Switching Anti-Depressants
September 10, 2009 10:51 AM   Subscribe

Is there really no important difference between Lexapro and Celexa, as my pharmacist claims? I have new insurance that might require switching from L to C. I have had very good results with L, but can't pay full price.
posted by LittlePumpkin to Health & Fitness (18 answers total) 3 users marked this as a favorite
I too would like to know the answer to this. Celexa is mad cheap.
posted by leotrotsky at 10:52 AM on September 10, 2009

Here's a recent NY Times article that considers this question.

The F.D.A. views the two medicines as so interchangeable that the agency recently approved Lexapro’s use in depressed adolescents based in part on the results of a study Forest conducted using Celexa.
posted by brain_drain at 10:58 AM on September 10, 2009 [1 favorite]

Lexapro® (escitalopram oxalate) and Celexa® (citalopram hydrobromide) are both prescription medications classified as selective serotonin reuptake inhibitors. Both Lexapro and Celexa are approved for the treatment of depression; only Lexapro is *approved* to treat anxiety. This does not mean that Celexa will not work for anxiety or that your provider cannot prescribe Celexa for anxiety; it just means not enough study yet for approval.

Some pharma-funded studies suggest Lexapro may be better for depression, but the funding behind the studies suggest that, IMHO, it's worth a trial given the difference with cost.

BTW, if you need to stick with Lexapro and it's not covered, you can get a card that offers a discount on any uncovered meds and works at most/all major pharmacies (seriously).

Here's the card: http://www.rxsavingsplus.com/

I have the card, and I used it to pay for my dog's script after her surgeries. (Yes, you can use it on pet meds.)
posted by Arch1 at 10:58 AM on September 10, 2009

This is the first result by Googling "Lexapro and Celexa." Truth is, though, your pharmacist is a professional, but you should ask your doctor.
posted by General Malaise at 10:59 AM on September 10, 2009

I honestly think that the only way you will find out is by trying it. I take Celexa with very good results (and have several friends who also take Celexa), but had a friend whose insurance made her switch from Lexapro to Celexa and she did not like it as much (I can't remember why, but I think it had to do with the side effects).

However, in my experience, many insurance companies who make you try a cheaper medication in lieu of a more expensive one will allow you to switch back to the more expensive one if your doctor can justify it to the insurance co. (and having you try it & not have good results is a justifiable reason).

Is there any harm in giving the Celexa a shot for 6-8 weeks and taking it from there? I will warn you that there are side effects with Celexa, for me it was mainly anorgasmia and sleepiness, but both wore off within a month.
posted by tastybrains at 11:00 AM on September 10, 2009

My doc explained that they are the "chemical opposites" of each other - Lexapro is newer than Celexa, and apparently has fewer side-effects. I have heard anecdotally that people react differently to each, but I've only taken Lexapro.
posted by radioamy at 11:07 AM on September 10, 2009

I take Lexapro for anxiety. When my insurance tried to force me into taking Celexa or paying full price out of pocket for Lexapro, the reasons my p-doc gave for not switching to Celexa included higher chance of weight gain, and increased tendency toward mania. I take it for anxiety rather than depression, and while I didn't try the Celexa, I do know from experience that most ADs other than Lexapro tend to increase my manic/anxious tendencies. So, if you have sensitivities that way I wouldn't recommend it.

It took a bit of a fight, but we were able to get my insurance to cover the Lexapro as a non-formulary, which means I pay the highest copay but it's still mostly covered. Perhaps this is an option for you.
posted by chez shoes at 11:36 AM on September 10, 2009

Lexapro is Celexa minus an inactive ingredient. Basically, Celexa's patent was expiring and the company needed a new drug. They took out some inactive ingredients and renamed it, but it's basically the same thing. My partner switched from L to C when she lost her insurance (Celexa is a $4 prescription at Target, Walmart, etc.), and did not feel a difference. My career field is mental health, and I have lots of experience with the medications. I am not, however, a doctor or pharmacist.
Just FYI, Effexor and Pristiq are the same way. Effexor's patent expired so the drug company came out with Pristiq, which is the same drug minus an inactive ingredient.
posted by catwoman429 at 11:38 AM on September 10, 2009

What catwoman said is incorrect, or at least misleading. Lexapro is an enantiopure drug. This means that Celexa contains both the "left-handed" and "right-handed" versions of the molecule, whereas Lexapro only contains the "left-handed" version of the molecule. If you're curious, you can read a little more about "handedness" of molecules, more properly known as chirality, here.

