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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Nanci on August 18, 2000, at 21:29:11
I have been on Prozac for about 2 years, but was having a few side effects that bothered me. My doctor recently put me on Celexa, 20 mg. a day. I have now been on it for about 3 weeks. How long does it usually take to take effect? Has anyone been on Prozac and then switched to Celexa? What are the advantages/disadvantages that you have experienced? Someone else suggested that Serzone might be effective for me also. I felt like Prozac made me tired all the time (I took it at night). Is there anything known to help increase energy level as well as alleviate depression?? Thanks for any help you can give me.
Posted by Cam W. on August 18, 2000, at 23:17:06
In reply to Celexa, posted by Nanci on August 18, 2000, at 21:29:11
Nanci - As with any antidepressant it takes a minimum of 2 weeks to notice any effect and 4 to 8 weeks (or more) for full effect. I like to say that in 2 weeks others notice a lifting of your depression and in 4 weeks you begin to notice the change.
While both of these drugs are SSRIs (selective serotonin reuptake inhibitors) the main differences between Prozac™ (fluoxetine) and Celexa™ (citalopram) are as follows:
1) - the half-life (the time it takes for half of the drug to leave the body) of Prozac and it's main active metabolite is about 100 hours, while the half-life of Celexa and it's active (but less potent) metabolites is about 37 hours. This means that Celexa does not accumulate in the body as readily as Prozac, so if you have to switch to a different class of antidepressants, it can be done quicker from Celexa (2 week washout) than from Prozac (5 week washout). Switching within the SSRI class can be done without a washout period.
2) - Prozac inhibits a certain portion of a liver enzyme system called the cytochrome P450 system. This system is involved in the metabolism of many different drugs. The inhibition of a certain portion of this enzyme system can cause an increase in the blood concentration of certain other drugs. This is called a drug-drug interaction and the dose of the other drug may need to be modified. This enzyme inhibition is not caused by Celexa to any appreciable extent, so Celexa has really no significant drug interactions other than with the monoamine oxidase inhibitor antidepressants (MAOIs).
3) - Celexa affects fewer receptor systems in the body than Prozac. Even though Prozac is called a selective serotonin reuptake inhibitor it affects other receptors as well as the serotonin reuptake receptor. In essence, SSRIs block the reuptake of the neurotransmitter serotonin back into the nerve cell from which it was released, leaving more serotonin in the synaptic gap between nerve cells, enhancing the electrical signals from one nerve cell to another. Although a lack of serotonin is not the cause of depression, increasing it's levels in the body seems to resolve the depressive symptoms in a majority of subtypes of depressions. This is probably not be the full mechanism of action of SSRI antidepressants, but it is a reproduceable feature of them. By affecting more than just the serotonin reuptake receptor (eg certain other serotonin receptors, norepinephrine reuptake receptors, etc.) Prozac supposedly has more side effects (and possibly therapeutic effects, in some cases) than Celexa, which only really blocks the serotonin reuptake receptor. Celexa is said to be a "cleaner" (more selective) drug than Prozac.
3) - Prozac can be augmented by lithium when it doesn't fully relieve the depressive symptoms, while augmenting Celexa with lithium causes no enhancement of antidepressant effect.
These are some of the main differences between Prozac and Celexa. I have probably missed some, but others on the board will fill in the gaps. Even though SSRIs are thought to have similar actions in depression, people do have different responses to the different SSRIs (one SSRI may not resolve a person's depressive symptoms, while another will).
Is Celexa right for you? Unfortunately, we can only roughly estimate if a certain antidepressant will work for a certain person. You have to give each antidepressant you try an adequate trial period (usually 8 weeks). Stick it out for the 8 weeks and see if it works, unless your doctor decides differently.
Will Serzone™ (nefazodone) work for you? Again, the only way to know is to give it an 8 week trial.
I have seen several people who have stopped responding to Prozac (on this board we call it "poop-out") and have been tried on Celexa and it has worked. This is not true for everyone and I don't know what the percentages of responders are. As we say, "Your Mileage May Vary".
