Celexa vs Lexapro: Understanding Your Options

If you’re deciding between Celexa (citalopram) and Lexapro (escitalopram), you may feel overwhelmed by medical terms that don’t answer your real questions. You want to know which one is more likely to help you feel better with fewer side effects.

Both Celexa and Lexapro are effective treatments for depression and anxiety. Some industry-sponsored research suggests Lexapro may have slight statistical advantages, but independent reviews question whether these differences matter in real-world treatment. Major treatment guidelines recommend both equally. Your personal response to the medication is usually more important than general comparisons. Working closely with your healthcare provider helps identify which medication fits your specific situation.

This article provides educational information about Celexa and Lexapro. It is not medical advice. Always discuss medication decisions with your doctor or psychiatrist.

*Citalopram is used off-label for anxiety disorders (not FDA-approved for this indication), while escitalopram is FDA-approved for generalized anxiety disorder in adults.

Both medications are effective treatments recommended equally in major treatment guidelines. Individual response varies based on your unique biology and medical history.

Celexa vs Lexapro: Quick Comparison

Feature	Celexa (Citalopram)	Lexapro (Escitalopram)
FDA Approvals	Depression (adults)	Depression (adults & teens 12–17), Generalized Anxiety Disorder (adults)
Off-Label Uses	Anxiety disorders*	Various anxiety conditions*
Effectiveness	Effective first-line SSRI, recommended equally in guidelines	Effective first-line SSRI, recommended equally in guidelines
Starting Dose	20 mg daily	10 mg daily
Typical Range	20–40 mg daily	10–20 mg daily
Maximum Dose	40 mg daily (20 mg for older adults)	20 mg daily
Generic Available	Yes (citalopram)	Yes (escitalopram)

*Citalopram is sometimes used off-label for anxiety, whereas escitalopram is FDA-approved for generalized anxiety disorder in adults.

Both medications are effective first-line treatments. Individual response varies based on your unique biology and medical history.

What Makes Celexa and Lexapro Different?

Both medications increase serotonin in the brain, which helps regulate mood. The main difference is that Lexapro contains only the active part of Celexa. Celexa contains two mirror-image molecules; only one is active. That active molecule is escitalopram, which is the drug in Lexapro [1-2].

Despite minor chemical differences, research shows both medications are effective first-line treatments for depression and anxiety [3].Guidelines from organizations such as NICE and the American Psychiatric Association treat them equally. Factors such as insurance coverage, cost, dosing convenience, FDA approval for your condition, and individual tolerance usually guide the choice rather than differences in effectiveness.

Celexa vs Lexapro Effectiveness: What Research Shows

Some industry-sponsored studies suggest escitalopram may be slightly more effective than citalopram, but independent reviews question whether these small differences are clinically meaningful. For example, one analysis found that 14 people would need to take escitalopram instead of citalopram for one additional person to benefit, which is generally considered a minimal difference [4].

Major treatment guidelines do not favor one over the other. Your individual response, influenced by genetics, medical history, and other factors, is far more important than these small population-level differences [5].

Setting Realistic Expectations About Treatment

Understanding realistic timelines helps manage expectations and prevents premature discontinuation.

What Research Shows About First-Line Treatment Success

In the STAR*D study, one of the largest real-world antidepressant trials, about 47% of patients responded to first-line citalopram, and 27–37% achieved remission [6]. This means many patients require additional treatment strategies.

If your first medication doesn’t fully work, it’s common, not a failure. Persistence, monitoring, and collaboration with your provider are essential.

Treatment Timeline

Timeframe	What to Expect	What to Do
Week 1–2	Improved sleep, slightly more energy, reduced physical anxiety	Continue daily medication; nausea usually temporary; report severe side effects
Week 2–4	Initial mood improvements may appear	Track symptoms; report concerning side effects or worsening mood
Week 4–6	Gradual mood improvement	Discuss lack of improvement with your provider; some need more time
Week 6–8	Full effects usually reached	If minimal improvement, discuss dose adjustment or other approaches
Ongoing	Benefits continue	Regular provider check-ins; never stop abruptly

Most people notice some benefits within 1–4 weeks. Full antidepressant effects usually take 6–8 weeks. Close monitoring is important, especially in the first few weeks, due to the FDA black box warning about increased suicidal thinking in people under 25. Contact your provider immediately if you experience worsening depression, suicidal thoughts, or unusual behavior [7-8].

