Posted by Mtom on May 5, 2018, at 11:25:25
In reply to Re: Celexa anxiety side effect: less than most AD's?, posted by SLS on May 4, 2018, at 22:52:39
I have spent many hours researching Lexapro versus Celexa and the information is inconsistent and far from definitive. In general, there seems to be a slight leaning towards Lexapro for efficacy and towards Celexa for less intense adverse affects:
http://www.med.umich.edu/1info/FHP/practiceguides/depress/depress05.pdf states that Celexa may be initially sedating (dose-dependent) or initially increase alertness but also may be the least stimulating SSRI. And it is a minimal inhibitor of CYP 2D6 isoenzymes.
There are a couple of papers hypothesizing whether differences in enantiomers could mean a difference in therapeutic or adverse effects, but without really firm conclusions.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829184/ states claims about clinically relevant superiority of Lexapro over Celexa are not supported by evidence. It points out that results of antidepressant clinical trials do not reflect the real world due to a number of reasons (design, unpublishsed studies, industry influences, modest generalizability, etc., produces results that do not reflect the real physical world and inflated effect sizes suggest more benefit than really exists.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950952/pdf/IJPsy-46-333.pdf found greater response and fewer adverse effects for Lexapro than Celexa, but the differences were not huge, especially for anxiety (1% Lexapro, 3% Celexa) and agitation (2% Lexapro, 5% Celexa). And noted most adverse advents were mild in severity. There is discussion regarding evidence that antidepressant benefits have been overestimated and choices of drugs influenced more by marketing than evidence, noting both drugs were developed by the same company and that Lexapro appeared at the time of Celexa patent ending, promoted as being something new and better. This latter point was made in several papers and articles I read.
One article cited agitation and anxiety being common with Lexapro, but did not mention these as side effects with Celexa. Another site specifically stated that side effects of Lexapro that are different from Celexa include agitation or restlessness. As my readings indicate agitation/anxiety are associated with greater serotonin activity, this would seem to correlate with the postulation that Lexapro does enhance serotonin more so than Celexa.
One article did document significantly greater efficacy with Lexapro at initial doses, but similar after dose increase with Celexa.
Lexapro is approved for Generalized Anxiety Disorder where Celexa is not, however it is pointed out that Celexa has not been studied for this while Lexapro has. Some sites state that both Lexapro and Celexa are used to treat despression and anxiety disorders. One says that Celexa is approved in the UK and other European countries for treatment of panic disorder, and is used off-label in the U.S. for anxiety and panic disorder.
The main caveat about Celexa is that high doses have occasionally been linked to heart rhythm abnormalities in, I think, a small and select proportion of patients.
Several websites state Celexa, is reported as having fewer overall side effects than other SSRIs. At least two articles (citations for which I cant find right now) claimed Celexa was the gentlest of the antidepressants. One article showed the same side effects for both with the exception of diarrhea with Celexa but not Lexapro.
One website rated them as practically identical in efficacy and side effects from consumer reviews (1063 for Lexapro and 530 for Celexa) with Celexa being very slightly better.
You could spend days and days researching and not finding definitive answers for these or other drugs!
My own Doctor was ambivalent about the choice, in her experience she has not noted a difference.
poster:Mtom
thread:1098520
URL: http://www.dr-bob.org/babble/20180331/msgs/1098540.html