Lexapro vs Celexa: what's the difference?

Lexapro and Celexa share many similarities. Both are used for anxiety and/or depression. And both are selective serotonin reuptake inhibitors (SSRIs) designed to increase serotonin levels in the brain, which can help alleviate symptoms of mental health conditions. But there are subtle but important differences between Lexapro vs Celexa that might influence which medication is best for you.

In this article, we explore the key differences and similarities between Lexapro vs Celexa, including their uses, dosages, side effects, interactions, and costs. By understanding these factors, you can work with your healthcare provider to make an informed decision that best supports your mental health journey. 

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Lexapro vs Celexa comparison table

*Per drugs.com and with its discount.

What is Lexapro?

Lexapro (escitalopram) is an SSRI medication that’s U.S. Food and Drug Administration (FDA) approved to treat major depressive disorder (MDD) in people over 12 and generalized anxiety disorder in people over 7.

It works by increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that plays a key role in mood regulation, by inhibiting its reabsorption (reuptake) into neurons. By increasing serotonin levels, Lexapro can alleviate symptoms such as persistent sadness, loss of interest in activities, excessive worry, and physical symptoms associated with anxiety.

Lexipro strengths, forms, and dosages

Lexapro is sold as a brand-name and generic medication, escitalopram. Both are available in 5-, 10-, and 20-milligram tablets and a 1-milligram/milliliter oral solution. 

It’s recommended that adults take 10 milligrams of Lexapro once daily with or without food. The dose can be increased to 20 milligrams after a week if needed. The maximum daily dose is 20 milligrams.

Fixed-dose trials found that both 10 milligrams and 20 milligrams were effective. But 20 milligrams didn’t offer greater benefits than 10 milligrams. 

For pediatric patients ages 7 and up, the starting dosage is 10 milligrams per day, with a maximum dose of 20 milligrams.

Your healthcare provider will determine the appropriate dosage based on your condition, age, and response to treatment.

Conditions treated

FDA-approved uses

• Major depressive disorder (MDD)
• Generalized anxiety disorder (GAD)

Off-label uses

• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder
• Premenstrual dysphoric disorder (PMDD)
• Bulimia nervosa
• Insomnia

Lexapro side effects

Common side effects

• Trouble sleeping (insomnia)
• Sweating
• Decreased sex drive
• Delayed ejaculation
• Nausea
• Tiredness
• Sleepiness
• Delayed orgasm or inability to have an orgasm

Serious side effects

• Increased risk of suicidal thoughts and behaviors: Particularly in individuals under 24 years old. Close monitoring is essential.
• Serotonin syndrome: Symptoms include agitation, hallucinations, rapid heart rate, fever, muscle stiffness, and coordination problems.
• Discontinuation syndrome which may cause changes in mood, hypomania, confusion, and more. 
• Seizures.
• Manic episodes in people with bipolar disorder.
• Low sodium levels (hyponatremia): Symptoms include headache, weakness, confusion, and unsteadiness.
• Increased risk of bleeding if taken with aspirin and other nonsteroidal anti-inflammatories (NSAIDS), warfarin and other blood thinners.
• Visual problems (angle-closure glaucoma) that may cause eye pain, changes in vision, or swelling and redness of the eye or eye area.
• Sexual problems (dysfunction)

If you experience any severe side effects or signs of an allergic reaction (such as rash, itching, swelling, severe dizziness, and trouble breathing), seek medical attention immediately. And consider reporting any negative side effects you have to the FDA by visiting MedWatch or calling 1-800-FDA-1088.

Warnings and interactions for Lexapro

Warnings for use

Lexapro has an FDA-boxed warning for suicidal thoughts and behaviors in pediatric and young adult patients. Monitor any patient for worsening depression or suicidal thoughts, especially during the initial treatment period or dosage changes.

Additional warnings to be aware of when taking Lexapro include:

• Serotonin syndrome
• Discontinuation syndrome
• Seizures: Can lower the seizure threshold
• Activation of mania or hypomania for people with bipolar disorder
• Hyponatremia (low blood-sodium levels)
• Increased bleeding risk: Increased when combined with NSAIDs, aspirin, or anticoagulants
• Impacts on cognitive and motor performance
• Liver or kidney impairment: Dosage adjustments may be needed
• Pregnancy and breastfeeding: Consult your healthcare provider

Drug interactions

• Monoamine oxidase inhibitors (MAOIs): Don’t use within 14 days of MAOI therapy.
• Pimozide: Increased increase the risk of QT prolongation and/or ventricular arrhythmias
• Other SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs): Increased risk of serotonin syndrome
• Blood thinners, such as warfarin and aspirin and other NSAIDS: Increased bleeding risk
• Sumatriptan: due to the risk of weakness, hyperreflexia, and incoordination
• Carbamazepine
• Drugs metabolized by CYP2D6

Always inform your healthcare provider about all medications, supplements, and herbal products you’re taking.

Lexapro costs

Different pharmacies charge varying costs for Lexapro 5-milligram oral tablets. According to drugs.com with its discount:

• Brand-name Lexapro costs approximately $1,484 for 100 tablets of 5 mg for cash-paying customers.
• Generic escitalopram can be as low as $15.70 for 30 tablets (5 mg).

Other tablet strengths (10 mg, 20 mg, and 40 mg) are also available, with prices differing between brand-name and generic versions. Prices may vary depending on the pharmacy and location.

Out-of-pocket costs may be lower with insurance coverage.

What is Celexa?

Celexa (citalopram) is an SSRI medication FDA approved to treat MDD in adults. Like Lexapro, it works by increasing serotonin levels in the brain, helping to improve mood and alleviate depressive symptoms. 