Celexa vs Lexapro Side Effects

Both medications have similar side effects because they work in the same way. Before starting treatment, your provider should discuss:

• Baseline sexual function
  
  
• Expected timelines for improvement
  
  
• Common side effects and duration
  
  
• How to manage problematic side effects
  
  

Common, usually temporary side effects:

• Nausea or upset stomach
  
  
• Sleep changes (insomnia or drowsiness)
  
  
• Dry mouth
  
  
• Increased sweating
  
  
• Mild headaches
  
  
• Sexual side effects (decreased desire, difficulty with arousal or orgasm)
  
  

Sexual side effects:
 40–65% of patients report some difficulties when directly asked. Depression itself can cause sexual difficulties in 40–50% of untreated patients [9]. Management may include dose adjustment, switching medications, adding another medication, or carefully timed breaks under supervision.

Serious side effects – contact your provider immediately:

• Unusual mood changes or suicidal thoughts
  
  
• Severe allergic reactions
  
  
• Irregular heartbeat or chest pain
  
  
• Severe restlessness or inability to sit still
  
  
• Seizures, confusion, or hallucinations
  
  
• Symptoms of serotonin syndrome
  
  
• Unusual bleeding or bruising
  
  

Discontinuation warning:
 Never stop SSRIs abruptly. Withdrawal symptoms may include dizziness, nausea, anxiety, “brain zaps,” and flu-like symptoms. Always taper under medical supervision.

Dosing Differences

• Lexapro: 10 mg starting, 10–20 mg effective, 20 mg max
  
  
• Celexa: 20 mg starting, 20–40 mg effective, 40 mg max (20 mg for older adults)
  
  

Celexa offers more dosing flexibility. Lexapro’s lower doses may mean fewer pills. These are practical considerations rather than effectiveness differences [10-11].

Individual Factors Affecting Your Response

Response depends on:

• Genetics: Metabolism rate, serotonin-related gene variants
  
  
• Medical history: Previous medication responses, other conditions, other medications/supplements
  
  
• Lifestyle: Stress, sleep, diet, exercise, social support, severity of depression

Trial and adjustment are often necessary; this does not indicate treatment failure.

Special Populations

Pregnancy & breastfeeding: Both are Category C. Risks and benefits must be discussed. Small amounts pass into breast milk [12].

Older adults: Lower doses recommended; Celexa max is 20 mg due to heart rhythm concerns.

Adolescents: Lexapro approved for ages 12–17; Celexa is not. Black box warnings apply.

Liver/kidney issues or heart conditions: Dose adjustments or monitoring may be necessary.

Questions to Ask Your Healthcare Provider

Which medication do you recommend for me and why?

Have I tried either before, and what happened?

What are realistic expectations and timelines?

How will side effects be monitored, especially sexual effects or suicidal thoughts?

How will treatment be adjusted if the first choice doesn’t work?

Options may include:

• Adjusting dose
  
  
• Switching between citalopram and escitalopram
  
  
• Trying a different class of antidepressants
  
  
• Adding a second medication
  
  
• Addressing other health factors
  
  
• Adding psychotherapy

Persistence and communication with your provider are essential.

What If the First Choice Doesn’t Work?

Finding the right antidepressant sometimes involves trial and adjustment. As mentioned earlier, in the large STAR*D study, only about one-third achieved remission with first-line treatment. [6] This doesn’t mean failure. It means your provider has information to guide next steps.

If your initial choice doesn’t work well, options include:

• Adjusting the dose (sometimes people need higher doses)
• Switching between citalopram and escitalopram (despite similarities, individual responses can differ)
• Trying a different antidepressant class (SNRIs, bupropion, mirtazapine, etc.)
• Adding a second medication to enhance effects
• Addressing other factors (sleep disorders, thyroid problems, vitamin deficiencies, chronic pain)
• Adding psychotherapy if not already included

Many people find effective treatment through persistence, even if the first medication isn’t right. Stay in communication throughout this process and don’t lose hope if the first try doesn’t work perfectly [13-14].

