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Paxil vs Celexa
Introduction
For patients grappling with major depressive disorder (MDD) or other types of depression, certain drugs function to modify the concentrations of neurotransmitters in the brain. These are compounds that play a crucial role in mood regulation and can aid in stabilizing depressive lows and managing symptoms. Paxil and Celexa are two such prescribed medications for treating depression. Both have different impacts on neurotransmitters within the brain but share a common effect - mood stabilization for patients dealing with depression.
Paxil falls under selective serotonin reuptake inhibitors (SSRIs), affecting serotonin levels within the brain's network. On the flip side, Celexa is also an SSRI, designed to incrementally enhance serotonin levels by limiting its reabsorption into neurons, thus improving mood disorders. Despite their similar categories as SSRIs, these medicines differ in terms of specific usage cases, potential side effects, and patient response rates.
Paxil vs Celexa Side By Side
| Attribute | Paxil | Celexa |
|---|---|---|
| Brand Name | Paxil | Celexa |
| Contraindications | Should not be taken with or have been taking monoamine oxidase inhibitors (MAOIs). | Should not be taken with or have been taking monoamine oxidase inhibitors (MAOIs). |
| Cost | For brand name, around $125 for 30 tablets of Paxil CR (25 mg). Generic version costs between $0.25 and $1 per day depending on dosage. | For brand name, about $300 for 30 capsules of Celexa (20 mg). Generic version often under a dollar even at maximum safe dosage levels. |
| Generic Name | Paroxetine | Citalopram |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, especially in individuals under the age of 24 during the first few months of treatment. | Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat. |
| Severe Drug Interactions | Dangerous interactions with MAOIs. | Dangerous interactions with MAOIs. |
| Typical Dose | Oral dosages range from 20-50 mg/day, starting dose usually 20mg/day for adults. | Begins at a dosage of 20 mg/day, may gradually be increased to a maximum of 40 mg/day. |
What is Paxil?
Paroxetine (the generic name for Paxil) and Citalopram (the generic name for Celexa) belong to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). These were a significant improvement over the first generation of antidepressant drugs. Paroxetine was first approved by the FDA in 1992, primarily prescribed for various forms of depression, anxiety disorders and obsessive compulsive disorder. Similar to Prozac, Paxil works by increasing levels of free serotonin in the brain but has a slightly more sedating effect compared to other SSRIs due to its anticholinergic properties.
Citalopram on the other hand received FDA approval in 1998. Like Paxil, it also increases free serotonin levels but is generally considered less sedating and has fewer side effects related to weight gain or sexual dysfunction than paroxetine. However, both these medications can have withdrawal symptoms if abruptly discontinued so should be tapered off under physician's guidance.
What conditions is Paxil approved to treat?
Paxil is approved for the treatment of several mental health conditions:
- Major depressive disorder (MDD)
- Panic disorder, with or without agoraphobia
- Social anxiety disorder
- Generalized anxiety disorder (GAD)
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
On the other hand, Celexa is approved to treat:
- Major depressive disorder (MDD)
How does Paxil help with these illnesses?
Paxil works to manage depression by increasing the amount of serotonin available in the synapses of the brain. It achieves this by inhibiting its reuptake, which means it prevents serotonin from being reabsorbed by neurons, thus allowing higher levels to persist for longer durations. Serotonin is a neurotransmitter that serves as a chemical messenger in the brain and throughout our body, playing an essential role in mood regulation, cognition, memory formation and retention, sleep patterns, appetite control and regulating body temperature among other functions. It is generally believed that individuals with depression have relatively lower levels of serotonin. By elevating serotonin levels through Paxil's mechanism of action on serotonergic pathways in the brain, depressive symptoms can be managed more effectively helping patients stabilize their mood.
What is Celexa?
