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Cymbalta vs Celexa
Introduction
Cymbalta and Celexa are two drugs frequently prescribed for patients suffering from major depressive disorder (MDD) or other forms of depression. They both work by altering levels of certain neurotransmitters in the brain, substances that help regulate mood. Cymbalta, also known as duloxetine, is classified as a selective serotonin and norepinephrine reuptake inhibitor (SNRI). This means it primarily impacts levels of serotonin and norepinephrine in the brain to moderate mood swings effectively. On the other hand, Celexa or citalopram falls under the category of selective serotonin reuptake inhibitors (SSRIs), affecting only levels of serotonin which makes it more suitable for people with anxiety-related disorders alongside depression due to its calming effect on the central nervous system.
Cymbalta vs Celexa Side By Side
| Attribute | Cymbalta | Celexa |
|---|---|---|
| Brand Name | Cymbalta | Celexa |
| Contraindications | Should not be taken with, or within 14 days of stopping, MAO inhibitors. Increased risk of suicidal thoughts in individuals under 25. | Should not be taken with, or within 14 days of stopping, MAO inhibitors. Increased risk of suicidal thoughts in individuals under 25. |
| Cost | For the brand name, around $250 for 30 tablets of 60 mg. For generic duloxetine, approximately $1 - $3 per day depending on dosage and purchase location. | For the brand name, approximately $130 for 30 tablets of 20 mg. For generic citalopram, roughly $.10 - $0.80 per day depending on dosage and purchase location. |
| Generic Name | Duloxetine | Citalopram |
| Most Serious Side Effect | Increased thoughts of suicide or self-harm, severe skin reactions, vision changes, cardiovascular symptoms, low sodium levels, severe nervous system reaction. | Signs of an allergic reaction, serotonin syndrome, unusual bleeding or bruising, changes in sex drive and function, severe nausea vomiting or diarrhea, fast pounding irregular heartbeat. |
| Severe Drug Interactions | MAO inhibitors due to the risk of serious side effects including serotonin syndrome. | MAO inhibitors due to the risk of serious side effects including serotonin syndrome. |
| Typical Dose | 20–60 mg/day, with a maximum dosage of 120 mg/day. | Starts at 20 mg/day, can be increased to 40 mg/day. Maximum recommended dose is 40 mg per day for adults, 20 mg per day for elderly. |
What is Cymbalta?
Duloxetine (the generic name for Cymbalta) is a part of the serotonin and norepinephrine reuptake inhibitors (SNRIs) class of antidepressants, which was an important advancement over earlier types of antidepressant drugs. Duloxetine was first approved by the FDA in 2004. Cymbalta works by increasing levels of free serotonin and norepinephrine in the brain by preventing their reabsorption, thereby maintaining them in the brain for longer than usual. It is prescribed to treat several conditions such as major depressive disorder, anxiety disorders, fibromyalgia and neuropathic pain.
On the other hand, citalopram (Celexa's generic name), belongs to a class known as selective serotonin reuptake inhibitors (SSRIs). Celexa primarily affects serotonin with minor influence on dopamine and norepinephrine resulting in fewer side effects compared to other antidepressants that have stronger effects on these two neurotransmitters. However, unlike Cymbalta it doesn't help with nerve pain or fibromyalgia but it has been proven effective in treating depression.
What conditions is Cymbalta approved to treat?
Cymbalta is approved for the treatment of several different health conditions, including:
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Diabetic peripheral neuropathic pain
- Fibromyalgia
- Chronic musculoskeletal pain
How does Cymbalta help with these illnesses?
Cymbalta, like Celexa, is used to manage depression by increasing the amount of certain neurotransmitters available in the brain. Cymbalta works by inhibiting both serotonin and norepinephrine reuptake in the brain's neurons. By blocking their reabsorption into pre-synaptic neurons, it allows these mood-regulating chemicals to linger longer within the synaptic gap and be absorbed by post-synaptic receptors. Both serotonin and norepinephrine play key roles in modulating an individual's mood, cognitive function, sleep patterns, appetite and more. Depression is often associated with lower levels of these neurotransmitters; thus, by elevating their presence in synapses of the brain through inhibition of reuptake mechanism, Cymbalta can help mitigate depressive symptoms and stabilize patients' moods.