As for the energy issue, SSRIs usually are not that sedating in most people, but when they are you usually see it with Prozac, rather than with Celexa. Your lack of energy may be partially a symptom of depression, rather than fully due to the Prozac. One good non-drug way of increasing energy is to exercise regularily. There are many drugs, including some antidepressants that can increase energy (eg Wellbutrin™ - bupropion), but they may not work for your specific type of depression. Ask your doctor about other alternatives.
Sorry that this was so long winded, but once I started, I couldn't stop (sort of like potato chips).
Hope this helps - Cam
Posted by shantie on August 20, 2000, at 2:19:48
In reply to Re: Celexa » Nanci, posted by Cam W. on August 18, 2000, at 23:17:06
> Nanci - As with any antidepressant it takes a minimum of 2 weeks to notice any effect and 4 to 8 weeks (or more) for full effect. I like to say that in 2 weeks others notice a lifting of your depression and in 4 weeks you begin to notice the change.
>
> While both of these drugs are SSRIs (selective serotonin reuptake inhibitors) the main differences between Prozac™ (fluoxetine) and Celexa™ (citalopram) are as follows:
>
> 1) - the half-life (the time it takes for half of the drug to leave the body) of Prozac and it's main active metabolite is about 100 hours, while the half-life of Celexa and it's active (but less potent) metabolites is about 37 hours. This means that Celexa does not accumulate in the body as readily as Prozac, so if you have to switch to a different class of antidepressants, it can be done quicker from Celexa (2 week washout) than from Prozac (5 week washout). Switching within the SSRI class can be done without a washout period.
>
> 2) - Prozac inhibits a certain portion of a liver enzyme system called the cytochrome P450 system. This system is involved in the metabolism of many different drugs. The inhibition of a certain portion of this enzyme system can cause an increase in the blood concentration of certain other drugs. This is called a drug-drug interaction and the dose of the other drug may need to be modified. This enzyme inhibition is not caused by Celexa to any appreciable extent, so Celexa has really no significant drug interactions other than with the monoamine oxidase inhibitor antidepressants (MAOIs).
>
> 3) - Celexa affects fewer receptor systems in the body than Prozac. Even though Prozac is called a selective serotonin reuptake inhibitor it affects other receptors as well as the serotonin reuptake receptor. In essence, SSRIs block the reuptake of the neurotransmitter serotonin back into the nerve cell from which it was released, leaving more serotonin in the synaptic gap between nerve cells, enhancing the electrical signals from one nerve cell to another. Although a lack of serotonin is not the cause of depression, increasing it's levels in the body seems to resolve the depressive symptoms in a majority of subtypes of depressions. This is probably not be the full mechanism of action of SSRI antidepressants, but it is a reproduceable feature of them. By affecting more than just the serotonin reuptake receptor (eg certain other serotonin receptors, norepinephrine reuptake receptors, etc.) Prozac supposedly has more side effects (and possibly therapeutic effects, in some cases) than Celexa, which only really blocks the serotonin reuptake receptor. Celexa is said to be a "cleaner" (more selective) drug than Prozac.
>
> 3) - Prozac can be augmented by lithium when it doesn't fully relieve the depressive symptoms, while augmenting Celexa with lithium causes no enhancement of antidepressant effect.
>
> These are some of the main differences between Prozac and Celexa. I have probably missed some, but others on the board will fill in the gaps. Even though SSRIs are thought to have similar actions in depression, people do have different responses to the different SSRIs (one SSRI may not resolve a person's depressive symptoms, while another will).
>
> Is Celexa right for you? Unfortunately, we can only roughly estimate if a certain antidepressant will work for a certain person. You have to give each antidepressant you try an adequate trial period (usually 8 weeks). Stick it out for the 8 weeks and see if it works, unless your doctor decides differently.
>
> Will Serzone™ (nefazodone) work for you? Again, the only way to know is to give it an 8 week trial.
>
> I have seen several people who have stopped responding to Prozac (on this board we call it "poop-out") and have been tried on Celexa and it has worked. This is not true for everyone and I don't know what the percentages of responders are. As we say, "Your Mileage May Vary".
