What Are Celexa and Lexapro?
Celexa (citalopram) and Lexapro (escitalopram) are antidepressant s in the medication class called selective serotonin reuptake inhibitors (SSRIs). Citalopram is FDA-approved for the treatment of major depressive disorder (MDD) in adults. Escitalopram is FDA-approved for the treatment of MDD in adults and kids over 12 years old and the treatment of generalized anxiety disorder (GAD) in adults and kids over 7 years old.
These raise the amount of a brain chemical (neurotransmitter) called serotonin in your brain. Serotonin helps regulate your behavior, mood, memory, and digestive system. SSRIs seem to keep your serotonin levels high by preventing your nerve terminals from taking up serotonin for recycling after it has been used. So, it's there in your synapse ready to be used again.
Celexa vs. Lexapro: What's the Difference?
Citalopram (Celexa) and escitalopram (Lexapro) are both highly selective SSRIs, which means they work exclusively on one neurotransmitter: serotonin. Interestingly, citalopram and escitalopram are the same molecule, but they can form two different three-dimensional structures that are mirror images of one another. Chemists call this kind of structure an enantiomer. Citalopram is a mix of the two enantiomers, while escitalopram contains only one enantiomer. This means your body uses the two medicines a little differently.
Differences include:
- Escitalopram is slightly newer; it was FDA-approved in 2002, while citalopram was approved in 1998.
- Escitalopram is FDA-approved for depression in adults and children 12 and older. Citalopram is only approved for adults.
- Escitalopram is also approved for generalized anxiety disorder (GAD) in adults and children 7 and older. Citalopram is only approved for depression, although your doctor may use it off-label for GAD.
- According to some studies, escitalopram may work better than citalopram at treating the symptoms of depression.
- Both carry a risk of a side effect called QT prolongation. This is an electrical disturbance in your heart that may increase your risk of an irregular heartbeat. Citalopram seems to carry a higher risk of this than escitalopram, especially at the higher dose that citalopram is generally prescribed with.
Celexa and Lexapro Side Effects and Caution
Citalopram (Celexa) and escitalopram (Lexapro) share these common side effects:
- Trouble sleeping, including drowsiness and insomnia
- Fatigue
- Dizziness, headache
- Excessive sweating
- Nausea, vomiting, constipation, and diarrhea
- Dry mouth
- Sexual dysfunction, such as ejaculation delay, reduced libido, or not being able to reach orgasm
Less common side effects include:
- Prolonged QT interval (may be more common with citalopram, compared to escitalopram)
- Low blood sodium levels from medication-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH), especially in people older than 65
Serotonin syndrome
Both citalopram and escitalopram can cause serotonin syndrome. This is when you have too much serotonin in your body. The risk of serotonin syndrome is highest when you first start a new medicine that affects your serotonin levels or if you increase your dose. But you may get it if you take a couple of different medicines that raise your serotonin levels at the same time. For instance, some medicine used to treat migraine, such as sumatriptan, also affect your serotonin levels. Make sure your doctor knows all the medicines and supplements you take so they can make sure you aren't at risk of dangerous drug interactions.
Serotonin syndrome can cause symptoms such as:
- Nervousness
- Nausea, vomiting, and diarrhea
- Dilated pupils
- Tremor
- Agitation and restlessness
- Muscle twitching, contractions, spasms, and rigidity
- Sweating and shivering
- Side-to-side eye movements
- Confusion, disorientation, and delirium
- Fast heart rate
- High blood pressure
- Fever
- Seizures
- Fainting
- Death (in severe, untreated cases)
You may have a risk of suicidal thoughts as you start your antidepressant or when your dose changes. This risk seems to be especially high in children and adults younger than age 24 years. Signs that you need to talk to your doctor right away include:
- Depression that’s worse
- Thinking about suicide
- Intense worry
- Panic attacks
- Trouble sleeping
- Feeling restless, aggressive, or cranky
- Acting without thinking
- Unusual excitement
Are Lexapro and Celexa addictive?
No, doctors don't generally consider antidepressants addictive because the risk of abuse is low. But stopping antidepressants suddenly if you've taken them longer than 6 weeks can cause some uncomfortable side effects, such as mood changes, dizziness, and anxiety . This is called antidepressant discontinuation syndrome.
Experts think it happens because you have a sudden decrease in your serotonin levels when you stop taking either Celexa or Lexapro. Your body needs time to adjust to this lower serotonin level. To prevent symptoms of antidepressant discontinuation syndrome, don't go off antidepressants on your own. Talk to your doctor first so they can help you taper your dose slowly over time.