What is Celexa?
Celexa, the brand name for citalopram, is a selective serotonin reuptake inhibitor (SSRI) that increases levels of serotonin in the brain by reducing its reabsorption. It's used primarily to treat depression but can also be employed for anxiety disorders. Celexa was first approved by the FDA in 1998 and has since become one of the most commonly prescribed SSRIs.
As an SSRI, its mechanism differs from drugs like Cymbalta, which is both a serotonin and norepinephrine reuptake inhibitor (SNRI). This means that while Cymbalta affects both serotonin and norepinephrine levels in the brain, Celexa acts solely on serotonin. Since it does not influence norepinephrine or dopamine as SNRIs do, Celexa may have fewer side effects related to these neurotransmitters such as high blood pressure or heart rate disturbances.
However, common side effects of SSRIs like Celexa include nausea, dry mouth and sexual dysfunction. Yet despite this side effect profile being similar to other SSRIs', many patients respond well to Celexa when they haven't found success with 'typical' SSRI antidepressants.
What conditions is Celexa approved to treat?
Celexa, also known as citalopram, is a medication approved by the FDA for treating several conditions including:
- Major depressive disorder (MDD)
- Panic disorder with or without agoraphobia
It's an SSRI that increases serotonin levels in the brain, helping to improve mood and increase feelings of well-being.
How does Celexa help with these illnesses?
Serotonin is a neurotransmitter that plays an essential role in regulating mood, sleep, appetite and other body functions. Like norepinephrine, low levels of serotonin have been associated with depression. Celexa works by increasing the levels of serotonin available in the brain which can help to alleviate some symptoms of depression. It does this by blocking the reuptake of serotonin into neurons after it has transmitted its neural impulse, thus allowing more to remain in synapses and increase stimulation on postsynaptic neurons. This action predominantly focuses on serotonin without significantly affecting norepinephrine or dopamine like Cymbalta does, making it a selective serotonin reuptake inhibitor (SSRI). For this reason, Celexa is often prescribed when patients are experiencing significant depressive symptoms but not responding well to other classes of antidepressants such as SNRIs like Cymbalta.
How effective are both Cymbalta and Celexa?
Both duloxetine (Cymbalta) and citalopram (Celexa) have proven to be effective in treating depression, with Cymbalta being approved by the FDA in 2004 and Celexa in 1998. Both drugs act on neurotransmitters, but they do so differently - while Celexa is a selective serotonin reuptake inhibitor (SSRI), Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI). This means that it affects both serotonin and norepinephrine levels, which can make it more beneficial for certain types of depression or anxiety disorders.
Several studies have compared the efficacy of these two medications directly. A 2011 study found that patients with major depressive disorder treated with either drug showed significant improvement after six weeks. Side effects were similar between the two groups, suggesting comparable safety profiles.
A review from 2009 noted that SSRIs like Celexa are generally first-line treatments for depression due to their favorable side-effect profile and because they're well-tolerated by most patients. It also pointed out that Celexa has been shown to reduce symptoms of depression within the first week of treatment.
In contrast, SNRIs like Cymbalta are typically used when SSRIs aren't effective or cause intolerable side effects. However, a meta-analysis from 2012 indicated that SNRIs may be somewhat more effective than SSRIs at reducing symptoms of severe depression. Furthermore, since Cymbalta impacts both serotonin and norepinephrine levels, it might also help improve chronic pain – an advantage not shared by all antidepressants.
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At what dose is Cymbalta typically prescribed?
Oral dosages of Cymbalta range from 20–60 mg/day, but studies indicate that 40-60mg/day is often necessary for treating major depressive disorder in most adults. Children and adolescents may be started on lower doses, typically around 30 mg/day. For either population, dosage can be increased after a few weeks if there is no response. The maximum dosage that should not be exceeded in any case is 120 mg/day.
