Celexa vs. Lexapro: differences and similarities

There are a lot of big names in the antidepressant market. Celexa and Lexapro are two that you may recognize. Both are prescription drugs in a group of antidepressant medications called selective serotonin reuptake inhibitors or SSRIs. 

If you’re talking to your healthcare provider about using one of these medications to manage symptoms of depression or another mental health condition, here’s what you need to know about each and how they compare.

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Lexapro and Celexa are part of the most commonly prescribed group of antidepressants, selective serotonin reuptake inhibitors (SSRIs). SSRIs are used in the treatment of depression because they increase serotonin levels. Serotonin is a brain chemical (neurotransmitter) that is important in regulating your mood. Other SSRIs include sertraline (brand name Zoloft), fluoxetine (brand name Prozac), and paroxetine (brand name Paxil) (Chu, 2021).

If you notice the active ingredients for Celexa and Lexapro (citalopram and escitalopram), you'll see that the two look similar—that's not by accident. The two drug ingredients come from the same base chemical. Celexa (or citalopram) contains all forms (also called isomers or enantiomers) of the chemical. Lexapro, in contrast, contains only the S-enantiomer.  

Rates of depression are rising in the U.S., especially after the COVID-19 pandemic (Czeisler, 2020). Estimates indicate that around 12% of people will develop depression, which is the second most common cause of disability among American adults. Major depression is more than just feeling sad—the symptoms of depression can make getting through everyday activities feel impossible (Rush, 2020). 

Celexa is the brand name for citalopram hydrobromide. Unlike many of the other SSRIs, Celexa is only approved by the U.S. Food and Drug Administration (FDA) to treat major depressive disorder (MDD) (FDA, 2017-a). 

However, many providers use citalopram “off-label” to treat conditions like obsessive-compulsive disorder (OCD), binge eating disorder, panic disorder, post-traumatic stress disorder (PTSD), and others (Shoar, 2020). Using a medication off-label means that providers give the drug to treat conditions other than the ones it was FDA-approved to treat.

Lexapro is the brand name for the generic drug escitalopram oxalate. Lexapro is specifically approved to treat MDD and generalized anxiety disorder (GAD) (FDA, 2017-b). 

Like Celexa, healthcare professionals may also use Lexapro off-label to treat OCD, binge eating disorder, panic disorder, and PTSD, among others (UptoDate, n.d.-b). 

While both Celexa and Lexapro treat major depression, they differ in their FDA-approved and off-label uses.

Celexa

FDA-approved uses include (FDA, 2017-a):

• Major depressive disorder

Off-label (not FDA-approved) uses include (UptoDate, n.d.-a):

• Generalized anxiety disorder (GAD)

• Obsessive-compulsive disorder (OCD)

• Panic disorder

• Post-traumatic stress disorder (PTSD)

• Social anxiety disorder

• Premature ejaculation

• Premenstrual dysphoric disorder

• Binge eating disorder

Lexapro

FDA-approved uses include (FDA, 2017-b):

• Major depressive disorder in adults and adolescents over age 12 (short-term and long-term treatment)

• Generalized anxiety disorder in adults (short-term treatment)

Off-label (not FDA-approved) uses include (UptoDate, n.d.-b):

• Obsessive-compulsive disorder 

• Panic disorder

• Post-traumatic stress disorder

• Binge eating disorder

• Body dysmorphic disorder

• Bulimia nervosa

• Premature ejaculation

The FDA has issued a boxed warning—the most serious warning category—indicating that you should monitor for changes in behavior or mental health, including worsening depression symptoms, panic attacks, and suicidal thoughts when starting either medication or changing its dose. This risk of worsening depression and suicidality is highest in children, adolescents, and young adults (FDA, 2018).

Sexual side effects

SSRIs are notorious for causing sexual side effects, including decreased sex drive (libido), orgasm issues, and ejaculation difficulties. While the frequencies of these problems differ depending on which SSRI you are taking, around 50% of people will experience sexual side effects with these medications (Hirsch, 2019). One study suggests that Celexa may cause more sexual dysfunction than Lexapro, but how much is debatable (Jing, 2016). 

