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Celexa vs. Lexapro: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Major depressive disorder, commonly referred to simply as depression or MDD, is estimated to affect approximately 216 million people, or 3% of the world’s population. It is characterized by a low mood for at least a two week period through most situations. Patients may exhibit a loss of interest in activities they normally enjoy or low energy. They may also experience pain without any known cause.

Depression can be treated in a variety of ways. Counseling and exercise may be effective on their own in a large number of cases. Other patients may require medication. There are several classes of antidepressant drugs, and one of the most common of these are the selective serotonin reuptake inhibitors (SSRIs). There are several drugs in this class including Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine). Here we will discuss Celexa (citalopram) and Lexapro (escitalopram).

What are the main differences between Celexa and Lexapro?

Celexa is a prescription medication indicated in the treatment of major depressive disorder. It is available generically as citalopram and belongs to the group of antidepressants known as SSRIs. Celexa blocks the reuptake of serotonin at the neuronal membrane. By blocking serotonin reuptake by the transport pump, the drug is effectively leaving more free serotonin in the neuron synapse. Higher levels of serotonin are associated with improved mood and energy levels. The active ingredient, citalopram, has two isomers: R-citalopram and S-citalopram. The S-isomer is primarily responsible for the serotonin blockade that makes citalopram effective.

Celexa (What is Celexa?) is available in an oral tablet formulation in strengths of 10 mg, 20 mg, and 40 mg. It is also available in an oral liquid solution in concentrations of 10 mg/5 ml and 20 mg/5 ml.

Lexapro is another prescription medication indicated in the treatment of depression. The generic form of Lexapro is escitalopram, and it contains the more active isomer S-citalopram. Lexapro works in the same manner as Celexa by blocking serotonin reuptake.

Lexapro (What is Lexapro?) is available as an oral tablet in strengths of 5 mg, 10 mg, and 20 mg. It is also available as an oral solution in a 5 mg/5 ml concentration.

Main differences between Celexa and Lexapro
Celexa Lexapro
Drug class Selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitor
Brand/generic status Brand and generic available Brand and generic available
What is the generic name? Citalopram Escitalopram
What form(s) does the drug come in? Oral tablet and oral solution Oral tablet and oral solution
What is the standard dosage? 20 mg once per day 10 mg once per day
How long is the typical treatment? Long-term (months to years) Long-term (months to years)
Who typically uses the medication? Adolescents and adults Adolescents and adults

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Conditions treated by Celexa and Lexapro

Celexa and Lexapro are both indicated in the treatment of major depressive disorder. MDD is characterized by prolonged (two weeks or more) feelings of low mood and decreased energy levels. Patients may not find joy in things they enjoyed previously. Lexapro is also indicated in the treatment of generalized anxiety disorder (GAD). GAD is characterized by prolonged and obsessive worrying about a variety of topics. Celexa has been used in GAD as well, though this use is considered off-label because the FDA has not approved Celexa for this use.

Celexa and Lexapro are both used off-label in a variety of disorders that are closely related to depression and anxiety. These include obsessive compulsive disorder, panic disorder, and post traumatic stress disorder.

The following is not intended to be a complete listing of potential uses for Celexa and Lexapro. Only your healthcare provider can diagnose your disorder and decide which treatment option is best for you.

Condition Celexa Lexapro
Major depressive disorder Yes Yes
Aggression disorder (dementia associated) Off-label No
Binge eating disorder Off-label Off-label
Generalized anxiety disorder Off-label Yes
Obsessive compulsive disorder Off-label Off-label
Panic disorder Off-label Off-label
Posttraumatic stress disorder Off-label Off-label
Premature ejaculation Off-label Off-label
Premenstrual dysphoric disorder Off-label Off-label
Social anxiety disorder Off-label No
Body dysmorphic disorder No Off-label
Bulimia nervosa No Off-label

Is Celexa or Lexapro more effective?

A randomized, double-blind study was done to compare Celexa to Lexapro in the outpatient treatment of MDD. A daily dose of 40 mg of Celexa was compared to a 20 mg daily dose of Lexapro. The Montgomery-Asberg Depression Rating Scale (MADRS) was the scale of measurement, and the baseline score of participants was greater than or equal to 30. A higher MADRS score would be indicative of more severe depression. The MADRS score decreased more in the Lexapro arm than in the Celexa arm, and that difference was statistically significant. Lexapro also had more people respond to treatment overall. Tolerability of the drugs was similar between the two groups.

