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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by speedofthought on April 7, 2005, at 10:12:59
Hello all,
I joined this board in an attempt to get some feedback about Lexapro and Celexa.
As you may know, Lexapro (escitalopram) is the s-enantiomer of Celexa (citalopram). They have the same mechanism of action. Lexapro is more selective and thus an equivalent dose is half that of Celexa.
I have been reviewing all randomized controlled studies that compare Lexapro to Celexa for efficacy and safety, as well as meta-analyses that compare Lexapro and Celexa. I will tell you without exaggeration that *every single* study that says that Lexapro is safer and more effective than Celexa is sponsored by the makers (Forest/Lundbeck) directly, or the main authors have significant financial ties.
I realize that most major trials are expensive and sponsored by companies these days, but it is disheartening to me to think that there's so little independent information out there.
OregonDERP reviewed one article that said that Lexapro was better, and one that said the two drugs were the same. (Third reviewed article made no direct comparison). The messages from those not associated with Forest/Lundbeck are mixed. As you may know, the UK came down on Forest for trying to say that Lexapro is better than Celexa (this was a while ago now).
In addition, generic forms of citalopram (Celexa) are now available at a fraction of the cost of branded Lexapro.
I would appreciate any comments from both patients and doctors. Your comments will not go into my research, I am just trying to get a general impression of what people think.
Posted by Spriggy on April 7, 2005, at 11:27:44
In reply to Comments needed re: Lexapro and Celexa, posted by speedofthought on April 7, 2005, at 10:12:59
I am supposed to be "tight lipped" about this but somebody in my church is a drug rep for Celexa.
This person admitted to us that Lexapro is identical, just lesser dosage. Something about a patent running out or such.
Whether or not this is fact, I have no clue but I know for certain they are a drug rep and Celexa is on their list.
BUT shhhhhhhhhhh... don't tell anybody I told you. LOL
*looks out the blinds and windows*
Posted by speedofthought on April 7, 2005, at 11:45:00
In reply to Re: Comments needed re: Lexapro and Celexa, posted by Spriggy on April 7, 2005, at 11:27:44
> I am supposed to be "tight lipped" about this but somebody in my church is a drug rep for Celexa.
>
> This person admitted to us that Lexapro is identical, just lesser dosage. Something about a patent running out or such.
>
> Whether or not this is fact, I have no clue but I know for certain they are a drug rep and Celexa is on their list.
>
> BUT shhhhhhhhhhh... don't tell anybody I told you. LOL
>
> *looks out the blinds and windows*Well, we know that they are basically identical in theory, in the same way that Prilosec and Nexium are identical, and Claritin and Clarinex are identical.
However, what doctors have been convinced of is that by removing the non-active enantiomer, you decrease the risk of side effects. Some articles have even provided convincing evidence that Lexapro is more effective.
Like I said, though, ALL of these articles have been sponsored by Forest (aka Lundbeck, who distributes it in Europe). Something stinks to me... but Lexapro is a blockbuster drug now.
Posted by ed_uk on April 7, 2005, at 12:01:13
In reply to Re: Comments needed re: Lexapro and Celexa, posted by speedofthought on April 7, 2005, at 11:45:00
Hi,
>However, what doctors have been convinced of is that by removing the non-active enantiomer, you decrease the risk of side effects.
I've never been convinced that this was true. I very much doubt that R-citalopram has any significant pharmacological activity- not in most people anyway. Escitalopram is most likely to be responsible for all the side effects of racemic citalopram, as well as its antidepressant efficacy.
> Some articles have even provided convincing evidence that Lexapro is more effective.
I think it was a fluke!
Ed.
Posted by Spriggy on April 7, 2005, at 13:02:02
In reply to Re: Comments needed re: Lexapro and Celexa » speedofthought, posted by ed_uk on April 7, 2005, at 12:01:13
For what it's worth.. I HATED LExapro. It nearly killed me.. LOL OR I should say, that while on the Lexapro, it nearly caused me to kill me. LOL
I was prescribed it for anxiety-- and it flung me into the weirdest state of depression/anxiety/restlessness with hallucinations to boot.
Lexapro to me is like taking LSD (not that I've ever taken LSD but it's what I would imagine it to be like).
Posted by Phillipa on April 7, 2005, at 18:35:32
In reply to Re: Comments needed re: Lexapro and Celexa, posted by Spriggy on April 7, 2005, at 13:02:02
Couldn't take either of them. Fondly, Phillipa
Posted by Chris O on April 7, 2005, at 18:52:02
In reply to Comments needed re: Lexapro and Celexa, posted by speedofthought on April 7, 2005, at 10:12:59
Speed:
I'll just give you my experience of the two drugs. I just stopped taking Lexapro in January after an 8 month trial. I took mostly doses of 30-40mg/day. I found it to be..."weak" is the word I would use to describe it. It just did not fully knock out my depression, worrying and anxiety. The side effects, though, were minimal, just some fatigue is about it.
In 2000, I took Celexa 20mg/day for 6 months. In my memory, it was stronger than Lexapro (at knocking out my anxiety), even at that dose level, but the side effects were also worse (more twitching, anorgasmia, emotional blunting). However, that dose of Celexa was probably too weak for me too, as it did not fully address my issues.
The points you bring up are interesting and valid. I wish there was some we could all agree that health is scared right and that it is not benefitted by making it into another marketing game.
Chris
Posted by ed_uk on April 7, 2005, at 19:32:50
In reply to My experience » speedofthought, posted by Chris O on April 7, 2005, at 18:52:02
Hi Chris!
>In my memory, it was stronger than Lexapro (at knocking out my anxiety), even at that dose level, but the side effects were also worse (more twitching, anorgasmia, emotional blunting).......
It sounds like you may have developed a certain amount of tolerance to the effects of the drug. I've always found that certain SSRI effects tend to wear off over time, especially anorgasmia. Emontional blunting never wore off though.
Regards,
Ed.
Posted by NeilKramer on April 10, 2005, at 8:53:35
In reply to Re: My experience » Chris O, posted by ed_uk on April 7, 2005, at 19:32:50
I wouldn't write off SSRI's if you found Celexa and Lexapro to be "weak." According to my pdoc, they are the weakest of the SSRI's in terms of serotonin, and the side effects can be just as bad. They work great for some people, though. Paxil and Zoloft are the SSRI's that provide the best serotonin uplift. Prozac is somewhere in the middle.
This is the end of the thread.
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