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Anafranil vs Lexapro
Introduction
For patients suffering from major depressive disorder (MDD) or other types of psychological disturbances, there are specific medications that influence the balance of chemical substances in the brain related to mood, known as neurotransmitters. These drugs can assist in managing symptoms and stabilizing emotional lows. Anafranil and Lexapro are two such medications often prescribed for these disorders. Both impact different neurotransmitters within the brain but have similar mood-stabilizing effects. Anafranil is classified as a tricyclic antidepressant (TCA), primarily affecting serotonin levels along with some effect on norepinephrine levels. On the other hand, Lexapro is a selective serotonin reuptake inhibitor (SSRI) which mainly influences serotonin concentration in the brain.
Anafranil vs Lexapro Side By Side
| Attribute | Anafranil | Lexapro |
|---|---|---|
| Brand Name | Anafranil | Lexapro |
| Contraindications | Should not be taken with or recently after taking a monoamine oxidase (MAO) inhibitor. | Should not be taken with or recently after taking a monoamine oxidase (MAO) inhibitor. |
| Cost | For brand name: around $100 for 30 tablets (25 mg each). For generic (Clomipramine HCl): between $0.90 and $2 per tablet. | For brand name: approximately $320 for 30 tablets (10 mg each). For generic (Escitalopram Oxalate): ranges from $.40 - $.80 per tablet. |
| Generic Name | Clomipramine | Escitalopram |
| Most Serious Side Effect | Increased thoughts of suicide or harmful behavior, severe nervous system reaction. | Signs of an allergic reaction, low levels of sodium in the blood, suicidal thoughts. |
| Severe Drug Interactions | MAO inhibitors. | MAO inhibitors. |
| Typical Dose | 25-200 mg/day, starting dose usually 25 mg/day. | 10-20 mg/day, starting dose usually 10 mg/day. |
What is Anafranil?
Clomipramine (the generic name for Anafranil) is a tricyclic antidepressant (TCA), which was developed as a progression from the first generation of antipsychotic medications. Clomipramine, first approved by the FDA in 1989, increases levels of free serotonin and norepinephrine by preventing them from being reabsorbed, effectively maintaining their presence in the brain for longer durations. It is prescribed primarily for obsessive-compulsive disorder and major depressive disorder. On the other hand, Escitalopram (Lexapro's generic name) belongs to a newer class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Lexapro works by selectively inhibiting the reuptake of serotonin with very little effect on dopamine and norepinephrine neurotransmitters. As such, it tends to have fewer side effects than older antidepressants like Anafranil that influence multiple neurotransmitters.
What conditions is Anafranil approved to treat?
Anafranil is approved for the treatment of various mental health conditions:
- Obsessive-compulsive disorder (OCD)
- Panic disorder
- Chronic pain associated with narcolepsy
Lexapro, on the other hand, has been approved for different indications:
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
How does Anafranil help with these illnesses?
Anafranil helps manage obsessive-compulsive disorder (OCD) by increasing the amount of serotonin available in the synapses of the brain. It does this by inhibiting its reuptake into neurons, enabling it to remain active for longer periods. Serotonin is a neurotransmitter that plays essential roles in mood regulation, cognition, memory, sleep patterns and numerous other physiological processes. In individuals with OCD, it's believed there may be an imbalance or deficiency of serotonin. Therefore, by augmenting serotonin levels, Anafranil can help mitigate the symptoms associated with OCD and aid patients in managing their condition more effectively.
What is Lexapro?
Lexapro, the brand name for escitalopram, is a selective serotonin reuptake inhibitor (SSRI). This means it works by increasing levels of serotonin in the brain by reducing its reabsorption. It also has a very mild effect on norepinephrine and dopamine, although this action is not as significant as that seen with drugs like bupropion. Lexapro was first approved by the FDA in 2002. As an SSRI antidepressant, its primary action is on serotonin rather than other neurotransmitters which differentiates it from tricyclic antidepressants like Anafranil. Its focus on serotonin results in a side-effect profile distinct from Anafranil: it's less likely to cause dry mouth, constipation and urinary retention but may lead to sexual dysfunction or weight changes - common side effects associated with SSRIs such as Prozac. The increased serotonergic activity can be beneficial for treating depression and anxiety disorders, particularly in patients who do not respond well to older class of antidepressants like Anafranil.