>
> As for the energy issue, SSRIs usually are not that sedating in most people, but when they are you usually see it with Prozac, rather than with Celexa. Your lack of energy may be partially a symptom of depression, rather than fully due to the Prozac. One good non-drug way of increasing energy is to exercise regularily. There are many drugs, including some antidepressants that can increase energy (eg Wellbutrin™ - bupropion), but they may not work for your specific type of depression. Ask your doctor about other alternatives.
>
> Sorry that this was so long winded, but once I started, I couldn't stop (sort of like potato chips).
>
> Hope this helps - CamCam since you seem to have a pretty good understsnding of these drugs....does celexa's side effects really make you gain weight and have loss of hair? I am on 60mgs of ritalin and 300mgs of WB-i was supposed to start taking 20mgs of celexa a few days ago but i am afraid, especially after taking effexor for 3 months and gaining 16lbs. i dint really notice too much difference to me it wasnt worth it ......
Posted by mit on August 20, 2000, at 10:28:36
In reply to Celexa, posted by Nanci on August 18, 2000, at 21:29:11
I was on Celexa for about 5 weeks and I could have sworn that It did nothing for me, so I stopped. Recently I saw a psychopharm and he put me on Wellbutrin. After a week I hit the bottom (see my post above). As we were talking recently it occured to me that the Celexa was helping and I didn't even realize it (didn't feel guilty all the time, somewhat at ease in social situations, etc). The problem was that it didn't help with depression (I was still sleeping all day, felt a sense of hopelessness, no motivation). I have since added 20mg of Celexa to the 100mg Wellbutrin. It may be too early to tell but I feel better already. I have the benefits of Celexa with the added energy of Wellbutrin. I'm not fully where I want to be, but believe me it is a huge improvement (I don't feel the urge to take naps during the day and I look forward to getting up and doing something in the morning). Last Saturday I was thinking suicide was the only way out.My point is that the Wellbutrin + Celexa combo seems to be the way for you to go (Search this board for Wellbutrin and Celexa and you can get more info). Hope this is of some help.
Mit
Posted by Cam W. on August 20, 2000, at 10:46:25
In reply to Re: Celexa Cam, posted by shantie on August 20, 2000, at 2:19:48
Shantie - Yes, some people have lost hair while taking Celexa, but I have only personally seen it happen to one person who was not also taking mood stabilizers like Depakote™ (divalproex) or lthium.
As for the weight gain thing. Yes, SRIs can cause weight gain in many people and there doesn't seem to be much rhyme or reason for it. Although, a vast majority of these people are eating more while taking these antidepresssants. Is is do to the ADs causing carbohydrate cravings, changes in leptin levels, changes in energy utilization, changes in metabolism, stimulation of histamine-1 (H1) receptors, or just feeling better and eating more as a result of improved mood? I don't think anyone knows. There are trends, though. Eating more is one (need to stick to rabbit food - salads - even though that is not what you are craving). Another observation that I have made is that the weight gain with antidepressants, unlike with the atypical antipsychotics, is a delayed reaction. The weight doesn't seem to increase until one has been taking the AD for about 2 months. Also, weight gain with ADs does not seem to be as closely linked to the positive effect of the drug (ie decreased depressive symptoms) as is seem with the atypical antipsychotics. (The last two are observations that I have had and I have no proof of them).
In any respect, any side effect, with any drug, is a numbers game. Only a percentage of the population will get a certain side effect. There are very few cases where one can actually predict that a side effect will happen, even within drugs of the same class. I have given up trying to predict percentages, especially when using those found in a drug company's monograph. What I can say with certainty is that very few people lose hair when taking Celexa and more do seem to gain weight. Still, the chances of it happening to you are similar to the chances you have a craps table. You never know the outcome and these dice can't be rigged.
Another thing. Antidepressants are only bandages. They do relieve the depressive symptoms, but they don't "fix" the underlying problem that caused the depression. This is where the hard work comes in. One has to work on recovery, it doesn't happen in a vaccuum. Exercise does help, as does discovering and coming to terms with or changing parameters that caused one to become depressed in the first place.