In comparison, Celexa (citalopram) oral dosages typically start at 20 mg per day for adults with depression or anxiety, while elderly patients and those with liver problems might initially take a dose as low as 10mg per day. This dose can increase over time up to a maximum daily total of 40mg for adults and younger people under the age of sixty-five years old; however the recommended maximum dose for elderly patients (over sixty-five) or individuals suffering from liver problems is normally capped at no more than twenty milligrams per day due to an increased risk of associated side effects.
At what dose is Celexa typically prescribed?
Celexa treatment usually begins at a dosage of 20 mg/day and can be taken either in the morning or evening with or without food. After about one week, the dose may be increased to 40 mg/day, based on individual patient response and tolerance. The maximum recommended dose is 40 mg per day for adults while elderly patients (over age 60) should generally not take more than 20 mg per day due to slowing metabolism that occurs naturally with aging. It's important to note that antidepressants like Celexa often take several weeks before their full therapeutic effects are felt, so if there is no immediate response don't get discouraged - give it time and always consult your healthcare provider before changing your dosage.
What are the most common side effects for Cymbalta?
Common side effects that you may experience when taking Cymbalta include:
- Nausea
- Dry mouth
- Constipation
- Loss of appetite, weight loss
- Tiredness or drowsiness, insomnia
- Increased sweating
- Dizziness or lightheadedness
- Blurred vision
On the other hand, those who take Celexa may encounter:
- Nausea and upset stomach
- Diarrhea
- Dry mouth
- Loss of appetite
- Sweating excessively
- Tremors
- Sleep problems (either drowsiness or insomnia)
- Weight changes
In general, both drugs have their own set of side effects. It is crucial to consult with your healthcare provider to discuss which one would be more suitable for you based on your medical history and current health status.
Are there any potential serious side effects for Cymbalta?
When comparing Cymbalta to Celexa, it is important to note that both drugs can cause serious side effects in rare cases. These include:
- Increased thoughts of suicide or self-harm, especially in individuals under the age of 25
- Signs of an allergic reaction such as hives, difficulty breathing, swelling in your face or throat
- Severe skin reactions which may include a fever or sore throat; burning eyes; skin pain followed by a red or purple skin rash with blistering and peeling
- Vision changes such as blurred vision, tunnel vision, eye pain or swelling, seeing halos around lights
- Cardiovascular symptoms like fast or pounding heartbeats (palpitations), chest fluttering sensation (arrhythmia), shortness of breath and sudden dizziness
- Low sodium levels - symptoms might include headache confusion slurred speech severe weakness vomiting loss of coordination feeling unsteady
- Severe nervous system reaction including very stiff muscles high fever sweating confusion fast uneven pulse tremors feeling faint.
In addition to these common side effects for both medications any serotonin syndrome signs should also be reported immediately. Examples are agitation hallucinations fever sweating shivering quickened heartbeat muscle stiffness twitching lack coordination nausea vomiting diarrhea.
If you experience any potential life-threatening side-effects while taking either medication discontinue its use immediately and seek out immediate medical attention.
What are the most common side effects for Celexa?
The side effects of Celexa can include:
- Nausea, stomach pain, upset stomach
- Excessive tiredness and drowsiness
- Sleep problems such as insomnia
- Dry mouth or excessive sweating
- Nervousness or anxiety
- Frequent urination
- Weight changes, primarily weight loss.
More severe but less common side effects may also occur with Celexa use. These can include confusion, agitation, rapid heartbeat and noticeable tremors. It's important to report any new or worsening symptoms to your healthcare provider while on this medication. Blurred vision is not typically associated with Celexa but should be reported if experienced. Similarly unusual are rashes or joint/muscle pains – these too warrant immediate medical attention if they arise during treatment with Celexa.
Are there any potential serious side effects for Celexa?
While Celexa is generally well-tolerated, it can sometimes lead to severe side effects. If you experience any of the following symptoms while using Celexa, seek immediate medical attention:
- Signs of an allergic reaction such as difficulty breathing; swelling of your face, lips, tongue, or throat.
- Serotonin syndrome: agitation, hallucinations (hearing or seeing things that are not real), confusion, rapid heart rate, dizziness or fainting spells.
