Lexapro vs Zoloft: Who Should Avoid Each One?
Choosing the right treatment for adults dealing with both ADHD and anxiety can be complex. Stimulants like Vyvanse or non-stimulants such as Strattera may be effective, but individual needs vary. For those sensitive to stimulants, non-stimulants often offer better tolerance. It's crucial to find the best ADHD medication for adults with anxiety that manages focus without worsening anxious symptoms. Consulting a psychiatrist is essential to tailor a plan that balances both conditions. Often, therapy combined with medication offers the most comprehensive relief, helping individuals regain control over daily tasks and emotional well-being.
Lexapro (escitalopram) and Zoloft (sertraline) are antidepressants that belong to the SSRI class. They work by increasing the levels of serotonin in the brain, a neurotransmitter that plays a critical role in mood regulation. Lexapro is commonly prescribed for major depressive disorder (MDD) and generalized anxiety disorder (GAD), while Zoloft is approved for a broader range of conditions, including depression, anxiety disorders, panic disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
While Lexapro is generally well-tolerated, certain individuals should avoid it or only use it under close medical supervision. These include:
Lexapro can trigger manic episodes in individuals with bipolar disorder. If taken without a mood stabilizer, SSRIs like Lexapro may cause a sudden shift from depression to mania. This risk makes it essential for anyone with a history of bipolar disorder or undiagnosed mood swings to undergo thorough psychiatric evaluation before starting Lexapro.
Lexapro should never be taken in combination with MAOIs or within 14 days of stopping one. Combining these medications can lead to a potentially life-threatening condition known as serotonin syndrome. This condition causes symptoms like agitation, hallucinations, rapid heart rate, and high blood pressure.
Since Lexapro is metabolized in the liver, individuals with significant liver impairment may be at increased risk of drug accumulation and toxicity. Dosage adjustments or alternative medications may be necessary in such cases.
Although Lexapro may be prescribed during pregnancy if the benefits outweigh the risks, it's not typically the first choice. Some studies have shown potential risks of birth defects and neonatal complications. Breastfeeding women should also use Lexapro with caution, as small amounts of the drug can pass into breast milk.
Lexapro is approved for use in adolescents aged 12 and older for the treatment of depression. However, younger children should not take Lexapro unless specifically directed by a specialist. The drug may increase the risk of suicidal thoughts in young users, particularly during the first few weeks of treatment.
Zoloft has a broader range of approved uses than Lexapro, but it also comes with specific risks. The following individuals should avoid Zoloft or consult their healthcare provider before taking it:
Zoloft can lower the seizure threshold and may increase the risk of seizures in individuals with epilepsy or other seizure conditions. Such patients need close monitoring or an alternative medication.
Anyone who has previously experienced serotonin syndrome should avoid Zoloft, as it can trigger a recurrence. Combining Zoloft with other serotonergic drugs also increases this risk and should be avoided unless absolutely necessary.
Zoloft can increase the risk of bleeding, especially when taken with medications like aspirin, warfarin, or nonsteroidal anti-inflammatory drugs (NSAIDs). This risk is particularly high in older adults or individuals with a history of gastrointestinal bleeding.
Alcohol can amplify the sedative effects of Zoloft and increase the risk of liver toxicity and mood instability. Patients with a history of alcohol abuse or dependence should be cautious and may need a different treatment plan.
Zoloft may increase intraocular pressure, potentially worsening narrow-angle glaucoma. Patients with this eye condition should alert their ophthalmologist and psychiatrist before starting Zoloft.
While both drugs treat similar conditions, Lexapro is often noted for having a slightly better side effect profile and fewer drug interactions. However, Zoloft is more versatile in treating multiple anxiety-related disorders. When choosing between them, doctors consider the patient's medical history, existing conditions, other medications, and specific symptoms.