What conditions is Lexapro approved to treat?
Lexapro is a medication approved by the FDA for:
- Generalized anxiety disorder (GAD), which is chronic excessive worry about a number of different things.
- Major depressive disorder (MDD), characterized by persistent low mood, loss of interest or pleasure in normal activities, disturbed sleep or appetite, as well as feelings of guilt or low self-worth.
How does Lexapro help with these illnesses?
Serotonin is a neurotransmitter that has many roles in the body, it affects mood, appetite, sleep cycle and also plays a part in cognitive functions like memory and learning. Low levels of serotonin have been linked to depression. Lexapro works by increasing the availability of serotonin in the brain which can help alleviate some symptoms of depression. Its action on neuronal reuptake may also play an important part in its effectiveness as an antidepressant. Since it primarily targets serotonin levels, it is often prescribed when a patient doesn't respond well to tricyclic antidepressants (such as Anafranil), or it may be combined with these medications for more effective treatment.
How effective are both Anafranil and Lexapro?
Both clomipramine (Anafranil) and escitalopram (Lexapro) have a well-established track record in treating patients with depression. Clomipramine, approved by the FDA in 1989 and escitalopram in 2002, offer different mechanisms of action. Clomipramine is a tricyclic antidepressant primarily affecting serotonin reuptake while escitalopram, an SSRI, also targets serotonin but without the secondary effects on other neurotransmitters seen with Anafranil.
The efficacy of clomipramine was directly studied against placebo in numerous double-blind clinical trials since its inception; it consistently showed effectiveness at relieving symptoms of depression as well as having predictable side effect profiles. However, due to its broader mechanism of action compared to SSRIs like Lexapro, it can cause more varied side effects such as dry mouth or constipation.
A meta-analysis performed on studies involving escitalopram demonstrated that this drug has been effective from the first week of treatment for many patients experiencing depressive symptoms. Its safety profile has been generally favourable when compared to many other antidepressants and is usually well-tolerated across various populations including elderly individuals. It's worth noting that it's often chosen due to lower incidence rates for certain common side effects associated with older classes of antidepressants such as weight gain or sexual dysfunction.
While both drugs are considered effective treatments for depression, their use may depend largely on individual patient factors such as overall health status and presence of co-existing conditions along with potential interactions with concurrent medications being taken by the patient.
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At what dose is Anafranil typically prescribed?
Oral dosages of Anafranil range from 25-200 mg/day, but studies have shown that a dose of 25 mg/day is usually sufficient for treating obsessive-compulsive disorder (OCD) in most adults. Children and adolescents may be started on an initial dosage of 25 mg/day. In both populations, the dose can be increased after a few weeks if there is no response. The maximum dosage that should not be exceeded in any case is 200 mg/day.
On the other hand, oral doses for Lexapro typically range from 10-20 mg/day with research indicating that even a daily dosage as low as 10mg can effectively treat depression or anxiety disorders in many adults. Teenagers aged between12 to17 years old might start at lower doses around 5mg per day. As always, it's important to remember that this dosage could also increase over time depending on individual responses and toleration levels to medication—though exceeding the highest recommended limit of 20mg per day should generally be avoided.
At what dose is Lexapro typically prescribed?
Lexapro treatment typically begins at a dosage of 10 mg/day. Depending on the patient's response and tolerance, this dose can be increased to 20 mg/day after a minimum of one week. The dose is usually taken as one daily dose in the morning or evening, with or without food. It should be noted that some patients may not see full effects until they have been taking Lexapro for several weeks, so it's important to continue taking the medication even if immediate results are not seen. If no improvement is observed after several weeks of treatment at 20 mg/day, your doctor might consider adjusting your medication regimen.
What are the most common side effects for Anafranil?