- Unusual bleeding or bruising
- Changes in sex drive and function
- Severe nausea vomiting or diarrhea
- Fast pounding irregular heartbeat
- Extreme thirst with headache nausea vomiting and weakness
You should also watch for signs of mental health changes such as worsening depression and suicidal thoughts especially during the first few weeks of therapy and when your dose is adjusted up or down. Always consult a healthcare professional if you notice anything unusual while taking this medication.
Contraindications for Cymbalta and Celexa?
Both Cymbalta and Celexa, along with most other antidepressant medications, may exacerbate symptoms of depression in certain individuals. If you notice your depression intensifying or if there's an increase in suicidal thoughts or behavior while on these drugs, please seek immediate medical help.
Neither Cymbalta nor Celexa should be taken if you are currently taking, or have recently stopped taking monoamine oxidase (MAO) inhibitors. It is crucial to inform your doctor about all the medicines that you're using; MAOIs require a period of at least 14 days to clear from your system before starting either Cymbalta or Celexa to avoid potentially dangerous interactions.
How much do Cymbalta and Celexa cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Cymbalta (60 mg) averages around $250, which works out to about $8.33 per day.
- The price of 30 tablets of Celexa (20 mg) is approximately $130, working out to about $4.33 per day.
Thus, if you are in a higher dosage range for Cymbalta (i.e., 120 mg/day), then brand-name Celexa would be less expensive on a per-day treatment basis. Remember that cost should not be your primary consideration when deciding between these two drugs; it's more important to consider their effectiveness and side effects for your specific situation.
For the generic versions citalopram (Celexa) and duloxetine (Cymbalta):
-
Duloxetine is available in packs from 7 up to 90 capsules with dosages ranging from 20mg up to 60mg. For typical doses of duloxetine such as the common one being at around 60mg/day this could cost anywhere from roughly $1 - $3 depending on where you purchase.
-
On the other hand, citalopram can be found in quantities ranging from just a handful all way up towards several hundred pills packaged together; they too come varying strengths like those seen above but most commonly used version holds only twenty milligrams per capsule - so if we're considering an average daily dose amounting somewhere near its maximum limit set by FDA guidelines then overall expenses might run close enough within same ballpark figure: approximately $.10 -$0.80 regardless whether purchased individually or as part larger bulk order deal offered some pharmacies nationwide.
Popularity of Cymbalta and Celexa
Duloxetine, in its generic form as well as under brand names such as Cymbalta, was estimated to have been prescribed to about 10.3 million people in the US in 2020. Duloxetine accounted for just over 21% of prescriptions for serotonin-norepinephrine reuptake inhibitors (SNRIs) and around 15% of overall antidepressant prescriptions during this period. This drug has consistently grown in usage since it was first approved.
Citalopram, including brands such as Celexa, was prescribed to approximately 17 million people in the USA during the same year. In the US market, citalopram accounts for slightly more than a third of all selective serotonin reuptake inhibitor (SSRI) prescriptions and roughly a quarter of total antidepressant prescriptions. The use of citalopram has generally remained steady over the past decade.
Conclusion
Cymbalta (duloxetine) and Celexa (citalopram) are both proven effective treatments for depression, backed by numerous clinical studies demonstrating their efficacy over placebo. There may be situations where these drugs could be used together under careful physician supervision, despite some contraindications due to their different mechanisms of action. Cymbalta acts on both serotonin and norepinephrine while Celexa primarily targets the serotonin neurotransmitter system.
Celexa is often considered as a first-line treatment option in depression due to its favorable side effect profile and less potential for drug interactions. In contrast, Cymbalta might typically be considered as an addition to Celexa or in patients who did not respond well to SSRIs like Celexa or have co-existing conditions such as neuropathic pain or generalized anxiety disorder that would benefit from dual reuptake inhibition.
Both medications are available in generic form which can offer substantial cost savings particularly for those paying out-of-pocket. An adjustment period may be necessary with either medication before effects become noticeable.
While both drugs share common side effects associated with SSRI/SNRIs such as nausea, dry mouth, and sleep disturbances; sexual dysfunction is more commonly seen with citalopram than duloxetine. It's crucial patients monitor their moods closely when initiating therapy and seek immediate medical help if they notice worsening depression or emergence of suicidal thoughts.
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Refrences
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