Celexa vs Lexapro: Alternatives to Citalopram

Last Updated: June 30, 2021

Authored by Sharon Levy, MD, MPH

Reviewed by Michael Espelin APRN

Citalopram, under the brand name Celexa, is an SSRI that is used to treat mental health conditions and disorders such as depression, obsessive-compulsive disorder, panic disorder, and social phobia. Although Citalopram is a generally effective anxiety medication, its side effects force many people to seek alternative medicines. In fact, 55% of patients taking SSRIs, including Citalopram, have reported that one or more side effects of this drug are bothersome, and some of these are sexual dysfunction and drowsiness. Interestingly, there are many alternatives to Citalopram for patients who cannot handle the drug’s side effects or for patients who seem to have sensitivity to the drug. While patients need a prescription to obtain some of these alternatives, many come as over-the-counter drugs. In this article, information about the reasons when and why Celexa alternatives must be considered, a list of alternative drugs, side effects of the alternatives, the best alternative drug, and the importance of consulting medical professionals with regards to medication switching will be provided.

Why Look for Celexa Alternatives

SSRIs (selective serotonin reuptake inhibitors) such as Citalopram are widely used as a treatment for depression and other disorders. Aside from the side effects, age restriction is also a reason why people ask help from doctors to search for alternatives. In this section, information about the factors why patients search for Celexa alternatives will be provided.

Celexa Adverse Effects

The first and common reason why patients want to look for Celexa alternatives is that these patients cannot handle the side effects of Citalopram. In a different study using 700 patients, 26% of these reported that the side effects of Citalopram, such as sexual dysfunction, are severely bothersome.

Some other side effects of Citalopram are nausea, vomiting, dizziness, chills, and tremors. With this, it is a must to understand that every person is different from another, which means that some patients can tolerate the side effects of the drug while some will have a hard time. Whether tolerable or not, it is important to always consult for help by sharing the side effects experienced with a healthcare professional.

Celexa Overdose Risks

It is possible for a patient using Citalopram to be at risk for overdose, even if the overdose is unintentional. According to the FDA, the recommended dose per day for an adult (60 years old and older) is only 20mg. However, adults tend to forget that they have already consumed the drug which will make them take another dose of it. Additionally, as metabolism takes part on this drug, children using this medication are also at risk for overdose. A child who cannot metabolize the drug properly may experience overdose symptoms such as convulsions. Since within the group of SSRIs, Citalopram has the highest fatality rate caused by overdose, patients and doctors are starting to look for Celexa alternatives in order to avoid the health dangers of overdose.

Citalopram Withdrawal Symptoms

A patient’s health is in danger when there is sudden or abrupt discontinuation of Citalopram, and this is because of the possible occurrence of withdrawal symptoms. Some of these are irritability, nightmares, and a tingling sensation to the skin. Additionally, Citalopram withdrawal effects may last a couple of weeks, and although the severity of these symptoms depends on the dose consumed, every patient reacts to these differently. Because of these unwanted withdrawal symptoms, patients seek for help and doctors exert extra effort to find a better alternative to the drug.

A woman in pain takes a pill of Celexa.

Dangers of Polypharmacy

Polypharmacy is defined as taking more than five medications together. It increases the chance for adverse reactions to occur, and this makes it dangerous to the health. According to a study, elderly patients are most at risk of polypharmacy because this group of people tends to have multimorbidity associated with their age. So, to avoid undesirable effects when Celexa interacts with other drugs, a physician might start to look for Celexa alternatives.

Drugs Alternative To Citalopram

Citalopram is under the drug class SSRIs (selective serotonin reuptake inhibitors). These drugs work by increasing serotonin levels in the brain and are useful for the treatment of pain and behavioral disorders such as OCD (obsessive-compulsive disorder). Some Celexa benefits are the following:

  • Has a highly specific mechanism of action (affects serotonin, specifically) compared to other classes of antidepressants
  • Lower toxicity rate compared to TCAs (tricyclic antidepressants)
  • Low incidence of anticholinergic effects which results in cost-effective treatment and improved compliance
  • More effective in treating behavioral disorders such as OCD, social phobia, and panic disorder compared to other classes of antidepressants

SSRIs also come with disadvantages, for example, weight gain or loss, and these cause patients and doctors to choose Celexa alternatives. For information purposes, below are some disadvantages of this drug classification:

  • Bothersome withdrawal effects
  • Possibility of drug dependence
  • Heightened suicidal thinking and behavior
  • Incompatibility when it comes to younger patients (age)
  • Lack of sedative effect

Celexa alternatives can be prescribed when a patient struggles with severe side effects or doesn’t respond well to Citalopram treatment but these alternatives’ key effects may differ from the influence Citalopram exerts on the body, so it is crucial to consult a doctor before switching to any of them. In the following sections, information about the possible alternatives will be provided.