Other Uses of Celexa and Lexapro
Both citalopram (Celexa) and escitalopram (Lexapro) have several “off-label” uses. Off-label means it's not yet FDA-approved for those conditions, but your doctor may prescribe it because they think it can help you.
Citalopram may be used off-label for:
- Obsessive compulsive disorder (OCD)
- Panic disorder
- Generalized anxiety disorder (GAD)
- Social anxiety disorder (SAD)
- Separation anxiety disorder
- Premenstrual dysphoric disorder(PMDD)
- Binge eating disorder
- Posttraumatic stress disorder (PTSD)
- Premature ejaculation
- Post-stroke depression
Escitalopram may be used off-label for:
- Social anxiety disorder (SAD)
- Obsessive compulsive disorder (OCD)
- Panic disorder
- Posttraumatic stress disorder (PTSD)
- Premenstrual dysphoric disorder (PMDD)
- Symptoms of menopause, like hot flashes and night sweats
Who Shouldn’t Take Celexa or Lexapro?
You shouldn’t take Celexa or Lexapro if you:
- Are allergic or hypersensitive to any of the ingredients
- Take another type of antidepressant called a monoamine oxidase inhibitor (MAOI), or if you only stopped taking an MAOI less than 2 weeks ago. You also shouldn’t start taking an MAOI within 2 weeks of stopping Celexa or Lexapro.
You should also tell your doctor about any health conditions you have or issues you’ve had recently, such as:
- Liver, kidney, or heart problems
- Seizures or convulsions
- Bipolar disorder or mania
- Low sodium levels in your blood
- A stroke
- High blood pressure
- Have or had bleeding issues
Adults under 24, teens, and children who take antidepressants may have an increased risk of suicidal thoughts and actions. If you have thoughts of suicide, contact the National Suicide Prevention Lifeline (800-273-8255) right away.
Women who are pregnant or breastfeeding should check with their doctors about continuing or stopping either of these medications.
Celexa isn’t recommended for people who have:
- A congenital heart condition called long QT syndrome
- A heart rate that’s slower than normal
- Low potassium levels in their blood
- Low magnesium levels
- Had a heart attack recently
- Uncompensated heart failure
Celexa and Lexapro Drug Interactions
Before you start your prescription, you should also tell your doctor about any medications, supplements, or herbs you take. The items below could have a bad interaction with Celexa or Lexapro:
- Other antidepressants that work on serotonin
- Dapoxetine, an SSRI used to treat premature ejaculation
- Triptans, medicines for migraine headaches
- Fentanyl, a synthetic opioid pain medicine
- Tramadol, an opioid pain medicine
- Lithium, which is a medicine used to treat manic episodes that are part of bipolar disorder
- Buspirone, a medicine for anxiety
- Amphetamines, stimulants that you may take for attention deficit hyperactivity disorder (ADHD) or narcolepsy
- St. John's wort, a supplement you may take for depression
- Tryptophan, a supplement you may take to help with depression, bipolar disorder, or insomnia
- Methylene blue, a medicine used to treat methemoglobinemia and sometimes used as a dye during imaging
- Linezolid, an antibiotic you may get for pneumonia and some skin infections
- Urokinase, a medicine used to treat blood clots in your lungs
- Pimozide (Orap), a medicine used to treat tics in Tourette syndrome
Celexa vs. Lexapro: Which One to Choose
Celexa and Lexapro are in the same class of drugs, with similar efficacy and side effects. But Lexapro is approved for both depression and anxiety in both children and adults. And studies show that Lexapro may work better for depression than Celexa.
There will be trade-offs, no matter which you choose, so talk to your doctor. They can help explain the pros and cons of both and help you make an informed choice.
Takeaways
Celexa (citalopram) and Lexapro (escitalopram) are antidepressant s called selective serotonin reuptake inhibitors (SSRIs). They raise the amount of a neurotransmitter called serotonin in your brain. Citalopram is FDA-approved for the treatment of major depressive disorder in adults. Escitalopram is FDA-approved for the treatment of MDD in adults and kids over 12 years old, and the treatment of generalized anxiety disorder (GAD) in adults and kids over 7 years old. They have very similar efficacy and side effect profiles. Talk to your doctor about which might work for you.
Celexa and Lexapro FAQs
How long does Celexa or Lexapro take to work?
Celexa and Lexapro both generally start to work after about 1-4 weeks, but you'll generally need to take them 8-12 weeks to get the full benefit.
Can Celexa or Lexapro cause weight gain?
It's possible that Celexa or Lexapro causes some weight gain, but that's not one of the main side effects of either drug. If you do gain weight from taking either, it's likely to be a very small amount; for instance, a pound or two. Some people lose weight on Celexa or Lexapro because one of the side effects is a decreased appetite, at least until you get used to your dose.