Both Lexapro and Celexa may cause ejaculation disorder (delayed ejaculation), lowered sex drive, and erectile dysfunction in men. In women, both of these SSRIs may decrease libido and the ability to orgasm (FDA, 2017-a; FDA, 2017-b).

If you think you may be experiencing sexual problems from these drugs, talk to your healthcare provider—there may be other treatment options. For example, antidepressants like bupropion, mirtazapine, vilazodone, vortioxetine, and serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (brand name Cymbalta) and venlafaxine (brand name Effexor) may improve your symptoms of depression without the sexual side effects (Jing, 2016).

Discontinuation side effects

As with many other medications, you should not stop Lexapro or Celexa suddenly. If you feel you need to discontinue the medication, seek medical advice from your healthcare provider about slowly reducing your dose. 

Stopping abruptly may cause withdrawal symptoms, including nausea, vomiting, dizziness, irritability, headache, and paresthesias (prickling or tingling sensation on the skin). Discontinuation side effects of SSRIs usually start within the first week of stopping the drug and then improve a few weeks later (Hirsch, 2020).

Celexa side effects

Compared to Lexapro, Celexa may cause fewer side effects, but these adverse reactions affect a greater percentage of people taking the medication. Some of the more common side effects of Celexa include (FDA, 2017-a):

• Nausea

• Dry mouth

• Sleepiness 

• Insomnia

• Increased sweating

• Diarrhea

• Ejaculation disorder (delayed ejaculation)

Several side effects are dose-dependent, meaning they are likely to be worse at higher doses. These include delayed ejaculation, fatigue, sleepiness, insomnia, sweating, and yawning (Shoar, 2020). 

Lexapro side effects

How many and how frequently you experience side effects on Lexapro may depend on the dose prescribed. For example, more people experienced side effects on 20 mg than 10 mg in clinical trials. In people with major depression, the most common side effects (and how frequently they happened) were (FDA, 2017-b):

• Nausea 

• Trouble sleeping

• Ejaculation disorder (delayed ejaculation)

• Diarrhea

• Sleepiness

• Dry mouth

• Loss of appetite 

• Low sex drive 

As mentioned, the side effects of escitalopram are dose-dependent; more people on 20 mg stopped taking Lexapro because of side effects than those on 10 mg (FDA, 2017).  

Serotonin syndrome is one of the most serious drug interactions that can occur with any medication that raises serotonin levels. Serotonin syndrome happens when too much serotonin builds up in the body, leading to shivering, diarrhea, high blood pressure, racing heart rate, and fevers. In the worst cases, it can cause seizures, coma, and death. Since both Celexa and Lexapro work by increasing serotonin levels in the body, you run the risk of serotonin syndrome (Simon, 2021). 

The likelihood of developing serotonin syndrome increases if you take Celexa or Lexapro with other drugs that also raise serotonin levels, including tramadol, lithium, tryptophan, buspirone, pimozide, amphetamines, tricyclic antidepressants (like amitriptyline), and over-the-counter supplements containing St. John’s Wort (Simon, 2021).

You should also avoid taking Celexa or Lexapro with monoamine oxidase inhibitors (MAOIs), like phenelzine, selegiline, rasagiline, and tranylcypromine, as the combination also increases your risk of developing serotonin syndrome (Simon, 2021).

Tell your healthcare provider if you are taking any medicine with a blood-thinning effect, such as over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen, or prescription blood thinners, such as coumadin. Taking these drugs with Celexa or Lexapro can increase your risk of bleeding (FDA, 2017-a; FDA, 2017-b).

Celexa and Lexapro may cause drowsiness or affect your ability to think, react quickly, make decisions, etc. Alcohol can have similar side effects. Even though alcohol has not been shown to worsen these effects, most healthcare providers will tell you to avoid drinking when taking either of these medications (FDA, 2017-a; FDA, 2017-b).

This list does not include all of the possible drug interactions with Celexa or Lexapro—talk to your healthcare provider or pharmacist if you have any questions.

Here is a summary of some of the differences and similarities between Celexa and Lexapro:

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

June 25, 2021

Written by

Linnea Zielinski

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.