Celexa vs Lexapro

Considering Lexapro vs Celexa, both are among the most widely used drugs for treating depression. Despite both drugs having a number of similarities, Citalopram and Escitalopram differ in their chemical composition, FDA-approved uses and prescribed dosage, etc. That is why patients need to know what exactly makes these two drugs different from each other to avoid improper use of each drug. According to a study, when it comes to the treatment of depression, Lexapro is more effective than Citalopram. In the same study, the response rate of patients with depression consuming Citalopram and Escitalopram was 56% and 41%, respectively. In the chart below, comparative information between these two drugs will be provided.

DRUG BRAND NAME CELEXA LEXAPRO
GENERIC NAME Citalopram Escitalopram
DRUG CLASS Selective Serotonin Reuptake Inhibitor (SSRI) Selective Serotonin Reuptake Inhibitor (SSRI)
AVAILABILITY OF GENERIC VERSIONS Yes Yes
APPROVED AGE OF USE 18 years old and older 12 years old and older
TREATMENT LENGTH Long-term Long-term
PRESCRIPTION FORMS

STANDARD DOSAGE

Oral tablets

20mg once a day

Oral tablets

10mg once a day

RISK OF WITHDRAWAL OR OVERDOSE Yes Yes
INSURANCE COVERAGE Yes Yes

When comparing Celexa vs Lexapro, it is worth mentioning that both of these drugs have drug interactions resulting in no complications, as well as moderate and severe complications. Citalopram and Escitalopram should not be taken with MAOIs (monoamine oxidase inhibitors), including Isocarboxazid, Phenelzine, and Tranylcypromine. The MAOIs can be taken only after 14 days after stopping these two drugs.

Before taking any drug, patients need to know how effective they are. These two drugs are not an exception. Another study examining the treatment of new episodes of major depression has revealed that Escitalopram seems to be dominant in the treatment of new major depression occurrences when compared to Citalopram. When it comes to Lexapro vs Celexa side effects, it is worth noting that Citalopram side effects are more prevalent than Escitalopram ones. In another study, it was observed that Lexapro provides a faster onset of action compared to the other drug.

Celexa Vs Lexapro: Side Effects

Both antidepressants have a list of side effects, and the patients should be aware of them. While some users may experience no effects, others may experience anxiety when Citalopram is being discontinued or sexual problems when Lexapro is stopped. Being antidepressants, Celexa vs Lexapro affect weight gain. Not everyone is expected to experience weight changes, but it is much more likely during long-term treatment. As a result, patients can also have some side effects while withdrawal from Citalopram as well. Below is a chart that talks about the similar side effects of these two drugs:

  • nausea
  • dry mouth
  • changes in sex drive
  • sweating
  • hallucination
  • somnolence

Although somnolence is present as a side effect of both of the two drugs, it was reported that somnolence is more severe in patients who use Lexapro. For this reason, it can be said that even if the side effects are present in both Celexa vs Lexapro, the severity still differs depending on the amount of dose consumed. Moving on, below is a chart about what makes these two drugs differ from each other in terms of side effects:

SIDE EFFECTS OF CELEXA ALONE SIDE EFFECTS OF LEXAPRO ALONE
– fatigue

– changes in sex drive

– sweating

– heavy menstrual periods

– frequent urination

– weight gain/loss

– muscle or joint pain

– uncontrollable shaking

– weakness

– constipation

– decreased interest in sex

– fainting

– rash

– unexplained fever

– fast heartbeat

– twitching muscles

– unusual agitation

– troubled breathing

Both Celexa vs Lexapro uses have been proven to be excellent remedies for depression and related conditions. However, before taking each of them, a doctor’s consultation is required. Users should understand what Citalopram is and what Escitalopram medication is. At the same time, if a patient misuses any of the two drugs, an overdose may happen. Thus, it is strongly recommended that a victim visits a professional rehabilitation and addiction center as soon as possible.