Celexa, also known by its generic name citalopram, is a selective serotonin reuptake inhibitor (SSRI). This means it primarily increases the levels of serotonin in the brain by reducing its reabsorption. Celexa was first approved by the FDA in 1998 and has been widely used for treating depression since then. Unlike bupropion, which does not inhibit the reuptake of serotonin, Celexa specifically targets this neurotransmitter to alleviate symptoms of depression. The side-effect profile of Celexa differs from that of other SSRIs such as Paxil; it less frequently causes weight gain and sexual dysfunction which are common with other SSRI drugs like Paxil. Although this makes Celexa a more tolerable choice for many patients, its effects on serotonin make it an effective treatment option for those who do not respond well to alternative antidepressants like Paxil.
What conditions is Celexa approved to treat?
Celexa is approved by the FDA for the management of:
- Major depressive disorder (MDD)
- Panic disorder with or without agoraphobia.
It's important to note that while Celexa might be a preferable choice in managing these conditions, they should always be diagnosed and treated under professional medical supervision.
How does Celexa help with these illnesses?
Serotonin, a neurotransmitter, plays vital roles in maintaining mood balance and regulating body functions such as sleep cycle and digestion. Low levels of serotonin have been associated with depression. Celexa works by increasing the amount of available serotonin in the brain, thus helping to alleviate some symptoms of depression. Its effects on other neurotransmitters may also contribute to its function as an antidepressant. As it primarily affects serotonin levels, it is often prescribed when a patient doesn't respond well to other SSRI antidepressants (like Paxil), or can be combined with them for more effective treatment results.
How effective are both Paxil and Celexa?
Both paroxetine (Paxil) and citalopram (Celexa) are selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that inhibit the reabsorption of serotonin in the brain, thus elevating mood. These two drugs were approved by FDA only 3 years apart and have established histories in treating depression.
A direct comparison between Paxil and Celexa was conducted through a double-blind clinical trial in 2000; both drugs exhibited similar efficacy in managing symptoms of depression with comparable safety profiles. None of the different metrics studied to measure efficacy in treating depression differed significantly between patients receiving Paxil or those taking Celexa.
A meta-analysis report on paroxetine published in 2002 suggested its effectiveness at alleviating symptoms of depression from the first week, favorable side effect profile over many other antidepressants, good tolerance even among elderly populations, and optimal dosage typically at about 20-40 mg/day. Paroxetine has also been found beneficial for obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, generalized anxiety disorder and post-traumatic stress disorder.
Citalopram's effectiveness beyond placebo was indicated by a review and meta-analysis published in 2017. It is often considered as one of the first-line treatment options for major depressive disorders due to its tolerability profile which surpasses other older generation antidepressants. While equally effective as most common SSRIs such as paroxetine, it carries fewer risks associated with drug interactions making it an attractive choice especially for patients who are prescribed multiple medications.
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At what dose is Paxil typically prescribed?
Oral dosages of Paxil range from 20-50 mg/day, with studies showing that a starting dose of 20mg/day is usually effective for treating major depressive disorder in most adults. Children and adolescents, however, should be started on a lower dose of around 10 mg/day. If there's no response after a few weeks, the dosage can be increased under medical supervision. On the other hand, Celexa has a wider range of dosages from 20-40 mg per day for adults depending on their needs and responses to treatment. For children and adolescents aged 12-17 years old, it's recommended that they start with an initial dose of 10mg/day which can then be gradually increased by the doctor overseeing them. Regardless of whether one is taking Paxil or Celexa, exceeding maximum doses (60mg/day for Paxil; 40mg/ day for Celexa) should never happen without professional guidance due to potential health risks.
At what dose is Celexa typically prescribed?
Celexa treatment typically begins at a dosage of 20 mg/day. If necessary, the dose may gradually be increased to a maximum of 40 mg/day, divided into two doses taken in the morning and evening. It's crucial not to exceed this limit due to the potential risk for abnormal heart rhythms. The full effects of Celexa are often seen after about four weeks; if there is no significant improvement in symptoms by then, your doctor may consider adjusting your medication regimen or switching you to another type of antidepressant.
What are the most common side effects for Paxil?
