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Celexa vs. Lexapro: Which is Better For Depression?

Depression accounts for a major proportion of mental health problems in the country. According to the Centers for Disease Control and Prevention (CDC), about one in six American adults will experience depression at least once in their lifetime. The precise cause of depression is not known, but certain factors can increase the risk of experiencing depression. It is generally accepted that a combination of genetic, environmental, and psychological factors contribute to the development of depression. Factors that increase the likelihood of become depressed include:

  • Experiencing a traumatic event like abuse or financial trouble
  • Major life changes
  • Medical problems from diseases like cancer 
  • Chronic pain
  • Medications that increase the risk of depression
  • Excessive use of alcohol or drugs

Symptoms of depression can vary according to the individual and it is often difficult for a person to recognize that they are depressed and need medical treatment. Common symptoms of depression are regularly feeling sad or anxious, losing interest in daily activity, irritability, trouble sleeping, changes in sleep patterns, eating too little or too much, feeling tired and suicidal thoughts. Major depressive disorder, also known as clinical depression, is one of most common types of depression and is characterized by feelings of intense sadness that persist, and inability to perform activities that were once enjoyable.  Clinical depression is usually treated with a combination of medication and therapy. 

The most widely prescribed medications used to treat clinical depression belong to the selective serotonin reuptake inhibitors (SSRI) drug class or the serotonin-norepinephrine reuptake inhibitors (SNRIs) class of drugs. Among the SSRIs, Celexa and Lexapro are popular choices. Here is a comparison of drugs, how they work, side effects, and what to expect with each one for treating depression. 

Understanding Celexa? 

What is Celexa? Celexa, also known as the generic drug citalopram, works like all SSRI inhibitors by elevating the levels of serotonin in the brain to cause feelings of happiness. The drug block the reabsorption of serotonin into nerve cells allowing its accumulation in the brain that leads to elevated levels. The medication is usually taken once a day and the dosage ranges from 10 mg to 40 mg. Typically, your doctor will start you on a low dose to help your body adjust to the medication and gradually increase the dose depending on how your body responds. One of the benefits of taking Celexa is that the drug is not habit-forming, so it is a safe way to treat depression. Although the drug is used to treat anxiety too, this is an off-label use for it. Celexa is only FDA-approved for the treatment of clinical depression. Like other SSRIs, the drugs should not be stopped suddenly or symptoms can worsen. Rarely, Celexa can also cause a heart condition called QT prolongation, which is an electric disturbance in the heart, so other medications are preferred for people with pre-existing heart problems.

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Understanding Lexapro

What is Lexapro? Lexapro is the brand name for the drug escitalopram. This medication works like other SSRI inhibitors to decrease symptoms of depression by elevating serotonin levels in the brain. Lexapro is FDA-approved for the treatment of both depression and anxiety. These two conditions are interrelated, but not the same. The dosage of Lexapro is recommended to the individual based on the condition that it is being taken for. Similar to Celexa, an initial low dosage of Lexapro is used to help your body adjust to the medication. A maximum of 20 mg can be taken per day. The drug should not be stopped suddenly either, or symptoms can suddenly worsen. 