Lexapro and Zoloft are powerful tools in managing depression and anxiety, but they are not one-size-fits-all solutions. Lexapro may not be ideal for those with liver issues, bipolar disorder, or who are pregnant or breastfeeding. On the other hand, Zoloft may be risky for individuals with seizure disorders, bleeding risks, or glaucoma. Always consult a qualified healthcare provider before starting or stopping any antidepressant. Personalized care is essential in finding the safest and most effective treatment for your mental health needs.
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ADHD in UK Prisons: A Failing System of Care?
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As soon as you walk into the prison, it's like you're cut off from society and everything stops Jan was initially diagnosed with emotionally unstable personality disorder. 'When I looked into it more, I didn't think the diagnosis was right,' she told Medscape News UK . She eventually sought a private ADHD assessment in 2018. By then, her life was already in crisis, embroiled in court proceedings that resulted in her children being taken into care. Jan had to wait until 2021 for the NHS to confirm the ADHD diagnosis. It was too late to avoid a cascade of events: poor educational performance, teenage pregnancy, a string of abusive relationships, and, finally, a criminal conviction. 'I was quite vulnerable at the time of my offence,' Jan said. 'Because I hadn't really felt affection and was in a vulnerable place, it all added up. I feel like if I'd been able to manage my emotions, which is hard with ADHD, I potentially wouldn't have ended up in that situation. The decision-making would have been slightly different.' Jan said her ADHD was largely ignored in the first prison she was sent to. 'I don't think they really took that into consideration. As soon as you walk into the prison, it's like you're cut off from society and everything stops.' 'There needs to be more help in closed prisons,' she said. 'If you've only got one neurodiversity lead and they're not doing their job, you're letting down 150 people.' Conditions were better in the second prison, where staff were more responsive. 'The neurodiversity lead in the open prison was very invested in me,' Jan said. 'She said she felt like I was in the criminal justice system for the wrong reasons, like the system had failed me.' Gaps in Post-Release Support Jan's challenges continued after her release. 'I've found it very difficult to handle changes,' she said. Frequent housing moves disrupted referrals. 'There just seems to be some sort of drop in the system when you're released.' Confusion over probation conditions also caused distress. On several occasions she has said to her probation officer, 'please, just send me back to jail.' Young pointed out that many former inmates struggle to access care, lacking even a registered GP to renew prescriptions. According to the MoJ, entrants to the prison system should receive an initial health screen within 24 hours. This is followed by a full health assessment within 7 days. This provides 'opportunities for identification of known conditions or needs, as well as capturing any required reasonable adjustments,' Medscape News UK was told. Although HMPPS takes a needs-led approach to supporting people in prison, they 'would not attribute any additional needs that are identified during the screening process to a specific clinical condition ourselves but do encourage individuals to self-declare any conditions or needs they consider themselves to have.' HMPPS introduced the neurodiversity support manager (NSM) role in 2021 to improve support for people with ADHD and other neurodivergent conditions while they were behind bars. NSMs were responsible for providing training and guidance to prison staff to help them not only identify prisoners who may need extra support, but also to ensure that neurodivergent prisoners had access to appropriate education, skills and work opportunities within the prison. Communication and understanding was a big issue for Jan: 'Some of my licence conditions they've put there haven't really been explained. So, I've then done things that have potentially breached my licence without knowing it.' Does Medication Help? The evidence on whether medication reduces reoffending is mixed. Asherson and colleagues conducted a large randomised double-blind trial in the UK to assess the effects of methylphenidate on ADHD in a prison population. However, the results were null, which was somewhat unexpected. 