Here are some of the common side effects that may be experienced when taking Anafranil and Lexapro:
- Dry mouth
- Nausea, upset stomach or loss of appetite
- Diarrhea or constipation
- Drowsiness, dizziness or fainting spells
- Sweating and hot flashes
- Changes in sexual desire or ability
- Weight changes (loss or gain)
- Unusual bruising/bleeding
- Increased anxiety and restlessness
Insomnia
Tremors
Fatigue
Yawning more often than usual.
Always consult your healthcare provider to ensure you understand all potential side effects before starting any new medication regimen.
Are there any potential serious side effects for Anafranil?
When comparing Anafranil to Lexapro, there are potential serious side effects for both medications. For Anafranil, these may include:
- Increased thoughts of suicide or harmful behavior especially in those under the age of 24
- Signs of allergic reactions such as hives, difficulty breathing, swelling in your face or throat
- Changes in vision including blurred or tunnel vision and eye pain
- Rapid heartbeats, chest fluttering sensation, shortness of breath
- Low sodium levels leading to headache confusion slurred speech severe weakness vomiting loss of coordination feeling unsteady
- Severe nervous system reaction resulting in rigid muscles high fever sweating confusion fast uneven heart rate tremors fainting spells
It's also important to monitor for symptoms indicative of serotonin syndrome like agitation hallucinations fever excessive sweating shivering rapid heartbeat muscle stiffness twitching loss of coordination nausea vomiting and diarrhea.
If you experience any such effects while taking Anafranil it is crucial that you seek immediate medical attention.
What are the most common side effects for Lexapro?
Lexapro, also known as escitalopram, has the potential to cause several side effects. These may include:
- Dry mouth and throat discomfort
- Nausea, upset stomach, constipation or diarrhea
- A decreased appetite that can result in weight changes
- Increased sweating and feelings of anxiety or restlessness
- Sleep disturbances such as insomnia
- Dizziness or fainting sensations
- Muscle tension or joint pain Some individuals might also experience increased urination. Although less common, some people report blurred vision while on Lexapro. It's very important to monitor these symptoms closely and discuss any concerns with your healthcare provider immediately.
Are there any potential serious side effects for Lexapro?
Lexapro, although generally well-tolerated, can cause some serious side effects in rare circumstances. If you notice any of the following symptoms while taking Lexapro, it's important to seek immediate medical attention:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat.
- Hallucinations (seeing or hearing things that aren't real), loss of coordination and fainting - these may be indicative of low levels of sodium in the blood
- Unusual bleeding or bruising
- Palpitations or fast heart rate
- Changes in sexual desire and ability
- Worsening depression or anxiety
- Suicidal thoughts.
Remember to always speak with your healthcare provider before making changes to your medication regimen. It's crucial not to stop using Lexapro abruptly as this could lead to unpleasant withdrawal symptoms.
Contraindications for Anafranil and Lexapro?
Both Anafranil and Lexapro, like other antidepressant medications, may potentially worsen symptoms of depression in some individuals. If you notice your depressive symptoms intensifying or an increase in suicidal ideation or behavior, please seek immediate medical attention.
Neither Anafranil nor Lexapro should be taken if you are currently taking, or have recently stopped taking a monoamine oxidase (MAO) inhibitor. This is due to the potential for serious drug interactions that can occur between these classes of medications. It's critical to inform your healthcare provider about all the medication you're currently on; after stopping an MAOI, it will take approximately 2 weeks before starting Lexapro and at least 5 weeks before starting Anafranil to prevent dangerous interactions.
How much do Anafranil and Lexapro cost?
For brand name versions of these drugs:
- The price of 30 tablets (25 mg each) of Anafranil averages around $100, which works out to about $3.33/day.
- The price for 30 tablets (10 mg each) of Lexapro is approximately $320, equating to roughly $10.67/day.
If you are on a higher dosage range for Anafranil (i.e., up to the maximum recommended dose of 250mg per day), it's important to note that cost will significantly increase depending upon your prescribed dosage. However, even at its highest dosage levels, it remains less expensive than Lexapro on a daily basis.
