Celexa and Lexapro are two medications that are often confused with each other due to their remarkable similarity.
Both are selective serotonin reuptake inhibitors (SSRIs), are depressant drugs that prevent the reabsorption of serotonin in the brain, have a generic name that sounds as if someone had a lapse of consciousness while inventing it, and are used to treat depression with similar side effects.
However, that is where their similarities end.
Although Lexapro is essentially the “preferred” version of citalopram, it has proven to be different enough that patients should not assume the two are interchangeable.
The family connection
Celexa contains citalopram hydrobromide. The molecule of this substance comprises two enantiomers, which are mirror images of each other. One of them is responsible for the drug’s antidepressant properties, while the other is devoid of any therapeutic benefits.
Escitalopram oxalate, the active ingredient in Lexapro, is the “pure” enantiomer of citalopram. The “es” infix in the generic name of the drug actually designates the S-form of the molecule.
It would be wrong to suggest that the formulation of Lexapro is vastly different from the formulation of Celexa. Therefore it cannot be said that Lexapro is a significantly newer or more effective medication. It is simply slightly more potent due to the presence of a higher percentage of the active ingredient. However, it comes down to individual sensitivity, meaning that in some cases, one drug may turn out to be less suitable.
First things first
Celexa and Lexapro are both indicated for the treatment of depression. However, the former is taken at higher doses – usually starting with 20 mg per day, with the option to increase the dosage if necessary, while Lexapro generally starts with 10 mg and can even be given at 5 mg per day for older patients or those with liver problems.
The appropriate dose has to be determined by a physician, depending on the patient’s age, overall health and concurrent medicinal products, as well as their tolerance and sensitivity to the drug.
As for the comparison of the drug’s side effects, depression, anxiety and the rest
Celexa is approved by the FDA for the treatment of major depressive disorder in adults. Citalopram is also used to treat various anxiety disorders, although it is considered to be an off-label drug in this case.
Lexapro, on the other hand, is approved for both depression and generalized anxiety, and can even be prescribed to children and adolescents.
However, in practice, a prescription can only be made by a medical professional. In most cases, the doctor’s or clinical psychologist’s experience and understanding of the patient’s history play a much bigger role than the minor differences between the two medications.
What the first weeks may be like
One of the common pitfalls awaiting patients that have just received a prescription for Celexa or Lexapro is the expectation of results that is, unfortunately, unrealistic.
During the first few days, some patients may feel slightly sick, tired or confused. Some of them will experience insomnia and agitation as their bodies attempt to adjust to the medication. In a scenario where anxiety is involved, the first week can even be characterized by an increase in the discomfort felt.
For this reason, a prescription often raises more questions than it answers, as patients have to re-consider their options yet again after suffering through an uneventful first week of treatment. However, these unpleasant feelings are usually temporary, and after a few weeks, the therapeutic effect will begin to outweigh the side effects.
Sexual dysfunction, meanwhile, can be a problem for a considerably longer period of time in both cases. Patients may find themselves unable to reach an orgasm, suffer from sexual intercourse difficulties or erection problems. Increasing the dosage can make these side effects worse, but everyone’s reaction to the medication is different.
Weight gain or loss, although generally speaking a slower process, can also occur. It is hard to say if the drug itself is responsible for it, as depression and anxiety are known to suppress or stimulate the appetite depending on the case.
As for the risks associated with irregularities in the heart rhythm, they appear to be more common with Celexa. In rare instances, both drugs can lengthen the QT interval – a measurement of the heart’s electrical cycle. Citalopram is known to increase this interval by approximately 10% in healthy volunteers.
This effect becomes more prominent at higher dosages, which is why the drug is not recommended beyond 40 mg per day. There are special considerations for patients with impaired liver function, people aged 60 or older and those with abnormal sodium or potassium levels in their blood.
A similar limitation applies to Celexa – the maximum dosage of 50 mg per day is limited for the same reason. Other factors that may contribute to the issue include preexisting heart conditions, irregular heart rhythm and the use of other medications that prolong the QT interval. In any case, it is best to report any history of fainting, irregular or rapid heartbeat and family history of heart problems.
Is Lexapro easier on the system?
Sometimes — but not by much.
Escitalopram has been shown in several studies to be somewhat more effective or have somewhat fewer side effects than its counterpart. Individually, these two drugs can affect people in very different ways, and it is impossible to predict which of the two medications will be more suitable for a particular patient based on a few days’ worth of observations.
The “cleaner molecule” theory holds some water, but it does not apply to everyone. If one of the medications has a debilitating side effect profile, the other might not necessarily have it, but this does not always hold true. In such a situation, switching from one drug to another under medical supervision can be beneficial.
The safety precautions mostly overlap.
Both of the medications can increase the risk of serotonin syndrome when used concurrently with other serotonergic agents.
Drugs that increase serotonin levels cause symptoms such as restlessness, agitation, sweating, diarrhea, high fever, muscle stiffness, and confusion. If such an occurrence is observed, medical attention should be sought immediately.
Both medications carry a boxed warning about an increased risk of suicidal thoughts and behaviors in pediatric and young adult populations. In any case, sudden changes in mood, feelings of hopelessness or anxiety or thoughts of self-harm should be brought to a medical professional’s attention. Either drug should not be discontinued abruptly, as this can lead to adverse withdrawal effects such as dizziness, vivid dreams, insomnia and electric shock-like sensations.
Our guide on antidepressant use can provide further insight into the effects and dangers of taking such medication. If either of these two drugs appears to be ineffective or unusable due to uncomfortable side effects, there are other options available.
Celexa and Lexapro are two sides of the same coin. The latter is slightly more effective and is indicated for a wider variety of disorders, but Celexa comes with a more prominent warning about the risks it poses to the cardiovascular system. Ultimately, the most appropriate medication will depend on each patient’s unique situation.
The main priority should be to alleviate the uncomfortable and often debilitating symptoms that have determined the patient’s lifestyle for the past several weeks or months. After achieving this condition, a doctor should be consulted regarding the possibility of switching to another drug, if necessary.