I saw one cartoon in which a guy buys a box marked "New Life". He opens it up and reads the instructions that say, "Some assembly required." He retorts, "Doh, that figures!" TV and the drug companies (or, at least their ad agencies) have lulled us into a state where we think that we can take a pill to change our lives. It doesn't work that way. Change is hard and necessary for most of us. The medications just bring us to a level of self awareness where we can work on these changes. I think I am, myself, just coming to that realization.
The only way you can work around the dilemma you are having is to eat properly (keep a dieting/depressive symptom journal) and begin to execise, when starting Celexa. Give the Celexa a good 8 week trial and see what happens. Hide the Doritos and don't stop at McDonalds before supper (my downfall).
I hope this helps. I know it doesn't directly answer your question, but I don't think that there are any really definite answers (yet). - Cam
Posted by shantie on August 20, 2000, at 22:30:45
In reply to Re: Celexa » shantie, posted by Cam W. on August 20, 2000, at 10:46:25
hey Cam thanx for the info. Too bad i don't care for doritos and such, food is not my weakness. i pretty much eat salads and garden burgers i abhor pretty much anything white full of carbs starches potaotoes rice chips snacks etc. that is why i am so concerned about the weight. Besides (not to be mean) the girls i work with know how to locate the crispy cremes rather than any missing files LOL. Anyway they eat so much it is a great diet aid. I got some info from john l. that sounds pretty logical. i am gonna see what doc thinks about it. well gotta go. shantie
Posted by Alicia on August 21, 2000, at 16:07:14
In reply to Re: Celexa, posted by mit on August 20, 2000, at 10:28:36
Mit,
I've been on Celexa (20mg for 2 months and haven't noticed any great improvement. I do feel less guilty (as you said), but that's the only the thing that has changed. I'm still extremely tired, unhappy, hopeless, can not concentrate and have all the other symptoms that I had before I began taking Celexa. My doctor is increasing my dose to 40mg, and is considering switching me to Wellbutrin if that does not help. Do you think it would be better for me to continue taking Celexa and to start on a low dose of Wellbutrin? Celexa is the 1st antidepressant I've taken, so any advice you or anyone else can give would be greatly appreciated. Thanks.
Posted by mit on August 21, 2000, at 22:00:51
In reply to Re: Celexa Mit, posted by Alicia on August 21, 2000, at 16:07:14
Alicia,
I would try adding Wellbutrin the the Celexa. I am on what is considered a very low dose (100mg a day)but I felt the increased energy right away. I used to sleep all the time, now my only problem is that it is sometimes difficult to get to sleep at night which throws me off the next day but I am starting trazadone to help with that. By the way, are you getting meds from your family doctor or a psychopharm? My psychopharm ripped my family doctor's treatment method. (Went from Celexa 20mg to Celexa 40mg to Prozac 10mg to Prozac 20mg to 40mg, etc). He said that just isn't suppose to be done (going from one which was helping a little to another ssri-unless there are side effects). Anyway, my point is that the psychopharms may be able to speed up the process due to better knowledge. Also it is my understanding that family doctors are very reluctant to try new things (may not give you the Wellbutrin with the Celexa). Anyway, I hope this helps.
Mit
Posted by Debbie on November 28, 2000, at 10:00:43
In reply to Re: Celexa » shantie, posted by Cam W. on August 20, 2000, at 10:46:25
Cam, You are awesome! Thanks for the information. You have helped me a great deal! debbie
Posted by lizzy on April 14, 2001, at 13:02:38
In reply to Re: Celexa, posted by Debbie on November 28, 2000, at 10:00:43
> Cam, You are awesome! Thanks for the information. You have helped me a great deal! debbie
I agree! I just read this thread and found your information very helpful. I have a problem with sleeping too many hours and was considering Wellbutrin to lessen that. I'm definitely going to suggest that at my next appointment. I'm going to a primary care physician but my therapist gave me the number of a nurse practitioner who specializes in anti-depressants and comes to the building where I see my counselor. Thanks a bunch!
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