'It was a bit surprising at the time because prior research had suggested there was a very large effect of medication,' Asherson said. Asherson referred to a large Swedish trial that found lower reoffending among offenders treated for ADHD. There were also data to show that they were less likely to show violent behaviour. Data are conflicting as to whether treating people diagnosed with medication while in prison actually has an influence on their overall outcomes. Calls for Change Young told Medscape News UK : 'There's so much research. There's so many arguments,' that ADHD is prevalent in the prison population and that it urgently needs addressing. Like Asherson, Young also sat on the NICE ADHD guideline working group and noted that research was not being translated into practice. One issue is the lack of data. When Medscape News UK contacted the MoJ under a freedom of information (FOI) request to ask how many people within the prison system had a diagnosis of ADHD, the response received was that clinical diagnoses of neurodevelopmental conditions such as ADHD fell under the remit of NHS England. NHS England published its first national-level data on ADHD prevalence and assessment as recently as May 2025. The document acknowledged the need to improve data quality. Henry Shelford Henry Shelford, the chief executive of ADHD UK, criticised the delay, noting that NICE first published guidelines for ADHD in the year 2000. 'For NHS England to take 25 years to create any population estimate is an expression of their abject failure to properly manage and resource ADHD,' he told The Guardian . Takeda, a pharmaceutical company which manufactures several drugs for treating ADHD, has been campaigning for better ADHD recognition in the criminal justice system for several years. In 2024, it filed freedom of information requests with 44 prisons. Only seven (16%) replied, and none could provide data on ADHD diagnoses, screening practices, staff training, or prisoner support. Young called the results 'really frustrating.' 'I've been at this since the mid 90s, and it just seems to be cyclical. I just think, when is something going to be done?' Is Reform Finally on the Way? There are some signs that change may be coming. In March 2024, NHS England launched a national task force to examine system-wide ADHD challenges, including access, diagnosis, and care pathways. While not specifically focused on the criminal justice system, its first interim report in June 2025, highlighted the need for 'cross-agency and cross-government department working focused on the whole person' and early recognition of neurodivergent conditions. Young welcomed the effort but warned that clinicians and professionals should consider the wider consequences of having the condition. 'They may be seeing people with ADHD, but they just don't know it,' Young said. 'We don't routinely ask, 'have you committed a crime?' 'Have you ever been convicted of something?' But perhaps we should.' Young acknowledged she had received speakers' fees from Takeda, and previously from Eli Lilly & Company, Flynn Pharma, Janssen, Novartis and Shire. She had also received research grants from Eli Lilly & Company, Janssen, and Shire. Asherson has consulted for Eli-Lilly & Company, Flynn Pharma Jannsen-Cilag, and Shire.
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For individuals who struggle with focus or attention disorders, such as ADHD, mandala coloring can be a beneficial tool. It allows them to practice maintaining attention and can improve their ability to stay present in other activities throughout the day. 3. Enhanced Creativity Mandala coloring is not only a relaxing activity but also a creative outlet. Although the structure of a mandala is predefined, it's up to you to choose how to bring the design to life with your choice of colors and shading techniques. This freedom of expression allows you to experiment with different hues, gradients, and patterns, adding a personal touch to your artwork. The creative process can boost self-confidence and stimulate the imagination. For those hesitant about their artistic abilities, mandala coloring offers a low-pressure way to explore their creative side without fear of making mistakes. 4. Emotional Healing Mandalas have long been associated with emotional healing and personal growth. The circular, balanced shape of a mandala symbolizes harmony, and by engaging in this form of art, you may find yourself reconnecting with your inner peace. Many therapists incorporate mandala coloring into their practice as a tool for self-reflection and emotional processing. The repetitive nature of coloring can help release pent-up emotions, allowing individuals to express feelings they might find difficult to verbalize. In art therapy, creating and colouring mandalas can promote self-awareness and emotional healing, as the process encourages individuals to focus on their emotions and create a visual representation of their inner world. 5. A Tool for Meditation and Spiritual Growth In many spiritual traditions, mandalas are used as meditation tools to promote inner peace and self-awareness. The act of coloring a mandala can be transformed into a meditative practice in its own right. 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Whether you're seeking stress relief, emotional healing, or simply a way to unwind, mandala coloring can provide an enriching experience. As you immerse yourself in intricate patterns and vibrant colours, you may discover a deeper connection to your inner self and the world around you. So grab your favorite colouring tools, find a quiet space, and let the soothing art of mandala colouring transport you to a place of peace and creativity. TIME BUSINESS NEWS
