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Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
If you experience depression, anxiety, or other conditions that affect your mental health, you are among millions of others in the United States. More than 17 million American adults have major depressive disorder (MDD, or depression), and nearly 7 million adults have generalized anxiety disorder.
Celexa (citalopram) and Prozac (fluoxetine) are two popular medications prescribed for depression and other psychological conditions. Medication use with Celexa or Prozac is often employed along with psychotherapy with a psychologist or doctor of psychiatry. Both antidepressant medications are approved by the United States Food and Drug Administration (FDA).
These medications are part of a group of drugs called SSRIs, or selective serotonin reuptake inhibitors. SSRIs work by increasing levels of serotonin, a neurotransmitter, in the brain. This helps improve symptoms of depression. Although both medications are SSRIs, they have some differences, which we will discuss below.
What are the main differences between Celexa and Prozac?
Celexa (citalopram) is an SSRI medication and is available in brand and generic. Celexa is available as a tablet and oral solution. A typical dose is 20 mg daily, but the dosage varies. Celexa is only for use in adults. It is not approved for use in children.
Prozac (fluoxetine) is an SSRI medication. It is available in both brand and generic forms. Prozac is available in tablet and capsule form and an oral solution. Although the dose varies, a typical dose is 20 mg once a day. Prozac can be used in adults for all of the indications in the chart below. Prozac can be used in children older than 8 years old for depression or older than 7 years old for OCD.
| Main differences between Celexa and Prozac | ||
|---|---|---|
| Celexa | Prozac | |
| Drug class | Selective serotonin reuptake inhibitor (SSRI) | Selective serotonin reuptake inhibitor (SSRI) |
| Brand/generic status | Brand and generic | Brand and generic |
| What is the generic name? | Citalopram | Fluoxetine |
| What form(s) does the drug come in? | Tablet, oral solution | Tablet, capsule, oral solution, in combination with olanzapine as Symbyax |
| What is the standard dosage? | 20 mg once daily (dosage varies) | 20 mg once daily (dosage varies) |
| How long is the typical treatment? | Varies | Varies |
| Who typically uses the medication? | Adults | Adults and children & adolescents for depression (over 8 years old) or OCD (over 7 years old) |
Conditions treated by Celexa and Prozac
Celexa (What is Celexa?) is indicated for the treatment of major depressive disorder (MDD). Healthcare providers sometimes prescribe Celexa off-label for other indications as well.
Prozac (What is Prozac?) is indicated to treat major depression (MDD) and obsessive-compulsive disorder (OCD) in children, adolescents, and adults. Prozac is also used to treat bulimia nervosa, premenstrual dysphoric disorder, and panic disorder. Prozac is not approved for use in children under 7 years old.
Note: Symbyax is a combination drug that contains the ingredient in Prozac, fluoxetine, and another medication called olanzapine. Symbyax is used to treat depressive episodes associated with bipolar I disorder and is also used for treatment-resistant depression.
| Condition | Celexa | Prozac |
| Major depressive disorder (MDD) | Yes | Yes |
| Obsessive-compulsive disorder (OCD) | Off-label | Yes |
| Bulimia nervosa | Off-label | Yes |
| Panic disorder | Off-label | Yes |
| Premenstrual dysphoric disorder | Off-label | Yes |
| In combination with olanzapine (as Symbyax) to treat depressive episodes associated with bipolar disorder | No | Yes |
| In combination with olanzapine (as Symbyax) for treatment-resistant depression | No | Yes |
Is Celexa or Prozac more effective?
A study compared Celexa and Prozac and found both medications to be well-tolerated. The study concluded that Celexa was as effective as Prozac to treat depression, and patients who took Celexa started to feel better faster than patients who took Prozac.
A 2018 study looked at many different clinical trials to review 21 antidepressants, including Celexa and Prozac. The study concluded that all antidepressants were more effective than a placebo (inactive pill) and that Celexa and Prozac were among the more tolerable antidepressants. They also found that Prozac was in a group of less effective antidepressants.
Your healthcare provider can determine which drug will be better for you, based on your medical condition(s) and history, and any medications you take that can interact with Celexa or Prozac.
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Coverage and cost comparison of Celexa vs. Prozac
Most insurance and Medicare plans cover Celexa and Prozac. Opting for generic will likely save a significant amount of money. The brand-name products have a much higher copay or may not be covered.
Celexa can cost as much as $65 for 30, 20 mg generic tablets. You can use a free SingleCare Celexa coupon to save money—bringing the price down to as low as $4.
The retail cost for Prozac can run $15 or more for 30, 20 mg generic capsules. With a free Prozac coupon from SingleCare, the price is $4 for the generic form at participating pharmacies.