Similarities of Celexa and Lexapro 

  • Both Celexa and Lexapro belong to the same class of drugs, the SSRIs. This means that they both work in the same way through increasing serotonin levels in the brain to alleviate symptoms of depression. 
  • Both drugs have very similar side effects. These include headache, nausea, vomiting, excessive sweating, dry mouth, loss of appetite, sexual dysfunction, trouble sleeping, feeling anxious and dizziness. 
  • Once you start taking either drug, it may take up to two weeks to start feeling any better, but on average it takes between four to six weeks to feel the full effect of taking either medication. Do not stop taking either drug even if you do not notice any changes initially. 
  • Both drugs can cause serious side effects if they are withdrawn quickly. Some of these withdrawal symptoms include changes in sleep pattern, mood swings, headache and feeling like you are undergoing an electric shock. It is important that the dose of the medication is reduced gradually when you stop taking it to avoid experiencing these withdrawal symptoms. 
  • The potential drug interactions of either Celexa or Lexapro are similar. Both drugs have low potential to inhibit hepatic enzymes in the liver where drugs are metabolized, so they interact with very few other drugs. Some notable exceptions that do interact with Celexa and Lexapro include monoamine oxidase inhibitors (MAOIs), blood thinners, non-steroidal anti-inflammatory drugs (NSAIDs), anxiety drugs, seizure drugs, drugs for problems with the heart, and drugs that lower potassium or magnesium levels in the body. 
  • Both Celexa and Lexapro are associated with a low risk of abuse. Therefore, these drugs are not controlled substances, but require a prescription to be purchased. 
  • Both medications have generic versions available, making them generally inexpensive. The cost of either generic Celexa or Lexapro is comparable, but Celexa could be slightly cheaper depending on where you purchase it.  
  • Both Celexa and Lexapro are covered by Medicare Part D plans and private health insurance plans. 
  • Celexa and Lexapro are pregnancy category C drugs. These drugs have not been studied well enough to judge their safety in being taken during pregnancy. Research has shown that potential harm to the fetus may occur with either medication, so doctors prefer to prescribe other medications to treat depression for pregnant women. 

Differences between Celexa and Lexapro 

  • Celexa and Lexapro differ in their chemical structure. Celexa is the brand name of citalopram, while Lexapro is the brand name of escitalopram. Citalopram contains two stereo-isomers, or arrangement of atoms, called R-citalopram and S-citalopram, whereas escitalopram has only the S-citalopram isomer. 
  • Celexa is FDA-approved for the treatment of major depressive disorder. Lexapro is FDA-approved for the treatment of both major depressive disorder and general anxiety disorder. 
  • In addition to their FDA-approved indications, Celexa and Lexapro are often prescribed as ‘off-label’ treatment for other conditions. Celexa is prescribed to treat panic disorder, general anxiety disorder, binge eating, alcoholism, obsessive compulsive disorder (OCD) and premenstrual dysphoric syndrome. Lexapro is used off-label to treat OCD, insomnia, and it can be helpful in treating symptoms of menopause. 
  • Both Lexapro and Celexa have different age specifications for who can take the drugs safely. Celexa can be used by adults age 18 years and older, while Lexapro can be used by anyone above the age of 12. Young adults under the age of 24 are at higher risk of developing suicidal thoughts while taking anti-depressants, but clinical trials demonstrated that Lexapro could be safely taken by children between the ages of 12 and 17 for the treatment of major depressive disorder.
  • Celexa is not recommended for people with a history of heart problems such as bradycardia, congenital long QT syndrome, and low potassium or magnesium levels because it can cause a dangerous heart abnormality called QT prolongation. This can lead to sudden death. The risk of QT prolongation is increased with higher doses. 

Which one works better? 

Generally, both Celexa and Lexapro are regarded as equally effective drugs that can treat major depressive disorder. Both drugs are among the most commonly recommended prescription drugs used to treat clinical depression, averaging more than 20 million prescriptions annually. The majority of studies have indicated that there is no difference in how well Celexa and Lexapro work. However, one clinical study that examined the efficacy of the maximum dosage of citalopram (Celexa) at 40 milligrams a day, or escitalopram (Lexapro) at 20 milligrams a day, in 138 patients with moderate to severe major depressive disorder found that more patients responded to treatment with escitalopram compared to citalopram. However, many factors go into whether one drug will work better than the other in a specific individual, so your doctor can help you decide which one is likely to be better for you. 

The bottom line

Celexa and Lexapro are both effective drugs for the treatment of major depressive order. Both medications work in the same way, have similar side effects and drug interactions, comparable costs and they are both taken in the same way. Which drug you choose should depend on a combination of aspects like your personal medical history, condition that you are using it to treat and other medications that you may be taking. Lexapro also treats anxiety, so this can be weighed into your decision if this condition affects you. Ultimately, talking with your doctor can help you decide which drug is right for you. 

Published September 25th, 2020 by Chris Riley
Fact Checked by Chris Riley

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