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

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 and Lexapro. 

What are the main differences between Celexa and Lexapro?

Celexa (citalopram)  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 2 isomers, R-citalopram and S-citalopram. The S-isomer is primarily responsible for the serotonin blockade that makes citalopram effective.

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

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.

Conditions treated by Celexa and Lexapro

Celexa and Lexapro are both indicated in the treatment of major depressive disorder. MDD is characterized by prolonged (2 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 it is not FDA-approved 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 posttraumatic stress disorder.

The following is not intended to be a complete listing of potential uses for Celexa and Lexapro nor should it be considered medical advice. Only your healthcare provider can diagnose your disorder and decide which treatment option is best for you.

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 20mg 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.

How long does it take Celexa and Lexapro to start working?

The length of time in which it takes antidepressant therapy to start working has long been one of the most frustrating aspects of therapy for both patients and clinicians. Most healthcare professionals will advise you that it takes a minimum of two to four weeks for any noticeable change to occur in many cases, with the full effect of most treatments often not realized for two to three months. This can feel like an eternity when you are battling depression and anxiety symptoms which are already disrupting your life. 

There have been studies published which lead us to believe there could be a measurable improvement in symptoms in at least one week for some patients, though this still does not seem to be widely accepted by the medical community. Some of this could be because every patient is so different in terms of the severity of their disorder and their response to any particular medication. We still don’t fully understand why one patient can achieve success with one type of SSRI, and have treatment failure with a very similar SSRI. 

When comparing Celexa and Lexapro specifically, there is evidence that perhaps Lexapro starts working faster. Data was pooled from controlled clinical randomized double-blind trials to compare members of the SSRI drug class as well as Effexor (venlafaxine). MADRS scores were evaluated and the change from baseline was found to be significantly higher for Lexapro patients on day 7 than for all other SSRIs and venlafaxine. This suggests that Lexapro begins working faster than other SSRIs, including Celexa. However, it is important to recognize that none of these therapies begin working after the first dose, and the effects are cumulative over weeks for each one regardless of how fast they kick in.

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 brand Celexa 20 mg is approximately $351. 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 brand Lexapro 20 mg can be as much as $497. SingleCare offers a coupon for generic Lexapro which lowers the price to approximately $6 at participating pharmacies.

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.

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.

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.

Celexa and Lexapro both carry a boxed warning related to suicidal ideation. 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.

Stopping or switching between SSRIs should be done under the close advice of your clinician. In some cases, you must be completely weaned off of one antidepressant before beginning another one. Abruptly stopping your SSRI, including Lexapro and Celexa, can lead to adverse events which mimic flu-like syndrome, but can be severe. This can include nausea, lethargy, dizziness, anxiety, irritability, insomnia, and vivid dreams. Some patients have even reported “electric shock” sensations which are extremely disturbing. These symptoms can be disabling, and can begin within the first few days of not taking your SSRI. Most regimens call for a two to four week taper down of your current antidepressant if you are stopping treatment or switching therapy. Depending on if you are starting a new therapy and what therapy it is, you may be able to start that new treatment as you taper down, or you may have to wait until your current treatment is completely out of your system. It can get complicated, and this is why it is so important for your healthcare professional to be involved. It is very important that you do not abruptly stop treatment without the advice of your doctor. 

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 serotonin levels 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.

How do SSRI’s work for depression?

SSRIs block the reuptake of serotonin back into the neuron cells. If you think of a brain pathway which controls your mood and disposition, it is made of a string of neurons. The signaling between neurons leads to better mood and lower depression levels when less serotonin is taken up inside the neuron cell and is instead left in the free space between each neuron. While SSRIs directly inhibit the reuptake into the neuron, over time they also down regulate the receptors which trigger this activity too. This is partially why we think it takes an extended period of time for SSRIs to reach their full effectiveness.

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.