Celexa vs Zoloft

In the Celexa vs Zoloft drug class, both are under the SSRIs, and aside from depression, Zoloft is useful for the treatment of certain mental health disorders such as PTSD (post-traumatic stress disorder), SAD (social anxiety disorder), and PDD (premenstrual dysphoric disorder). Below is a chart about these drugs:

DRUG BRAND NAME CELEXA ZOLOFT
GENERIC NAME Citalopram Sertraline
DRUG CLASS Selective Serotonin Reuptake Inhibitor (SSRI) Selective Serotonin Reuptake Inhibitor (SSRI)
AVAILABILITY OF GENERIC VERSIONS Yes Yes
APPROVED AGE OF USE 18 years old and older 6 years old and older for obsessive-compulsive disorder
TREATMENT LENGTH Long-term Varies
PRESCRIPTION FORMS

STANDARD DOSAGE

Oral tablets

20mg once a day

Oral tablets

25 to 100mg once a day

RISK OF WITHDRAWAL OR OVERDOSE Yes Yes
INSURANCE COVERAGE Yes Depends on the healthcare provider

Zoloft is one of the most popular Citalopram alternative medicines. It is effective and affordable, causes less sleepiness, and can be taken during pregnancy. Comparing Celexa vs Zoloft, the two drugs score equally in terms of efficiency, although Zoloft has fewer side effects reportedly. Below are the common side effects present in both drugs:

  • nausea
  • increased sweating
  • fatigue
  • somnolence
  • decreased libido
  • ejaculation disorder
  • anorgasmia
  • dizziness
  • agitation
  • shaking
  • diarrhea

Both of the drugs are structurally and chemically similar medications used to treat mental health conditions. Because of this, their side effects are almost the same as well. However, they still have side effects that differ from one another. Below is a chart about Celexa vs Zoloft side effects differences:

SIDE EFFECTS OF CELEXA ALONE SIDE EFFECTS OF ZOLOFT ALONE
– Constipation

– Respiratory infections

– headache

– Indigestion

When it comes to metabolism, both of the drugs are metabolized in the liver, but the average half-life of Zoloft is 26 hours while Citalopram’s half-life is 35 hours. With this, it can be said that Zoloft may cause fewer side effects. Zoloft comes with advantages compared to Citalopram. Some of these are improved patient tolerability, low risk of lethality in overdose, and no dependence potential.

Celexa vs Prozac

In the Celexa vs Prozac drug class, both are under the SSRIs and both are used to treat psychological conditions such as anxiety and depression.  In Celexa vs Prozac comparison, Prozac beats Citalopram by having fewer side effects and being more energizing. Below are the common side effects of the two drugs:

  • headache
  • constipation
  • nausea
  • diarrhea
  • decreased libido
  • ejaculation disorder
  • dry mouth
  • drowsiness
  • insomnia
  • loss of appetite
  • nervousness

When it comes to Celexa vs Prozac side effects, sweating is associated with the former and not with Prozac. It is important to understand that different patients respond differently to the drug. To know more about the difference between these two drugs, a chart below will explain:

DRUG BRAND NAME CELEXA PROZAC
GENERIC NAME Citalopram Fluoxetine
DRUG CLASS Selective Serotonin Reuptake Inhibitor (SSRI) Selective Serotonin Reuptake Inhibitor (SSRI)
AVAILABILITY OF GENERIC VERSIONS Yes Yes
APPROVED AGE OF USE 18 years old and older 8 years old and older for depression

7 years old and older for obsessive-compulsive disorder

TREATMENT LENGTH Long-term Varies
PRESCRIPTION FORMS

STANDARD DOSAGE

Oral tablets

20mg once a day

Oral tablets and capsules

20mg once a day

RISK OF WITHDRAWAL OR OVERDOSE Yes Yes
INSURANCE COVERAGE Yes Yes

Prozac requires at least 1-2 weeks to start working and as many as 12 weeks to start exerting its maximum effect. According to a study, patients who took Citalopram were able to feel better faster compared to those who took Prozac. For this reason, it was concluded that Citalopram is a better option when treating depression. Both of the drugs are tolerable medications, however, in another study, it was reported that Prozac can be categorized under the less effective antidepressants.

Celexa vs Wellbutrin

Comparing Wellbutrin vs Celexa drug class, the latter is an SSRI while Wellbutrin (Bupropion) is under the drug class NDRIs (norepinephrine and dopamine reuptake inhibitors). Still, both of them are used in the treatment of major depressive disorder. Wellbutrin is one of the most well-tolerated antidepressants. Additionally, both of these drugs are not controlled substances, but they are only approved for use on patients 18 years old and older.

Examining the Wellbutrin vs Celexa side effects, the common side effects of these two are nausea, dizziness, and drowsiness. However, Bupropion has fewer sexual negative consequences than most antidepressants, and it can even boost sex drive. When it comes to prescribing these drugs, a doctor will have to know the goal of treatment.