Supporting Your Treatment Success

• Therapy: Combining medication with psychotherapy improves outcomes.
  
  
• Lifestyle: Regular exercise, sleep, stress management, and social support help.
  
  
• Monitoring: Track mood, sleep, energy, and functioning.
  
  
• Medication adherence: Take consistently; never double up.
  
  
• Communication: Report side effects and concerns honestly.

Cost and Insurance Considerations

Both Celexa and Lexapro are available as generics, which reduces costs. Insurance coverage may vary. Affordable, consistent medication is more important than a theoretically “better” option you cannot maintain [14].

Moving Forward With Confidence

Choosing between Celexa and Lexapro is a personal decision. Both are effective, and small statistical differences are less important than your unique biology, medical history, and life circumstances. Partnering with a knowledgeable healthcare provider is key.

Effective treatment may take time and adjustment. The goal is not perfection but finding an approach that improves functioning and manages side effects.

If you are struggling with depression or anxiety, reaching out to a healthcare provider is the first step. Effective treatment is available, though persistence may be required.

PsychPlus offers online psychiatry services with board-certified providers who can help you navigate medication decisions. Appointments are available in as little as 48 hours. Schedule a consultation to take the first step toward feeling better.

References

[1] Sanchez C, Bogeso KP, Ebert B, et al. Escitalopram versus citalopram: the surprising role of the R-enantiomer. Psychopharmacology. 2004;174(2):163-176. https://pubmed.ncbi.nlm.nih.gov/15205879/

[2] Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366. https://pubmed.ncbi.nlm.nih.gov/29477251/

[3] Montgomery SA, Hansen T, Kasper S. Efficacy of escitalopram compared to citalopram: a meta-analysis. Int J Neuropsychopharmacol. 2011;14(2):261-273. https://academic.oup.com/ijnp/article/14/2/261/696727 Note: This meta-analysis was co-authored by researchers with pharmaceutical industry ties and should be interpreted alongside independent analyses.

[4] Trkulja V, Barić H. Is escitalopram really relevantly superior to citalopram in treatment of major depressive disorder? A meta-analysis of head-to-head randomized trials. Croat Med J. 2010;51(1):61-73. https://pubmed.ncbi.nlm.nih.gov/20162747/

[5] NICE Guideline. Depression in adults: treatment and management. National Institute for Health and Care Excellence. 2022. https://www.nice.org.uk/guidance/ng222

[6] Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163(1):28-40. https://pubmed.ncbi.nlm.nih.gov/16390886/

[7] Taylor MJ, Freemantle N, Geddes JR, Bhagwagar Z. Early onset of selective serotonin reuptake inhibitor antidepressant action: systematic review and meta-analysis. Arch Gen Psychiatry. 2006;63(11):1217-1223. https://pubmed.ncbi.nlm.nih.gov/17088502/

[8] Hu XH, Bull SA, Hunkeler EM, et al. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression. J Clin Psychiatry. 2004;65(7):959-965. https://pubmed.ncbi.nlm.nih.gov/15291684/

[9] Rothmore J. Antidepressant-induced sexual dysfunction. Med J Aust. 2020;212(7):329-334. https://pubmed.ncbi.nlm.nih.gov/32248536/

[10] FDA. Lexapro (escitalopram oxalate) Prescribing Information. 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021365s047lbl.pdf

[11] FDA. Celexa (citalopram hydrobromide) Prescribing Information. 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020822s047lbl.pdf

[12] Yonkers KA, Wisner KL, Stewart DE, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry. 2009;31(5):403-413. https://pubmed.ncbi.nlm.nih.gov/19703633/

[13] Cuijpers P, Sijbrandij M, Koole SL, et al. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13(1):56-67. https://pubmed.ncbi.nlm.nih.gov/24497254/

[14] FDA. Generic Drugs: Questions and Answers. 2021. https://www.fda.gov/drugs/questions-answers/generic-drugs-questions-answers