For some drugs, the difference between the handed versions is quite straightforward: "left-handed" naproxen is Aleve, whereas "right-handed" naproxen would damage your liver and not provide any pain relief. With Celexa versus Lexapro, it is more a matter of subtly differing effects, and it is between you and your doctor to decide whether you want to try switching to Celexa, and if, should you choose to do so, you are happy with it.
posted by mayhap at 12:02 PM on September 10, 2009 [1 favorite]

...nthing all of the above. Lexapro is a little more effective, or equally effective at lower dosages. Lower dosages mean fewer side effects.

They charge way more for Lexapro than for Celexa, and all that money is phat profitz. The FDA approval for Lexapro was much faster and cheaper than the approvals for Celexa, and you know they made their money back off Celexa and then some.

Some friends gave me a bunch of Indian made escitolopram (Lexapro) with the brand name Escitol-10. It's the same, as far as I can tell, as my Lexapro 10 mg, except it has a coating on the tablet. I chew it up (mmmmm, bitter) so that I pass less of the good stuff.

If you have to go to Celexa, the doctor should prescribe a higher dosage, but you'll want to ask her.
posted by Xoebe at 12:26 PM on September 10, 2009

When I switched from C to L, I felt extremely tired every day. The mood effect was the same for both. The transition from one to the other and back again wasn't difficult at all, so I didn't lose much by trying the newer drug.
posted by wryly at 1:52 PM on September 10, 2009

mayhap's explanation of the structural difference is exactly correct.

Lexapro is the version that is most potent. No one is marketing a drug containing only the non-Lexapro version of citalopram. Celexa came first, has a different patent owner, is cheaper to produce, and is discounted because it's later in the product's life cycle; put all this together and you have a strong market for a less-potent product.

Taking Celexa, with the dosage tweaked under a doctor's guidance, should be virtually the same as taking Lexapro. It's entirely reasonable to ask your doctor to spend a few minutes thoughtfully discussing your options.
posted by RobinFiveWords at 2:10 PM on September 10, 2009

My doctor explained it to me like this: They are both extremely similar. The patent was up for Celexa, and so the company made a minor change, branded it as Lexapro, and got a new patent. I used to take Lexapro, and I switched to Celexa (citalopram) because of the cost difference, and noticed no difference.
posted by Houstonian at 3:12 PM on September 10, 2009

Don't know about Lexapro, but Celexa is THE almighty goody for Seasonal Affective Disorder (SAD) in my experience. When I die, I want to be buried amidst heaps of Celexa in case I might be going somewhere cloudy.
posted by BostonTerrier at 3:20 PM on September 10, 2009

I've taken both. Lexapro is more effective for me with fewer side effects. It effectively combats my anxiety without flattening my affect in a way that Celexa did at the necessary dose.

According to my psych, they are not the same drug and based on my experience, I would concur.
posted by wildeepdotorg at 4:36 PM on September 10, 2009

What mayhap and RobinFiveWords said. The simple way of looking at it is that gram for gram, Celexa is 50% inactive stuff, and 50% active stuff, and Lexapro is 100% active stuff, so two times the dose of Celexa should equal the equivalent amount of Lexapro.

In reality, it's probably not so simple. (The strict chemical difference is that Celexa is racemic citalopram hydrobromide, while Lexapro is S-citalopram oxalate, and the choice of anion may make a difference in terms of drug absorption and metabolism.)

(IANADyet, take this advice with a grain of salt, for educational purposes only.)
posted by greatgefilte at 5:53 PM on September 10, 2009

BTW, the same goes for Losec and Nexium. Two times the dose of Losec should be equivalent, if not better than, one dose of Nexium, because of the same principle. YMMV, but that's chemistry for you.
posted by greatgefilte at 5:56 PM on September 10, 2009

Response by poster: thanks all - a lot to digest, but super helpful...
posted by LittlePumpkin at 7:02 PM on September 10, 2009

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