02/16/2026
I like to think of SSRIs (selective serotonin reuptake inhibitors) for anxiety or depression in 2 buckets: activating vs sedating.
🌻 Activating SSRIs like fluoxetine (Prozac) or sertraline (Zoloft) tend to work well for patients with more depressive symptoms because they are more likely to increase energy and boost motivation compared to other SSRIs. However, they are also more likely to cause insomnia and GI side effects like nausea, diarrhea.
🥱 Sedating SSRIs like paroxetine (Paxil) and citalopram (Celexa) tend to work well for patients with more anxiety symptoms because they are more likely to cause sedation and drowsiness with less GI side effects. However, I personally do not like them as much, especially in older adults, because the sedating properties can lead to dry mouth, urinary retention, dizziness that leads to falls, and cardiac side effects.
😊 Escitalopram (Lexapro) is a happy medium between activating and sedating, which is why it’s used commonly in patients who experience anxiety and/or depression symptoms.
🌱 There’s no one size that fits all though - depending on your needs and other medical conditions, you may be a better fit for one SSRI than another. Talk to your doctor, but the best SSRI is the one that you will take consistently!
