Celexa Vs. Zoloft

Introduction

According to the National Institute of Mental Health, almost 21 million American adults, or 8.7% of the US population, suffer from one or more major depressive disorders [¹]. For patients suffering from such major depressive disorder (MDD), certain medicinal drugs can help alter the concentration of chemicals in the brain that influence mood and behavior. These chemicals are called hormones and act as messengers that tell the brain what to do and how to feel. However, malfunctioning the number of chemical messengers sent to the brain can alter a person's mood and cause major depressive disorder.

Celexa and Zoloft are two medical drugs that can help treat such depression by monitoring and managing hormone levels in the brain to balance the mood scale. Both Celexa and Zoloft work similarly, as they both work on the hormone serotonin. However, Celexa and Zoloft may have different efficacy and side effects when treating patients with MDD.

About Celexa and Zoloft

What is Celexa?

Celexa (also known by its generic name, Citalopram) is an antidepressant agent that belongs to the class of selective serotonin-reuptake inhibitors (SSRIs) and is the first choice for treating depression. Celexa first received approval from the FDA in 1998 [²]. Celexa, chemical formula

C20H21FN2O is typically available in tablet form and is effective in improving symptoms of depression within two weeks of starting the dosage. Celexa works by increasing serotonin levels in the brain, the hormone responsible for mood.

What Conditions is Celexa Approved to Treat?

Celexa has received FDA approval for the treatment of several mental health issues, including [³]:

Depression: Celexa is approved by the FDA for treating a major depressive disorder in adults. Symptoms of depression may include feelings of sadness, hopelessness, worthlessness, guilt, and changes in appetite, sleep patterns, and energy levels.
Panic disorder with or without agoraphobia: Celexa is also approved for treating panic disorders, which are characterized by recurrent panic attacks that may include symptoms such as chest pain, shortness of breath, and sweating. In some cases, panic disorder may also be accompanied by agoraphobia, a fear of places or situations where escape may be difficult or embarrassing.
Social anxiety disorder: Celexa is approved for treating social anxiety disorder, a condition characterized by intense fear or anxiety in social situations. People with a social anxiety disorder may experience symptoms such as blushing, sweating, trembling, and difficulty speaking.
Obsessive-compulsive disorder (OCD): Celexa is also approved for the treatment of OCD, which is a condition characterized by intrusive and persistent thoughts, images, or impulses (obsessions) that are often accompanied by repetitive behaviors or mental acts (compulsions).

How Does Celexa Work For Depression?

Depression is thought to be caused by an imbalance of chemicals in the brain, including serotonin [⁴]. Serotonin is a neurotransmitter that regulates mood, sleep, appetite, and other bodily functions. Celexa works by inhibiting serotonin reuptake into the synaptic cleft (out of the brain) by targeting the serotonin transporter, increasing the neurotransmitter's availability in the brain [⁵]. This can help improve mood and reduce symptoms of depression.

Celexa is typically prescribed at a low dose and gradually increases over time as tolerated. It may take several weeks before the full effects of the medication are felt, and it is important to continue taking the medication as prescribed, even if symptoms improve.

What is Zoloft?

Zoloft (also known by its generic name Sertraline) is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs) and is the first-choice medication for the treatment of MDD and other mental conditions linked with depression. Zoloft received FDA approval in 1999 [⁶]. Zoloft, chemical formula C17H17Cl2N, is available in oral tablet and liquid suspension form that is taken once a day. Like Celexa, Zoloft targets the serotonin levels in the brain to regulate mood.

What Conditions are Zoloft Approved to Treat?