Common side effects of Paxil and Celexa may include:
- Anxiety or nervousness
- Insomnia or trouble sleeping
- Somnolence, feeling drowsy or tired
- General weakness (Asthenia)
- Tremors, unintentional shaking movement
- Nausea and vomiting
- Changes in appetite, which might lead to weight changes
- Dry mouth
- Sweating excessively
- Diarrhea or constipation
-Dyspepsia (burning sensation, discomfort or pain in the upper abdomen)
-Decreased libido (sex drive), delayed ejaculation and impotence.
It's important to note that not everyone will experience these side effects but if they persist it is essential to consult with your healthcare provider.
Are there any potential serious side effects for Paxil?
When comparing Paxil to Celexa, there are some potential side effects to consider. In rare cases, both medications can cause:
- Increased thoughts about suicide or self-harm, especially in individuals under the age of 24 during the first few months of treatment
- Signs of an allergic reaction such as hives; difficult breathing; swelling in your face or throat; fever with a severe blistering and peeling red skin rash
- Visual disturbances like blurred vision, tunnel vision, eye pain or swelling, seeing halos around lights
- Cardiovascular issues - fast or pounding heartbeats, palpitations (feeling fluttering in your chest), shortness of breath and sudden dizziness
- Low sodium levels which could lead to headache, confusion, slurred speech, severe weakness,vomiting loss of coordination,and an unsteady feeling
- Severe nervous system reactions that include stiff muscles high fever sweating confusion uneven heartbeat tremors fainting.
Both Paxil and Celexa may also cause serotonin syndrome — though very rarely — symptoms include agitation hallucinations fever sweating shivering rapid heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea. If you experience any these symptoms while taking either medication seek immediate medical attention.
What are the most common side effects for Celexa?
Celexa, also known as citalopram, can have a range of side effects which may include:
- Dry mouth or excessive salivation
- A feeling of nausea, possibly accompanied by vomiting
- Stomach pain and loss of appetite
- Sleep issues such as insomnia
- Sweating excessively or experiencing tremors
- Feeling anxious or nervous without apparent reason
- Rapid heartbeat that you might perceive as palpitations
- Confusion, agitation, irritability
- Skin rashes in some rare cases
- Potential for slight weight changes (either weight loss or gain) -Increased urination frequency -Symptoms like headache and dizziness.
In very few cases muscle or joint pain could be experienced. It is important to note that not all individuals will experience these side effects and they are generally manageable with dose adjustment under your doctor's supervision.
Are there any potential serious side effects for Celexa?
While Celexa is generally well-tolerated, it can have side effects in rare cases, which may require immediate medical attention. Watch out for:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Changes in mood or behavior with symptoms like anxiety, panic attacks, trouble sleeping or if you feel impulsive and irritable
- Persistent headaches accompanied by chest pain and severe dizziness leading to fainting could be a sign of high levels of serotonin in the body
- Unusual bleeding
- High fever with hallucinations (seeing things), loss of coordination followed by nausea and vomiting indicating low sodium levels in blood.
If any such adverse reactions are observed while taking Celexa, stop its use immediately and seek professional help without delay.
Contraindications for Paxil and Celexa?
Both Paxil and Celexa, along with most other selective serotonin reuptake inhibitors (SSRIs), may worsen symptoms of depression in some people. If you notice your depression worsening, or an increase in suicidal thoughts or behavior, please seek immediate medical attention.
Neither Paxil nor Celexa should be taken if you are taking, or have been taking monoamine oxidase inhibitors (MAOIs). Always inform your physician about any medications you are currently using; MAOIs will require a period of approximately two weeks to clear from the system after discontinuation to prevent dangerous interactions with Paxil and Celexa.
How much do Paxil and Celexa cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Paxil CR (25 mg) averages around $125, which works out to approximately $4.16/day depending on your dose.
- The price for 30 capsules of Celexa (20 mg) is about $300, working out to roughly $10 per day.
Thus, if you are in the higher dosage range for Paxil (i.e., 50 mg/day or higher), then brand-name Celexa could be less expensive on a per-day treatment basis. However, cost should not be a primary consideration in determining which of these drugs is right for you.