A meta-analysis was conducted to compare the relative efficacy of Celexa and it’s more active s-isomer, Lexapro. The nine studies used in the analysis addressed both moderate and severe depression. Across the studies, one of two types of measurements were used; the MADRS or the Hamilton Depression Rating Scale (HAMD). After accounting for differences between the studies, Lexapro was shown to be superior to Celexa in the treatment of moderate and severe depression. The difference was both statistically and clinically significant.

Ultimately, only your physician can decide which treatment is best for you. Always consult your doctor before making any changes to your treatment regimen.

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Coverage and cost comparison of Celexa vs. Lexapro

Celexa is a prescription medication that is covered by both commercial and Medicare drug insurance plans. The average retail price for a 30-day supply of Celexa 20 mg is approximately $65. With a coupon from SingleCare, you could obtain the generic for less than $4.

Lexapro is also a prescription medication that is typically covered by both commercial and Medicare drug plans. The out-of-pocket price for a 30-day supply of Lexapro 10 mg can be as much as $180. SingleCare offers a generic Lexapro coupon, which brings the price to less than $15 at participating pharmacies.

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Celexa Lexapro
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage 30, 20 mg tablets 30, 10 mg tablets
Typical Medicare copay Less than $10 Less than $10
SingleCare cost $4-$20 $15-$70

Common side effects of Celexa vs. Lexapro

Celexa and Lexapro are similar chemically but vary somewhat in their potential side effects. Somnolence is a consistent side effect amongst all SSRIs. Lexapro was reported to cause somnolence in 6% of patients, while somnolence was reported in 2% of patients on Celexa.

Gastrointestinal side effects are more common with Lexapro. Patients on Lexapro reported a higher incidence of nausea, dyspepsia, and diarrhea than patients on Celexa reported. A decreased sex drive has been reported with SSRI use but appears to be worse in Lexapro than Celexa.

The following list is not intended to be a complete list of adverse events. Please consult a pharmacist, doctor, or another medical professional for a complete list of possible side effects.

Celexa Lexapro
Side effect Applicable? Frequency Applicable? Frequency
Asthenia Yes 1% No n/a
Nausea Yes 4% Yes 5%
Dry mouth Yes 1% Yes 5%
Sweating No n/a Yes 5%
Vomiting Yes 1% No n/a
Diarrhea No n/a Yes 8%
Constipation No n/a Yes 3%
Dyspepsia No n/a Yes 3%
Dizziness Yes 2% No n/a
Somnolence Yes 2% Yes 6%
Agitation Yes 1% No n/a
Decreased appetite No n/a Yes 3%
Decreased libido No n/a Yes 2%

Source: Celexa (DailyMed) Lexapro (DailyMed)

Drug interactions of Celexa vs. Lexapro

Due to their chemical similarities, Celexa and Lexapro have a similar drug interaction profile. Both drugs are metabolized through the cytochrome P450 enzyme system. Celexa is a major substrate of CYP2C19 and CYP3A4, a minor substrate of CYP2D6, and a weak inhibitor of CYP2D6. Lexapro is a major substrate of CYP2C19 and CYP3A4 and a weak inhibitor of CYP2D6.

Celexa and Lexapro may increase the serum concentrations of antipsychotics, such as aripiprazole, through their inhibition of CYP2D6. If concomitant use is necessary, patients should be monitored for the effects of the antipsychotics. In some patients, a dose decrease of the antipsychotic may be necessary.

Strong CYP3A4 inducers, such as the antiepileptic agent carbamazepine, may increase the metabolism of Celexa and Lexapro. Therapy modifications may be necessary to avoid this type of interaction.

The following list is not intended to be a complete list of drug interactions. It is best to consult your doctor or pharmacist for a complete list.

Drug Drug Class Celexa Lexapro
Antineoplastics Yes Yes
5HT Agonist/Triptans (antimigraine agents) Yes Yes
Amphetamines Yes Yes
5HT3 Antagonists
(anti-nausea agents)
Yes Yes
Antiplatelets Yes Yes
Aripiprazole Antipsychotic Yes Yes
Nonsteroidal anti-inflammatory drugs (NSAIDs) Yes Yes
Anticoagulants Yes Yes
Bupropion Dopamine/norepinephrine reuptake inhibitor Yes Yes
Buspirone Antianxiety Yes Yes
Carbamazepine Anticonvulsant Yes Yes
Enzalutamide Chemotherapy
Yes Yes
Proton pump inhibitor Yes Yes
Fluconazole Antifungal Yes Yes
SSRIs Yes Yes
Hydroxychloroquine Aminoquinolone/
Yes Yes
Linezolid Antibiotic Yes Yes
Muscle relaxers Yes Yes
Pimozide Antipsychotic Yes Yes
Monoamine oxidase inhibitor (MAOI) Yes Yes
St. John’s Wort Herbal supplement Yes Yes
Thiazide diuretics Yes Yes
Tramadol Opiate pain reliever Yes Yes
Tricyclic antidepressants Yes Yes
Venlafaxine Selective norepinephrine reuptake inhibitor (SNRI) Yes Yes

Warnings of Celexa and Lexapro

Selective serotonin reuptake inhibitors, including Celexa and Lexapro, do not start resolving symptoms immediately. Typically, changes in symptoms take a minimum of two weeks to observe, with most patients needing at least four to six weeks to see if the drug is having an impact on their symptoms.