Zoloft has received FDA approval for several mental health conditions, including [⁷]:

Major Depressive Disorder (MDD): Zoloft is approved for treating MDD, characterized by persistent feelings of sadness or hopelessness, loss of interest or pleasure in activities, and a range of physical and emotional symptoms. Studies have shown that Zoloft can significantly improve symptoms of depression and improve the quality of life in people with MDD.
Obsessive-Compulsive Disorder (OCD): Zoloft is approved for the treatment of OCD, a condition characterized by persistent, intrusive thoughts or images (obsessions) and repetitive behaviors or mental acts (compulsions). Studies have shown that Zoloft can significantly reduce the frequency and severity of OCD symptoms.
Panic Disorder: Zoloft is approved for the treatment of panic disorder, which is characterized by recurrent panic attacks, along with symptoms such as sweating, trembling, and a racing heart. Studies have shown that Zoloft can significantly reduce the frequency and severity of panic attacks.
Post-Traumatic Stress Disorder (PTSD): Zoloft is approved for treating PTSD, a condition that can develop after experiencing or witnessing a traumatic event. Symptoms of PTSD can include flashbacks, nightmares, avoidance, and hyperarousal. Studies have shown that Zoloft can significantly reduce the frequency and severity of PTSD symptoms.
Social Anxiety Disorder: Zoloft is approved for treating social anxiety disorder, a condition characterized by excessive fear or anxiety in social situations. Symptoms can include sweating, trembling, blushing, and a racing heart. Studies have shown that Zoloft can significantly reduce social anxiety symptoms and improve quality of life.
Premenstrual Dysphoric Disorder (PMDD): Zoloft is approved for treating PMDD, a condition characterized by emotional and physical symptoms that occur in the days leading up to menstruation. Symptoms can include mood swings, irritability, anxiety, and bloating. Studies have shown that Zoloft can significantly reduce PMDD symptoms.

How Does Zoloft Work for Depression?

Depression is thought to be caused by a chemical imbalance in the brain, specifically a deficiency in serotonin. Zoloft works by inhibiting serotonin reuptake, which means more serotonin is available in the brain to help regulate mood and other functions.

Zoloft inhibits (blocks) serotonin reuptake in the presynaptic neuronal membrane. In simple terms, Zoloft prevents serotonin from leaving the Central Nervous System and the brain and keeps it there so it can do its best to elevate mood. The increase in serotonin results in increased serotonergic neurotransmission, which is responsible for anti-depressive effects [⁸]. Moreover, Zoloft prevents the entry of norepinephrine (adrenaline) into the brain, which is responsible for feelings of anxiety and stress [⁹]. Therefore, not only does Zoloft help keep the good hormones in the brain, but it also keeps out the bad ones.

Effectiveness

How Effective are Celexa and Zoloft for Treating Depression?

Celexa and Zoloft are the first-choice medications for treating symptoms of depression, and many health studies have researched the efficacy and safety of Celexa and Zoloft. Both Celexa and Zoloft work by inhibiting the reuptake of serotonin in the brain. In simple words, whenever we relax or feel happy, serotonin is pushed into our brains. Once we are done being happy, serotonin is taken out of the brain. Thus, by preventing the reuptake process, Celexa and Zoloft can effectively alter and improve mood.

A six-week clinical trial found that Celexa effectively treated and improved symptoms of depression when administered in 40 or 60-mg doses [¹⁰]. Another study concluded those patients who received Celexa for around six months had better and steadier moods than those that received a placebo [¹¹].

A review article of 59 clinical studies found that Zoloft not only effectively treats major depression disorder but is favored by patients compared to several other antidepressants [¹²]. Another study found that Zoloft can effectively improve conditions in patients suffering from postpartum depression [¹³].

A double-blind clinical trial involving Celexa and Zoloft was studied over six weeks to evaluate and compare their efficacy in treating depression. The study concluded that both Celexa and Zoloft were effective in treating depression, but Celexa showed signs of improvement in early symptoms, acting quicker than Zoloft [¹⁴].

Dosage Information

How is Celexa Administered for Depression?

Celexa is an oval tablet coated with a film containing Citalopram HBr in 10mg, 20 mg, and 40 mg strengths. Celexa is also available as an oral liquid suspension in 10 mg/5 ml and 20 mg/ 5 ml concentrations.

