Lexapro vs Celexa
How escitalopram and citalopram compare, two closely related SSRIs.
How they're similar
Escitalopram and citalopram are both selective serotonin reuptake inhibitors, usually shortened to SSRIs. Given how closely they are related, they share a long list of features.
- They work the same way, by slowing the reuptake of serotonin so more of it stays available between nerve cells.
- They share a similar set of side effects, including nausea and other stomach effects, sexual side effects, increased sweating, and changes in sleep.
- They follow the same timeline. Early side effects can show in the first week or two, while the fuller effect on mood and anxiety usually takes four to six weeks.
- Both have a dose-related effect on the QT interval, a measure of heart rhythm.
- Both carry the antidepressant boxed warning about a possible increase in suicidal thoughts in people under 25, especially early in treatment.
- Both have been available as inexpensive generics for years.
How they differ
The differences here are unusually narrow, because escitalopram is the purified active form of citalopram. The table below sums up the core points, with more detail underneath.
| Escitalopram (Lexapro) | Citalopram (Celexa) | |
|---|---|---|
| Drug class | SSRI | SSRI |
| Relationship | The active mirror-image form of citalopram | The original mixture of both mirror-image forms |
| FDA-approved uses | Major depressive disorder, generalized anxiety disorder | Major depressive disorder |
| Heart rhythm (QT) | Dose-related QT effect, with lower maximum doses for older adults | Dose-related QT effect, with lower maximum doses for older adults |
| Approximate dose comparison | About 10 mg | Roughly comparable to about 20 mg |
The relationship is the heart of it. A citalopram molecule exists in two mirror-image forms, and only one of them does the antidepressant work. Escitalopram is that active form on its own. Because of this, the doses do not match one for one. About 10 mg of escitalopram is roughly comparable to about 20 mg of citalopram.
The approved uses differ slightly. Escitalopram is FDA-approved for major depressive disorder and generalized anxiety disorder. Citalopram is approved for major depressive disorder, and its use for anxiety is off-label, meaning a use that evidence supports but the label does not formally list.
On tolerability, escitalopram is often regarded as slightly cleaner and better tolerated, and it is frequently the one chosen now. Citalopram remains widely used and well established. The difference is a tendency, not a rule, and many people do well on either.
Side effects compared
The everyday side effects of these two medications overlap closely, which is expected given how related they are. Both can cause nausea and other stomach effects, sexual side effects, increased sweating, and changes in sleep. With both, side effects tend to arrive before the benefit, and the stomach-related ones often ease within the first couple of weeks.
Both also have a dose-related effect on the QT interval, the measure of heart rhythm. For that reason, both carry lower maximum doses for older adults. That can matter for people with certain heart conditions, or for people who take other medicines that affect heart rhythm. If a side effect is severe, or it is not improving after a few weeks, that is a conversation to have with a prescriber rather than a reason to stop on your own.
Sleep, weight, and sexual effects
For sleep, weight, and sexual effects, the two are broadly similar.
Both are roughly weight-neutral in the short term. Both can disturb sleep, and less often, both can make some people sleepier. Sexual side effects are common with both. They can include lower sex drive, delayed orgasm, and arousal difficulties, and they tend to last as long as the medication is taken rather than fading like nausea does. These effects are worth raising with a prescriber, because there are real options, including a dose change or a switch.
Why a clinician might choose one over the other
Because the two are so close, the choice is minor.
A clinician might choose escitalopram for the generalized anxiety approval and a slightly cleaner profile. A clinician might choose citalopram as a perfectly reasonable, well-established option that has been used widely for years. Beyond that, prior response to either medication matters a great deal. Someone who has done well on one of them already has a strong reason to stay with it.
The bottom line
These are two of the most similar antidepressants there are, since escitalopram is the refined version of citalopram. Neither is clearly better. The choice between them is small and individualized, and it is made with a prescriber. Trying one and switching to the other is a normal step, not a failure.
Sources
This guide draws on current prescribing information and public health references. It is reviewed for clinical accuracy and updated as guidance changes.
- U.S. Food and Drug Administration. Escitalopram prescribing information.
- U.S. Food and Drug Administration. Citalopram prescribing information.
- MedlinePlus, U.S. National Library of Medicine.
- National Institute of Mental Health. Mental health medications.
Managing a medication needs a prescriber
Any psychiatric medication has to be started and adjusted by a clinician who can follow you over time. If you don't have a prescriber, our guides section explains the options, including in-person care and telepsychiatry, and how to choose between them.
This guide is for general education. It is not medical advice and is not a substitute for evaluation, diagnosis, or treatment by a qualified clinician. Never start, stop, or change a medication without talking to your prescriber. If you are in crisis or thinking about harming yourself, call or text 988 in the U.S. to reach the Suicide and Crisis Lifeline.