Please remember that cost should not be the primary factor in determining which drug is right for you; always prioritize effectiveness and safety first.
Regarding generic versions:
- Clomipramine HCl (generic version of Anafranil) costs between $0.90 and $2 per tablet depending upon strength and quantity purchased, with potential daily costs ranging from $0.90 to multiple dollars if taking higher doses.
- Escitalopram Oxalate (generic version of Lexapro) ranges in cost from $.40 - $.80 per tablet based on strength and amount bought upfront leading to an approximate daily running cost starting as low as $.40 but not exceeding about $.80/day assuming standard dosages.
Popularity of Anafranil and Lexapro
Clomipramine, commonly known by the brand name Anafranil, is a tricyclic antidepressant (TCA) that was estimated to have been prescribed to about 300,000 people in the US in 2020. Clomipramine accounted for around 1% of TCA prescriptions in the US. It holds a unique place within its class due to its potent effects on serotonin reuptake and relative selectivity compared to other TCAs. Despite being an older medication with potentially more side effects than selective serotonin reuptake inhibitors (SSRIs), clomipramine continues to be used because of its effectiveness, particularly for obsessive-compulsive disorder.
Escitalopram, also sold under the brand name Lexapro, however, was prescribed much more frequently - it reached nearly 27 million people across America in 2020 alone. In terms of SSRI prescriptions overall within the country during this period, escitalopram made up just over 20%. As one of the most commonly-prescribed SSRIs since its release onto market back in early-2002s; popularity has stayed relatively consistent throughout last decade or so due largely part because it carries fewer potential drug interactions than some other options available today.
Conclusion
Both Anafranil (clomipramine) and Lexapro (escitalopram) have long-standing records of usage in patients with depression, anxiety disorders, and are backed by numerous clinical studies indicating that they are more effective than placebo treatments. While both medications can be used together under careful doctor supervision, there is a risk of serotonin syndrome due to their similar mechanisms of action.
Anafranil acts primarily on the reuptake inhibition of serotonin and norepinephrine while Lexapro selectively inhibits serotonin reuptake. Owing to their different profiles, Anafranil might be prescribed for obsessive-compulsive disorder or panic disorder, whereas Lexapro is often utilized as a first-line treatment option for generalized anxiety disorder and major depressive disorder.
Both drugs are available in generic form which represents significant cost savings especially for patients who must pay out-of-pocket. Both Anafranil and Lexapro may require an adjustment period meaning that effects may not be noticeable right away.
The side effect profile differs between the two drugs; while both being generally well-tolerated, Anafranil carries potential side-effects including dry mouth, constipation, weight gain or sexual dysfunction unlike Lexapro which has fewer reports of such effects. For both drugs however patients must closely monitor their moods especially when starting treatment and should seek medical help immediately if they notice worsening depression or begin having suicidal thoughts.
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Refrences
- Aronson, S., & Delgado, P. (2004). Escitalopram. Drugs of Today. Portico.http://doi.org/10.1358/dot.2004.40.2.799424
- Waxman, D. (1975, November). An Investigation into the Use of Anafranil in Phobic and Obsessional Disorders. Scottish Medical Journal. SAGE Publications.http://doi.org/10.1177/00369330750200s113
- Patel, O. P., & Simon, M. R. (2006). Oculogyric Dystonic Reaction to Escitalopram with Features of Anaphylaxis Including Response to Epinephrine. International Archives of Allergy and Immunology. S. Karger AG.http://doi.org/10.1159/000091840
- Schloss, P., & Williams, D. C. (1998, March). The serotonin transporter: a primary target for antidepressant drugs. Journal of Psychopharmacology. SAGE Publications.http://doi.org/10.1177/026988119801200201
- Anagha, K., Shihabudheen, P., & Uvais, N. A. (2021, July 29). Side Effect Profiles of Selective Serotonin Reuptake Inhibitors. The Primary Care Companion For CNS Disorders. Physicians Postgraduate Press, Inc.http://doi.org/10.4088/pcc.20m02747