From the Guidelines
Escitalopram (Lexapro) is generally preferred over citalopram due to its greater efficacy and fewer side effects, as evidenced by a relative benefit of 1.14 (95% CI, 1.04 to 1.26) in 5 studies comparing the two medications 1.
Key Differences
- Escitalopram is the S-enantiomer (active component) of citalopram, which contains both S and R enantiomers.
- Typical dosing for escitalopram ranges from 10-20mg daily, while citalopram is usually prescribed at 20-40mg daily.
- Escitalopram tends to work more effectively at lower doses, potentially causing fewer side effects like nausea, insomnia, and sexual dysfunction.
Treatment Approach
- Both medications treat depression, anxiety disorders, and OCD by increasing serotonin levels in the brain.
- Escitalopram's more selective action on serotonin transporters explains its improved efficacy and tolerability profile.
- Treatment duration is similar for both medications, typically requiring 4-6 weeks for full effect and continuation for at least 6-12 months after symptom improvement to prevent relapse.
Evidence Summary
- Evidence from 18 fair-quality efficacy trials showed no differences among second-generation antidepressants, including escitalopram and citalopram, in terms of quality of life or functional capacity as secondary outcomes 1.
- A large good-quality study, STAR*D, provided evidence for assessing alternative medications in patients whose initial therapy failed, but found no difference among the medications, including escitalopram and citalopram 1.
From the FDA Drug Label
Escitalopram is the pure S-enantiomer (single isomer) of the racemic bicyclic phthalane derivative citalopram Since escitalopram is the active isomer of racemic citalopram (Celexa), the two agents should not be coadministered.
The main difference between Lexapro (escitalopram) and citalopram is that escitalopram is the active isomer of the racemic compound citalopram. This means that escitalopram is a purified version of one of the two isomers present in citalopram.
- Key differences:
From the Research
Comparison of Lexapro (Escitalopram) and Citalopram
- Lexapro (escitalopram) and citalopram are both selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety disorders 3.
- Escitalopram is the therapeutically active S-enantiomer of citalopram, which means it is the active component of citalopram that produces the therapeutic effect 3.
- Studies have shown that escitalopram has a faster onset of action and greater efficacy than citalopram in treating major depressive disorder, particularly in patients with severe depression 4, 5.
- Escitalopram has been shown to have a significant advantage over citalopram in terms of response rates and remission rates, with a faster time to response and a greater magnitude of effect 4, 5.
- Both escitalopram and citalopram have similar safety profiles, with the most common adverse events being nausea, insomnia, and ejaculation disorder 3, 6.
- Escitalopram has been shown to have a cost-effectiveness and cost-utility advantage over citalopram and other SSRIs, making it a potentially more cost-effective treatment option for patients with major depressive disorder 7.
Efficacy Comparison
- A pooled analysis of placebo-controlled trials found that escitalopram was significantly more effective than citalopram in improving symptoms of depression and anxiety, with a faster onset of action and a greater magnitude of effect 5.
- A study comparing the efficacy of escitalopram and citalopram in patients with severe major depressive disorder found that escitalopram was significantly more effective than citalopram in improving depressive symptoms and achieving remission 4.
- Another study found that escitalopram was at least as effective as citalopram in treating major depressive disorder, with a similar safety profile and a potentially faster onset of action 6.
Pharmacoeconomic Comparison
- A pharmacoeconomic review of escitalopram found that it had a cost-effectiveness and cost-utility advantage over citalopram and other SSRIs, making it a potentially more cost-effective treatment option for patients with major depressive disorder 7.
- A prospective pharmacoeconomic analysis found that escitalopram was associated with lower direct costs and similar efficacy compared to venlafaxine XR, a serotonin-noradrenaline reuptake inhibitor (SNRI) 7.