s label has a caution but no cap below its 200 mg maximum. The certainty of evidence was moderate to very low, 78% of the trials were industry funded, and the pooled effect of all antidepressants against placebo was a standardised mean difference of 0.30. None of that says which one fits you.

Which is prescribed more, Celexa or Zoloft?

The page shows federal survey estimates we compute from AHRQ’s Medical Expenditure Panel Survey public-use files for both citalopram and sertraline: patients and prescriptions in the latest reliable year, and the yearly series from 2014 where AHRQ’s reliability rule allows it, with a direction stated only when the change is larger than the survey’s margin of error. Prescription volume reflects habits, prices, and marketing as much as evidence, so it is context, not a verdict.

Where these numbers come from

Patients and prescriptions: computed by us from AHRQ's public-use Medical Expenditure Panel Survey Prescribed Medicines files, 2014 (HC-168A) to 2024 (HC-254A), with AHRQ's reliability rule (a year with fewer than 60 respondents or a relative standard error over 50% is not shown) — counts of people filling prescriptions, not outcomes. A direction is stated only when the change is larger than the survey's margin of error. Until 29 September 2026 these came from ClinCalc DrugStats, a third-party site; see the correction under each drug where a figure changed.
Medicare/Medicaid: CMS public datasets; commercial insurance publishes no per-drug series, so it renders as an absence, never a synthesized number.
Label facts: the drugs' current FDA labels via DailyMed — quoted in context on each drug's approval-journey page.
FAERS: openFDA — reports, never rates; the caveat travels above every count.
Litigation: court records and regulator documents only, on the linked record pages; settled is never adjudicated.

Explore both drugs in depth: /m/citalopram · /m/sertraline · or the whole library →