Celexa vs Xanax

There is a difference in Celexa vs Xanax drug classification as the latter falls under the Benzodiazepines. Benzodiazepines are depressants that lower the activity of the brain. With this, it can be said that these two drugs essentially work in opposite ways: Citalopram is an antidepressant, and Alprazolam is a CNS (central nervous system) depressant. While Citalopram facilitates the production of serotonin, Xanax works as a sedative. The common uses of these drugs are for the treatment of anxiety and panic disorder, and when it comes to Celexa vs Xanax comparison, there is no clear winner. Xanax helps treat anxiety, panic disorders, and insomnia, while Citalopram may also be used against depression.

Citalopram is not a controlled substance, while Xanax is a controlled one. However, both of these drugs are only approved for use on patients 18 years old and older. When it comes to Celexa vs Xanax side effects, the common ones for both drugs are drowsiness, tiredness, dizziness, dry mouth, and declined sexual desire. Since treatment for the mental health condition depends on the symptoms, only a doctor will be able to prescribe what is best for the patient.

Young female professional doctor physician consulting old male patient.

Celexa vs Cymbalta

When comparing Cymbalta vs Celexa drug class, the latter is an SSRI while Cymbalta (Duloxetine) is an SNRI (selective serotonin and norepinephrine inhibitors). Both of these drugs increase the levels of serotonin in the brain. The only difference is that Cymbalta also increases the levels of norepinephrine. In addition, Duloxetine can be used as a chronic pain reliever and for the treatment of stress urinary incontinence in women in addition to its antidepressant properties, and patients with poststroke depression may consider taking Cymbalta over Citalopram as the former is well tolerated and significantly more effective compared to the latter.

Cymbalta vs Celexa, both of these drugs are not classified as controlled substances. However, Citalopram is only approved for use by patients 18 years old and older while Cymbalta can be used by children 7 years old and older for the treatment of generalized anxiety disorder.

Celexa vs Paxil

In the Celexa vs Paxil (Paroxetine) drug class, both are under the SSRIs, and these drugs generally act the same. In Celexa vs Paxil, Paxil gives more adverse implications while being significantly more expensive. On another note, both of these drugs give similar results on their anti-panic effects, and they are both well-tolerated. Additionally, for the treatment of anxiety, both of them decrease the anxiety of a patient during the first week of treatment.

Both of these drugs are not controlled substances, but they are only approved for use on patients 18 years old and older. Moreover, Paxil is not recommended for seniors and patients with dementia. It is more likely to cause sexual dysfunction than the majority of other Celexa alternatives.

Celexa vs Effexor

Celexa is under the drug class SSRIs, while Effexor (Venlafaxine) is under the drug class SNRIs (selective serotonin and norepinephrine inhibitors). Both of these drugs increase the levels of serotonin in the brain. The only difference is that Effexor also increases the levels of norepinephrine. Additionally, both of these drugs improve a patient’s mood. However, Effexor has an additional benefit: it helps a patient relax.

Both of these drugs are not classified as controlled substances but they are only approved for use on patients 18 years old and older. When it comes to side effects, Effexor causes more sleepiness.

What is The Best Celexa Alternative?

While others may feel bothersome effects, others may simply experience little implications even after prolonged treatment. Because of this, it can be said that this drug is not a suitable medication for many people despite the significant Celexa benefits it gives, such as:

  • Treatment for depression
  • Improves energy level and feelings of well-being
  • Useful in the management of irritable bowel syndrome
  • Used to treat bulimia
  • Treatment for anxiety

In cases when Citalopram doesn’t work, medical help is given by choosing from several available Celexa alternatives, as this can improve the person’s state and facilitate recovery. When switching to another medication or alternative, the very first thing to do is to connect with a medical professional as symptoms of the condition will be considered. If a patient is sensitive to SSRIs, a Benzodiazepine might be an option. If a patient cannot handle the side effects of Citalopram, using Lexapro may be the best alternative.

Reasons To Consult A Doctor Before Changing Medications

It is crucial to remember that psychiatric medicines can have unpredictable effects on a person’s health. Fluctuations in the dosage of any alternative to Citalopram medication can lead to the development of various dangerous conditions, and quitting Citalopram abruptly can significantly worsen the patient’s state. Such cases require professional treatment. If the signs of abuse are observed, drug rehabilitation centers can help to recover. Even the natural alternatives to citalopram pose health risks if misused. Therefore, it is vital to consult a doctor before switching to an alternative drug and remain under medical supervision during a course of treatment.

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Published on: April 23rd, 2019

Updated on: June 30th, 2021

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.