Celexa vs. Lexapro: What's the Difference?
Medically reviewed by Erika Prouty, PharmD
Depression, also known as major depressive disorder (MDD), is a common mental health condition affecting almost 1 in 6 people at some point in their lifetime. Depression is the most commonly diagnosed mental disorder in the United States.
Healthcare providers may use varying strategies to manage depression, including therapy and prescription medications like antidepressants.
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants to manage the symptoms of MDD. They are often the first-line treatment for depression.
If diagnosed with depression, you may be prescribed an SSRI such as Celexa (citalopram) or Lexapro (escitalopram), two common SSRIs for depression.
Celexa and Lexapro have many similarities. However, critical differences exist regarding requirements for use, dosing strategies, and active ingredients that consumers should be aware of.
What Is Celexa?
Celexa is an SSRI antidepressant that contains the active ingredient citalopram. Celexa treats depression in adults 18 and older. It is not typically prescribed to children or adolescents.
It is available in both brand name and generic forms.
Celexa is sometimes prescribed off-label for uses that the Food and Drug Administration (FDA) has not approved. Such off-label uses include:
Obsessive-compulsive disorder (OCD): Intrusive thoughts or obsessions that lead to repetitive behaviors or compulsions
Panic disorder: A condition where individual experiences frequent, unexpected panic attacks to daily life stressors
Generalized anxiety disorder (GAD): A constant feeling of anxiety that interferes with daily life
Premenstrual dysphoric disorder (PMDD): A severe form of premenstrual syndrome that causes extreme mood shifts as well as physical symptoms like bloating and breast tenderness
Binge eating disorder (BED): Frequently eating large amounts of food at once and feeling out of control)
Post-traumatic stress disorder (PTSD): A mental health condition in which a person has a difficult time recovering after experiencing or witnessing a traumatic event
What Is Lexapro?
Lexapro is an SSRI antidepressant that contains the active ingredient escitalopram. Lexapro treats MDD in adults and adolescents 12 and older. It can also treat GAD in adults and children 7 and older.
On a chemical level, escitalopram and citalopram are very similar.
Like Celexa, Lexapro (escitalopram) is available in brand name and generic forms. It is sometimes prescribed off-label for uses such as:
Hot flashes associated with menopause
Premenstrual dysphoric disorder
Help Is Always Available
Several treatment resources and support groups can also be found through the Substance Abuse and Mental Health Service Administration (SAMHSA) National Hotline at 800-662-HELP (4357).
If you have suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor.
If you or a loved one is in immediate danger or feel like you may be in a position to hurt yourself or others, call 911 immediately.
How Do Celexa and Lexapro Work?
Serotonin is a neurotransmitter (chemical messenger) sending signals between the brain and the rest of the body. It helps boost mood and affects many other functions of the body, including memory, sleep, and breathing. Low levels of serotonin are associated with depression.
Serotonin is usually reabsorbed (known as reuptake) by nerve cells in the brain. SSRI antidepressants work by increasing serotonin levels in the brain. They block nerve cells from reabsorbing serotonin, allowing more serotonin to be active in the brain.
Dosing Guidelines: Celexa vs. Lexapro
Read on for more information regarding general dosing guidelines for Celexa and Lexapro.
Know, however, that a healthcare provider will always determine your exact dosing regimen.
Celexa
Celexa is available in 10 milligrams (mg), 20 mg, and 40 mg tablets. The starting dose is 20 mg once daily.
A healthcare provider may increase the dosage to an adequate dosage after at least one week. The maximum dosage is 40 mg per day.
Lexapro
Lexapro is available in 5 mg, 10 mg, and 20 mg tablets and an oral solution (a liquid form of administration) at 5 mg per 5 milliliters (mL).
General Lexapro dosing guidelines are as follows:
For adults with depression or anxiety, the starting dose is 10 mg once daily. After at least one week, if needed, the healthcare provider can increase the dosage. The maximum dosage is 20 mg per day.
For the treatment of depression in adolescents 12 to 18 years old, the starting dose is 10 mg once daily. After at least three weeks, if needed, the healthcare provider can increase the dosage. The maximum dosage is 20 mg per day.
To treat anxiety in children and adolescents ages 7 to 18, the starting dose is 10 mg once daily. After at least two weeks, if needed, the healthcare provider can increase the dosage. The maximum dosage is 20 mg per day.
| Celexa (citalopram) | Lexapro (escitalopram) |
Dosage forms | Oral tablet: 10, 20, 40 mg | Oral tablet: 5, 10, or 20 mg |
Adult dose for depression | 20 to 40 mg once daily | 10 to 20 mg once daily |
Adult dose for anxiety | (Not FDA-approved) | 10 to 20 mg once daily |
Pediatric dose for depression (12–18 years old) | (Not FDA-approved) | 10 to 20 mg once daily |
Pediatric dose for anxiety (7 years and older) | (Not FDA-approved) | 10 to 20 mg once daily |
Celexa or Lexapro should not be stopped abruptly. When stopping Celexa or Lexapro, the healthcare professional will provide you with a tapering schedule, so you can safely stop taking the medication over some time.
Side Effects and Safety: Celexa vs. Lexapro
Celexa and Lexapro carry black box warnings. The warning states a higher risk of suicidal thoughts (thinking about ending your own life) and behaviors (trying to end your life) in children, teenagers, and young adults who take antidepressants.
A black box warning is the strongest warning issued by the FDA. The black box warning on Celexa and Lexapro applies to all antidepressants.
Because of this risk, people of any age who take antidepressants should be closely monitored for any changes in mood and behaviors, as well as suicidal thoughts and behaviors.