Contact your insurance plan for up-to-date coverage information on Celexa or Prozac.
| Celexa | Prozac | |
| Typically covered by insurance? | Yes (generic) | Yes (generic) |
| Typically covered by Medicare Part D? | Yes (generic) | Yes (generic) |
| Standard dosage | 30, 20 mg tablets | 30, 20 mg capsules |
| Typical Medicare copay | $0-$15 | $0-$20 |
| SingleCare cost | $4-$20 | $4-$20 |
Common side effects of Celexa vs. Prozac
The most common side effects of Celexa are dry mouth, sweating, nausea, diarrhea, drowsiness or insomnia, and sexual problems.
The most common side effects of Prozac are headache, nausea, drowsiness, insomnia, appetite loss, sexual side effects, and nervousness, or anxiety.
When you fill or refill your prescription of Celexa or Prozac, you will receive a medication guide that discusses side effects, warnings, and other important information.
This is not a full list of side effects. Other serious side effects may occur. Consult your healthcare provider for a complete list of side effects.
| Celexa | Prozac | |||
| Side effect | Applicable? | Frequency | Applicable? | Frequency |
| Headache | Yes | >2% (exact percent not reported) | Yes | 21% |
| Constipation | Yes | >2% (exact percent not reported) | Yes | 5% |
| Nausea | Yes | 21% | Yes | 21% |
| Diarrhea | Yes | 8% | Yes | 12% |
| Sweating | Yes | 11% | No | – |
| Ejaculation disorder/sexual dysfunction | Yes | 3%-6% | Yes | % not reported |
| Dry mouth | Yes | 20% | Yes | 10% |
| Drowsiness | Yes | 18% | Yes | 13% |
| Insomnia | Yes | 15% | Yes | 16% |
| Loss of appetite | Yes | % not reported | Yes | 11% |
| Nervousness/anxiety | Yes | 4% | Yes | 12%-13% |
Source: DailyMed (Celexa), DailyMed (Prozac)
Drug interactions of Celexa vs. Prozac
Because both drugs are in the same category, they have similar drug interactions.
Do not use an MAO inhibitor (MAOI, or monoamine oxidase inhibitor) within 14 days of Celexa or Prozac. The combination may increase the risk of serotonin syndrome, a life-threatening medical emergency due to excess serotonin. Triptans—migraine medications, such as Imitrex (sumatriptan), as well as other antidepressants, such as Elavil or Cymbalta, should not be used in combination with Celexa or Prozac due to the risk of serotonin syndrome. Also, the cough suppressant dextromethorphan, which is found in Robitussin-DM and many other cough and cold products, should be avoided as it can also cause serotonin syndrome when combined with Celexa or Prozac.
Other drugs that may interact with Celexa or Prozac include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or painkillers such as Ultram (tramadol). Avoid alcohol when taking Celexa or Prozac.
This is not a full list of drug interactions. Consult your healthcare provider for a complete list of drug interactions.
| Drug | Drug class | Celexa | Prozac |
| Rasagiline Selegiline Tranylcypromine |
MAOIs | Yes (separate use by at least 14 days) | Yes (separate use by at least 14 days) |
| Alcohol | Alcohol | Yes | Yes |
| Rizatriptan Sumatriptan Zolmitriptan |
Triptans | Yes | Yes |
| St. John’s Wort | Supplement | Yes | Yes |
| Warfarin | Anticoagulant | Yes | Yes |
| Codeine Hydrocodone Morphine Oxycodone Tramadol |
Opioid pain relievers | Yes | Yes |
| Dextromethorphan (in many cough and cold products) | Cough suppressant | Yes | Yes |
| Azithromycin Clarithromycin Erythromycin |
Macrolide antibiotics | Yes | Yes |
| Aspirin Ibuprofen Meloxicam Nabumetone Naproxen |
NSAIDs | Yes | Yes |
| Desvenlafaxine Duloxetine Venlafaxine |
SNRI antidepressants | Yes | Yes |
| Amitriptyline Desipramine Imipramine Nortriptyline |
Tricyclic antidepressants | Yes | Yes |
| Flecainide Propafenone Thioridazine Vinblastine |
Drugs metabolized by enzyme CYP2D6 | Yes | Yes |
| Alprazolam Clonazepam Diazepam |
Benzodiazepines | Yes | Yes |
Warnings of Celexa and Prozac
All SSRIs, including Celexa and Prozac, have a black box warning of suicidality. A black box warning is the strongest warning required by the FDA. Children, adolescents, and young adults (up to 24 years old) who take antidepressants have an increased risk of suicidal thoughts and behavior. All patients on antidepressants should be carefully monitored.
Other warnings:
- Serotonin syndrome is a life-threatening emergency caused by too much serotonin. Patients taking Celexa or Prozac should be monitored for signs and symptoms of serotonin syndrome, such as hallucinations, seizures, heart rhythm or blood pressure changes, and agitation. Patients should seek emergency medical treatment if any of these symptoms occur. Patients who take other drugs that increase serotonin levels (triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, dextromethorphan, amphetamines, St. John’s Wort, and MAOIs) are at higher risk for serotonin syndrome.