Adults and children who suffer from MDD are more likely to suffer from suicidal ideation. This can get worse if MDD is not adequately treated, or not treated at all. Some studies have shown that antidepressant drugs, including SSRIs, can increase suicidal ideation in children and young adults. All patients taking SSRIs should be monitored closely, and SSRIs should only be used in children and young adults when the benefit clearly outweighs the risk.

SSRIs should not be stopped abruptly. Patients may experience withdrawal symptoms such as nausea, vomiting, dizziness, and headache. A doctor will determine the best way to taper Celexa and Lexapro if therapy must be discontinued.

Celexa has been known to cause QT prolongation. This is an abnormality in the electrocardiogram characterized by Torsade de Pointes (TdP) and ventricular tachycardia. This is potentially a very serious side effect and can lead to sudden death. The risk of heart problems goes up with dose, and for this reason, patients should not take more than 40 mg per day.

Serotonin syndrome has been reported with all SSRIs. This is a condition related to abnormally high levels of serotonin and can result in the patient feeling agitated, dizzy, and having an increased heart rate. This can be brought on by the use of two serotonergic drugs together. It is important to refer to the manufacturer’s information on drug interactions when prescribing these drugs.

Frequently asked questions about Celexa vs. Lexapro

What is Celexa?

Celexa is a prescription antidepressant medication. It belongs to a class of medications known as selective serotonin reuptake inhibitors. It is prescribed to treat major depressive disorder, and it works by increasing available serotonin in the neuron synapse. Celexa is available in 10 mg, 20 mg, and 40 mg strengths.

What is Lexapro?

Lexapro is a prescription antidepressant medication. It belongs to a class of medications known as selective serotonin reuptake inhibitors. It is prescribed to treat major depressive disorder, and it works by increasing available serotonin in the neuron synapse. Lexapro is available in 5 mg, 10 mg, and 20 mg strengths.

Are Celexa and Lexapro the same?

Celexa and Lexapro are both antidepressants in the same class, however, they are not the same. Celexa is a racemic mix of the R-enantiomer and S-enantiomer of citalopram. Lexapro contains only the S-enantiomer, which is the more active isomer responsible for the serotonergic effects.

Is Celexa or Lexapro better?

A meta-analysis of nine separate clinical trials in patients with moderate to severe major depressive disorder determined that Lexapro produced a significantly greater decrease in depression scale scores than did Celexa. A greater decrease in score is indicative of a more significant improvement in depression symptoms, and researchers determined that Lexapro was the superior drug.

Can I use Celexa or Lexapro while pregnant?

Celexa and Lexapro are pregnancy category C, meaning there have not been adequate human studies to determine efficacy. Animal studies have shown teratogenic effects on the fetus, including cardiovascular effects, and it has been determined that Celexa and Lexapro cross the human placenta. For this reason, the use of Celexa or Lexapro in pregnancy must be weighed against potential harm to the fetus. Clinicians may choose other options to treat depression during pregnancy.

Can I use Celexa or Lexapro with alcohol?

Alcohol can increase the toxic effects of SSRIs. Drinking alcohol while taking Celexa or Lexapro can cause significant psychomotor impairment, and for this reason patients are advised to avoid alcohol if taking Celexa or Lexapro.

Is Celexa good for anxiety?

Celexa has been used off-label for generalized anxiety disorder. This means that it has not been approved for this indication by the Food and Drug Administration (FDA), but is commonly used in practice. However, Lexapro is approved in the use of generalized anxiety disorder.

Does Celexa or Lexapro cause more weight gain?

In controlled studies, patients on Celexa gained 0.5 kg more than patients on placebo. Controlled studies involving Lexapro showed no difference in weight gain compared to placebo. Weight changes are not a significant concern with either drug.

Does Celexa help with anger?

Celexa does not have an approved indication to treat anger or aggression. However, it has been used off-label to treat aggression associated with dementia. It is important to remember that patients over the age of 60 should not take more than 20 mg daily.