Common Side Effects of Celexa
Common side effects of Celexa include:
Stomach problems like stomach pain, nausea, vomiting, diarrhea, indigestion
Sleepiness/tiredness
Tremor
Sexual problems, including impotence and loss of interest in sex
Flu-like symptoms
Appetite loss
Anxiety
Dizziness
Common Side Effects of Lexapro
Common side effects of Lexapro may include:
Stomach problems like stomach pain, gas, nausea, indigestion, vomiting, constipation, or diarrhea
Sexual problems, including impotence and loss of interest in sex
Trouble sleeping
Sleepiness/tiredness
Dry mouth
Excessive sweating
Dizziness
Flu-like symptoms
Appetite loss
Neck, back, and shoulder pain
Anxiety
Menstrual problems
Numbness and tingling
Irritability/anger
Severe Side Effects of Celexa and Lexapro
Serious side effects and their symptoms, in addition to mood or behavior changes or having suicidal thoughts or actions, can include the following:
Anaphylaxis (severe allergic reaction): Get emergency medical help if you have urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat.
Severe, life-threatening skin reactions: Get emergency medical help if you have symptoms of fever, burning eyes, sore throat, skin pain, red/purple rash, or blistering/peeling skin.
QT prolongation (also known as long QT syndrome): This is a heart rhythm condition in which the intervals between heartbeats are longer than usual, which can lead to torsades de pointes (a fast heart rhythm that starts in the heart's lower chambers). Both drugs, but especially Celexa, can cause QT prolongation. Because the risk increases with a higher dose, the maximum recommended Celexa dose is 40 mg.
Serotonin syndrome: This is a potentially life-threatening reaction from having too much serotonin in the body.
Bleeding
Glaucoma: This is a group of eye conditions that can cause vision loss.
Low sodium levels: Symptoms may include headache, confusion, slurred speech, weakness, vomiting, and problems with coordination.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH): High hormone levels cause the body to retain water instead of removing it through the urine.
Painful, prolonged erection: This symptom requires emergency medical attention.
Extrapyramidal symptoms: This is an inability to sit still, involuntary muscle contractions and facial movements, and stiff muscles.
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.
Report Side Effects
If you experience a severe side effect after getting medical attention, you or your provider may send a report to the FDA MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Drug-Related Interactions: Celexa vs. Lexapro
Tell your healthcare provider about all your medicines, including prescription and over-the-counter drugs and vitamins or supplements.
While taking Celexa or Lexapro, do not start any new medications without approval from your healthcare provider.
Celexa and Lexapro should not be used together. Other drug interactions include:
Alcohol should not be combined with Celexa or Lexapro. The combination can cause many complications, including extreme sedation, impairment, and stomach (or other types of) bleeding, which can be life-threatening.
Bleeding can also occur when Celexa or Lexapro is combined with certain medications such as aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet drugs such as Plavix (clopidogrel), or blood thinners like Jantoven (warfarin).
Serotonin syndrome is a life-threatening condition that can cause death if not treated. It can occur from the build-up of too much serotonin in the body. SSRI antidepressants increase serotonin levels, and serotonin syndrome can happen when the dose is increased or when Celexa or Lexapro is combined with another drug that increases serotonin levels, such as another antidepressant, triptans for migraine such as Maxalt (rizatriptan), opioid pain medications, the cough suppressant dextromethorphan, and Saint-John's-wort, among others. Serotonin syndrome symptoms may include agitation, hallucinations, fever, chills, sweating, fast heart rate, stiff or twitching muscles, incoordination, nausea, vomiting, or diarrhea.
Monoamine oxidase inhibitors (MAOIs), such as phenelzine or tranylcypromine, can also cause serotonin syndrome if combined with Celexa or Lexapro. MAOIs should never be mixed with Celexa or Lexapro. In addition, 14 days should separate the use of an MAOI and Celexa or Lexapro.
Drug Interactions
This is not a complete list of drug interactions. Other drug interactions may occur with Celexa or Lexapro. Consult with your healthcare provider regarding possible drug interactions and how they may affect you.
Summary
Celexa (citalopram) and Lexapro (escitalopram) are two SSRI antidepressants that are chemically related to each other. Both drugs are taken orally and share similar side effects. A black box warning regarding serious side effects applies to both antidepressants.
Celexa treats depression in adults 18 and older. In comparison, Lexapro can treat depression and anxiety in adults and adolescents 12 and older for depression. It can also treat GAD in adults and children 7 and older
Both are effective concerning their specific indications. However, some studies have shown that Lexapro works better for treating MDD.
Talk to your healthcare provider for more details about Celexa and Lexapro and to determine if one of these medications may be appropriate.
Frequently Asked Questions
When should I take Celexa vs Lexapro?
Your healthcare provider can determine which, if either, medication is appropriate for you. Both drugs can treat depression in adults. Lexapro can also treat depression in younger people and anxiety in adults and children 7 and older.
When should I not take Celexa or Lexapro?
These medications are not safe for everyone.
There are certain conditions in which it would be unsafe to take Celexa or Lexapro, such as if you have an allergy to an ingredient in the medication, heart or heart rhythm problems, or if you have taken a drug in the MAOI class within 14 days.
Pregnant people, people planning to become pregnant, and people breastfeeding should consult with their healthcare provider regarding using Celexa or Lexapro.
Are Celexa and Lexapro safe for children?
Celexa is not FDA-approved for use in children. However, some healthcare providers prescribe Celexa off-label to younger people.
Lexapro can be taken by adults and children 12 and older for depression and by adults and children 7 and older for anxiety. Some healthcare providers prescribe Lexapro off-label in younger people.