- When discontinuing Celexa or Prozac, withdrawal symptoms such as agitation may occur. The medicine should be tapered slowly and never stopped abruptly. Your healthcare provider can advise you on the best way to discontinue Celexa or Prozac.
- Celexa or Prozac should be used with caution in patients who have seizures.
- Hyponatremia (low sodium) due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) may occur and can be severe. Symptoms may include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. Patients should seek emergency treatment if symptoms occur, and the SSRI should be stopped.
- Avoid SSRIs in patients with untreated anatomically narrow angles (angle-closure glaucoma).
- SSRIs may increase bleeding risk. The risk of bleeding increases with concomitant use of aspirin, NSAIDs, or warfarin.
- Do not drive or operate machinery until you know how Celexa or Prozac affects you.
- Use Celexa or Prozac with caution in patients with kidney problems.
- In rare cases, there have been reports of rash and allergic reactions/systemic anaphylaxis reactions, which have been fatal. If you experience a rash or allergic symptoms, stop taking Celexa or Prozac, and seek immediate medical treatment.
- Celexa or Prozac may cause QT prolongation and ventricular arrhythmia, which can be life-threatening. Certain patients are at higher risk due to medical conditions or other medications. Ask your healthcare provider if Celexa or Prozac is safe for you.
Celexa or Prozac should only be used in pregnancy if the benefit to the mother is greater than the risk to the baby. Stopping the medication may cause a relapse of depression or anxiety. Patients should be evaluated on a case-by-case basis. Your healthcare provider can weigh the risk versus benefits of using an SSRI during pregnancy. Neonates exposed to SSRIs in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. If you already take Celexa or Prozac and find out you are pregnant, contact your healthcare provider immediately for guidance.
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Frequently asked questions about Celexa vs. Prozac
What is Celexa?
Celexa is an SSRI (selective serotonin reuptake inhibitor). Celexa treats depression in adults. The generic name of Celexa is citalopram.
What is Prozac?
Prozac is an SSRI or selective serotonin reuptake inhibitor. Prozac treats depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder, and panic disorder. Prozac is available in brand and generic. The generic name of Prozac is fluoxetine.
Are Celexa and Prozac the same?
Celexa and Prozac are both SSRI medications. As such, they are similar but not exactly the same. They have some differences, as outlined above. Other SSRI drugs you may have heard of include Lexapro (escitalopram), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline).
Another class of antidepressant drugs you may have heard of are serotonin and norepinephrine reuptake inhibitors (SNRI), which includes Cymbalta (duloxetine), Effexor (venlafaxine), and Pristiq (desvenlafaxine).
Is Celexa or Prozac better? / Is Prozac more effective than Celexa?
According to clinical studies (see above section), both drugs are effective and well-tolerated. Because people respond differently to different medications, your healthcare provider can help determine if Celexa or Prozac may be an appropriate medication for you.
Can I use Celexa or Prozac while pregnant?
Consult your healthcare provider for medical advice. He or she will weigh the benefits of an antidepressant vs. the risk to the baby. Neonates exposed to certain antidepressants, including SSRIs, in the third trimester of pregnancy, have developed serious complications.
If you are already taking Celexa or Prozac and find out that you are pregnant, consult your OB-GYN immediately for advice. If you are breastfeeding, consult your OB-GYN as well.
Can I use Celexa or Prozac with alcohol?
No. Celexa or Prozac should not be combined with alcohol. The combination may increase the risk of respiratory depression—slowed breathing, not getting enough oxygen—and increase sedation and drowsiness and impair alertness. The combination can also worsen anxiety and/or depression.
Are citalopram and fluoxetine the same thing?
Citalopram is the generic form of Celexa, and fluoxetine is the generic form of Prozac. Both drugs are in the SSRI category of prescription drugs. They are similar, but not exactly the same. They have some differences, as outlined above.
Which antidepressant has the least side effects?
All antidepressants have potential side effects. Consult your healthcare provider for medical advice. Some patients feel great with Celexa, while others do better with Prozac. Everyone has a different response to treatment, so your healthcare provider can guide you.
Is Celexa good for anxiety?
Celexa is currently only approved for use in depression. Many healthcare providers prescribe Celexa off-label for anxiety, though. Ask your healthcare provider if Celexa is appropriate for you.
Is it better to take Celexa at night?
According to the prescribing information, you can take Celexa in the morning or evening. It is best to choose a time that you will remember to take your medicine at approximately the same time each day. If the medication makes you tired, you may want to try taking it at night.
Can Celexa affect you sexually?
Yes, possibly. Celexa (and SSRIs, including Prozac, too) has sexual side effects. Celexa can affect libido in men and women and ejaculation in men. SSRIs can also cause priapism (an unwanted, painful, prolonged erection). However, not all patients who take SSRIs are affected sexually. Keep an open conversation with your healthcare provider so that if you experience sexual side effects while taking an SSRI, he or she can change your medication if necessary.