How is Zoloft Administered for Depression?

Zoloft is administered orally as tablets with 25, 50, and 100 mg concentrations. Zoloft is also available as an oral liquid concentrated in a multidose 60 mL bottle, concentrated at 20 mg /ml, and as 150 mg and 200 mg capsules.

Side Effects

What are the most common side effects of Celexa?

The most common side effects of Celexa include the following:

Nausea and vomiting
Dry mouth
Diarrhea
Constipation
Drowsiness
Dizziness
Headaches
Ejaculation disorder

Are there any potentially serious side effects of Celexa?

If you experience any of the following serious side effects of Celexa, seek medical help immediately:

Agitation or hostility
Panic attacks
Anxiety
Irritability
Insomnia
Suicidal thoughts
Manic behavior

What are the Most Common Side Effects of Zoloft?

The most common side effects of Zoloft include the following:

Nausea and vomiting
Dry mouth
Diarrhea
Constipation
Fainting
Dizziness
Hallucinations
Tremors
Ejaculation disorder
Fatigue

Are there any potentially serious side effects of Zoloft?

If you experience any of the following serious side effects of Zoloft, seek medical help immediately:

Agitation or hostility
Anxiety
Panic attacks
Insomnia
Impulsive behavior
Suicidal thoughts
Manic behavior

Contraindications and Interactions

Contraindications and important interactions for Celexa and Zoloft

Contraindications

Celexa

In patients taking monoamine oxidase inhibitors

Patients with hypersensitivity to Citalopram

Zoloft

In patients taking monoamine oxidase inhibitors

In patients taking pimozide

Patients with hypersensitivity to Sertraline

With disulfiram

Drug/Medication Interactions

Celexa

CNS drugs

Cimetidine

Digoxin

Lithium

Warfarin

Carbamazepine

CYP3A4 and 2C19 Inhibitors

Metoprolol

Imipramine and Tricyclic Antidepressants

Electroconvulsive Therapy

Zoloft

Warfarin

Digitoxin

Cimetidine

CNS active drugs

Drugs metabolized by P450 3A4

Drugs metabolized by P450 2D6

Serotonergic Drugs

Triptans

Sumatriptan

Tricyclic Antidepressants

Hypoglycemic Dr4ugs

Atenolol

Digoxin

NSAIDS

Food/Beverage/Supplement Interactions

Celexa

Alcohol

Thymine-rich food such as cheese and meat extract

St. John’s wort

Caffeine

Zoloft

Alcohol

Grapefruit

St. John’s Wort

Cost Comparison

How much do Celexa and Zoloft Cost?

A 100-tablet quantity of 20 mg Celexa can cost around $1,005 at $10.06 a tablet [¹⁵]. A 30-tablet quantity of 100 mg of Zoloft can cost around $444.6 at $14.8 a tablet [¹⁶]. According to the National Institute of Health Sciences, patients must generally take antidepressants for six months to a year [¹⁷]. That means a patient on a one-year dosage of Celexa or Zoloft will spend around $3650 and $5402, respectively.

The popularity of Celexa and Zoloft

According to data from Statista, the total prescription for Celexa in 2020 was 18.55 million [¹⁸]. Statista also reported that the number of prescriptions for Zoloft in 2020 was 38.22 million [¹⁹]. On Drug.com, Celexa has an average rating of 7.3/10.0, with over 857 ratings [²⁰]. Zoloft has an average rating of 7.2/10.0 on Drug.com with over 1871 ratings [²¹].

Conclusion

Takeaway

Ultimately, the decision between Celexa and Zoloft should be made in consultation with a healthcare provider who can evaluate the individual's needs and prescribe the most appropriate medication. It is important to remember that antidepressants are just one part of a comprehensive treatment plan for depression and anxiety and should be combined with therapy and other self-care strategies for the best outcome.