As with most medications, costs can significantly decrease when considering generic versions:
- Paroxetine (the generic version of Paxil) comes in packs from 5 up to several hundred pills and dosages ranging from 10mg up to 40mg daily. Costs can vary widely but generally run between $0.25 and $1 per day depending on dosage.
- Citalopram Hydrobromide (generic form of Celexa), available similarly in various pack sizes and dosages between 10mg and maxing at an FDA-recommended limit of no more than 40mg daily due its cardiac risk at high doses; prices typically fall within a similar range as paroxetine but do tend toward slightly lower costs overall - often under a dollar even at maximum safe dosage levels.
Popularity of Paxil and Celexa
Paroxetine, also known under the brand name Paxil, was estimated to have been prescribed to approximately 3.2 million people in the US in 2020. Paroxetine accounted for nearly 7% of all SSRI antidepressant prescriptions in the country that year. Despite being one of the older SSRIs, paroxetine remains a commonly chosen option due to its efficacy and broad range of approved indications such as generalized anxiety disorder and panic disorder.
Citalopram, branded as Celexa among others, has seen an increase in use over recent years due largely to its favorable side effect profile compared with other antidepressants. In 2020 alone, citalopram was prescribed to around 8 million Americans which made it accountable for about 17% of overall SSRI prescriptions and just under 9% of total antidepressant prescriptions within the United States during that period. Citalopram's prevalence has generally seen an upward trend since its introduction into pharmaceutical markets.
Conclusion
Both Paxil (paroxetine) and Celexa (citalopram) have established records of usage in patients with depression, and are backed by numerous clinical studies that reveal they are more effective than placebo treatments. In some cases, the drugs may be combined for a synergistic effect but this is subject to careful consideration by a physician as there can be interactions between the two. Due to their similar mechanisms of action, both being selective serotonin reuptake inhibitors (SSRIs), they tend to be prescribed under comparable circumstances.
Paxil has an additional FDA approval for social anxiety disorder while Celexa has one for panic disorder. Both medications are available in generic form which represents significant cost savings especially for patients who must pay out of pocket.
Both Paxil and Celexa might require an adjustment period—meaning that therapeutic effects might not appear immediately—it could take several weeks before full benefits take place. The side effect profile is quite similar between the two drugs; however, Paxil is associated with somewhat higher rates of sexual dysfunction compared to other SSRIs like Celexa. For both drugs, patients must closely monitor their moods especially when starting treatment or changing doses, and should seek medical help immediately if there's worsening depression or emergent suicidal thoughts.
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Refrences
- Mullins, C. D., Shaya, F. T., Meng, F., Wang, J., & Harrison, D. (2005, May). Persistence, Switching, and Discontinuation Rates Among Patients Receiving Sertraline, Paroxetine, and Citalopram. Pharmacotherapy. Wiley.http://doi.org/10.1592/phco.25.5.660.63590
- Wagstaff, A. J., Cheer, S. M., Matheson, A. J., Ormrod, D., & Goa, K. L. (2002). Spotlight on Paroxetine in Psychiatric Disorders in Adults*. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00023210-200216060-00006
- Parker, N. G., & Brown, C. S. (2000, June). Citalopram in the Treatment of Depression. Annals of Pharmacotherapy. SAGE Publications.http://doi.org/10.1345/aph.19137
- Sghendo, L., & Mifsud, J. (2011, November 18). Understanding the molecular pharmacology of the serotonergic system: using fluoxetine as a model. Journal of Pharmacy and Pharmacology. Oxford University Press (OUP).http://doi.org/10.1111/j.2042-7158.2011.01384.x
- Lader, M., Melhuish, A., Frcka, G., Fredricson Over�, K., & Christensen, V. (1986). The effects of citalopram in single and repeated doses and with alcohol on physiological and psychological measures in healthy subjects. European Journal of Clinical Pharmacology. Springer Science and Business Media LLC.http://doi.org/10.1007/bf00606656