Celexa, strengths, forms, and dosages

Celexa is a medication typically prescribed once daily, with an initial dose of 20 milligrams. The dose may be increased to a maximum of 40 milligrams per day based on the individual’s response. However, doses above 40 milligrams aren’t recommended due to the risk of QT prolongation (a heart rhythm disorder).

For patients over the age of 60, those with hepatic impairment, or poor CYP2C19 metabolizers, the recommended dose is 20 milligrams a day. A gradual dose reduction is needed when discontinuing Celexa to minimize the risk of withdrawal symptoms.

Available tablet strengths

• 10 milligrams
• 20 milligrams (scored)
• 40 milligrams (scored)

Your healthcare provider will tailor the dosage based on your specific needs and medical condition.

Conditions treated

FDA-approved use

• Major depressive disorder (MDD)

Off-label uses

• Generalized anxiety disorder (GAD) — learn about a Celexa for anxiety online prescription
• Panic disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Premenstrual dysphoric disorder (PMDD)
• Alcohol use disorder
• Premature ejaculation

Celexa can help reduce symptoms, such as persistent sadness, anxiety, irritability, and physical symptoms, associated with depression and anxiety disorders.

Side effects

Common side effects of Celexa

• Nausea
• Dry mouth
• Drowsiness or fatigue
• Increased sweating
• Tremor
• Diarrhea or constipation
• Sleep disturbances (insomnia or sleepiness)
• Sexual dysfunction (decreased libido, delayed ejaculation, or difficulty achieving orgasm)
• Appetite changes

Serious side effects

• Suicidal thoughts and behaviors: Particularly in individuals under 24 years old; close monitoring is recommended during initial treatment.
• Serotonin syndrome: Symptoms include agitation, hallucinations, fever, rapid heart rate, sweating, shivering, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
• QT prolongation: Higher doses (above 40 mg) increase the risk of dangerous heart rhythm abnormalities.
• Hyponatremia (low sodium levels): Can cause headaches, confusion, weakness, and in severe cases, seizures. More common in older adults and those taking diuretics.
• Allergic reactions: Symptoms may include rash, itching, swelling, severe dizziness, or trouble breathing.

Seek immediate medical attention if serious side effects occur. Also report negative side effects you have to the FDA by visiting MedWatch or calling 1-800-FDA-1088.

Warnings and interactions

Warnings for use

• Suicidal ideation: Close monitoring is essential, especially for those under 24.
• Heart conditions: Risk of QT prolongation; avoid in patients with congenital long QT syndrome.
• Electrolyte imbalances: Low potassium or magnesium levels increase the risk of heart rhythm issues.
• Liver or kidney impairment: Dosage adjustments may be needed.
• Seizure disorders: Use with caution due to seizure risk.
• Bipolar disorder: May trigger manic episodes.

Drug interactions

• MAOIs: Contraindicated within 14 days to avoid serious reactions.
• Other SSRIs or SNRIs: Increases the risk of serotonin syndrome.
• Heart rhythm medications: Includes certain antipsychotics, antibiotics, and antiarrhythmics.
• NSAIDs, aspirin, Warfarin: Heightened risk of bleeding.
• Triptans and tramadol: Increased chance of serotonin syndrome.
• St. John’s Wort: May raise serotonin levels.
• Alcohol: Can worsen side effects like drowsiness.

Always provide your healthcare provider with a complete list of medications and supplements.

Costs

According to drugs.com with its discount:

• Brand-name Celexa (10-milligram oral tablets): Costs approximately $965 for 100 tablets for cash-paying customers 
• 20-milligram brand-name tablets: Starting at $1,005.74 for 100 tablets

• 40-milligram brand-name tablets: Beginning at $1,049.12 for 100 tablets
• Generic citalopram (10-milligram oral tablets): $82.79for 100 tablets
• 20-milligram generic tablets: Starting at $84.95 for 100 tablets
• 40-milligram generic tablets: Beginning at $88.04 for 100 tablets

These prices apply primarily to cash-paying customers and may be less with insurance. 

Lexapro vs Celexa: which one should you take?

When deciding between Lexapro and Celexa, several factors come into play:

Chemical composition

• Lexapro (escitalopram): Contains only the S-enantiomer of citalopram, which is the more active and potent component. This typically means Lexapro may be effective at lower doses with potentially fewer side effects compared to Celexa.
• Celexa (citalopram): Contains both R- and S-enantiomers, but only the S-enantiomer is therapeutically active. The presence of the R-enantiomer means Celexa might be less potent and may require higher doses to achieve the same effect as Lexapro, potentially leading to more side effects.

Efficacy

• Lexapro is often considered more potent than Celexa and can have a faster onset of action due to its pure S-enantiomer content.
• Celexa is effective but can require higher doses to achieve similar therapeutic effects to Lexapro.

Side effects

• Lexapro generally has fewer side effects and is better tolerated than Celexa.
• Celexa has a higher risk of QT prolongation than Lexapro at doses above 40 milligrams.

Approved uses

• Lexapro is FDA-approved for both depression (MDD) and generalized anxiety disorder (GAD).
• Celexa is FDA-approved for depression but commonly used off-label for anxiety disorders.

Cost

• Celexa is typically less expensive than Lexapro.
• Lexapro is more expensive than citalopram.

Which is better for anxiety?

• Lexapro is generally preferred for anxiety disorders due to its FDA approval for GAD and potentially greater efficacy.

Which is better for depression?

• Both medications are effective for depression. The choice depends on individual response, side effect profiles, and cost considerations.

Ultimately, the decision between Lexapro vs Celexa should be made in consultation with your healthcare provider, who’ll consider your specific symptoms, medical history, other medications, and personal preferences.

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