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Trintellix vs Celexa
Introduction
For patients experiencing major depressive disorder (MDD) or other forms of depression, certain medications can help manage symptoms by altering neurotransmitter levels in the brain. Trintellix and Celexa are two such drugs commonly prescribed for this condition. Both impact serotonin levels but in different ways to aid mood stabilization in individuals with depression. Trintellix, known as a serotonin modulator and stimulator (SMS), works by stimulating specific types of serotonin receptors while blocking others, thereby enhancing the release of additional serotonin into the brain's synapse. On the contrary, Celexa is classified as a selective serotonin reuptake inhibitor (SSRI), which functions primarily by increasing available serotonin concentrations through inhibiting its reabsorption into neurons.
Trintellix vs Celexa Side By Side
| Attribute | Trintellix | Celexa |
|---|---|---|
| Brand Name | Trintellix | Celexa |
| Contraindications | Should not be taken with or within 2 weeks of MAOIs | Should not be taken with or within 2 weeks of MAOIs |
| Cost | Around $450 for 30 tablets of 10 mg | $8-$50 for 30 tablets of 20 mg |
| Generic Name | Vortioxetine | Citalopram |
| Most Serious Side Effect | Thoughts about suicide or self-harm, Serotonin Syndrome | Increased risk of suicidal thoughts, Serotonin Syndrome |
| Severe Drug Interactions | Monoamine oxidase inhibitors (MAOIs) | Monoamine oxidase inhibitors (MAOIs) |
| Typical Dose | 5–20 mg/day | 20 mg/day, up to a maximum of 40 mg/day |
What is Trintellix?
Vortioxetine (the generic name for Trintellix) is a novel antidepressant that belongs to the class of serotonin modulators and stimulators, signifying a significant progression from the first class of SSRI antidepressants. Vortioxetine received FDA approval in 2013. Trintellix works by enhancing levels of free serotonin and also impacts other neurotransmitters like norepinephrine, dopamine, histamine, acetylcholine, and GABA. It is prescribed mainly for major depressive disorder treatments.
Citalopram (marketed as Celexa), on the other hand, strictly falls under SSRIs - it increases levels of free serotonin in the brain by preventing its reabsorption or “trapping” it in the brain longer than usual. The selectivity of Celexa means it primarily influences serotonin with only minor effects on other neurotransmitters resulting in fewer side effects compared to drugs which have stronger effects on these additional neurotransmitters.
What conditions is Trintellix approved to treat?
Trintellix is approved for the treatment of a variety of depressive disorders, such as:
- Major Depressive Disorder (MDD), also known as unipolar depression
- Treatment-resistant depression, when other medications have failed to provide adequate relief
- It can be used off-label for anxiety disorders.
How does Trintellix help with these illnesses?
Trintellix operates by increasing the amount of serotonin available in the synapses of the brain. It does this not only by blocking it from being reabsorbed by neurons, but also stimulating its release. Serotonin is a neurotransmitter that orchestrates various bodily functions such as mood, cognition, memory, sleep patterns, hunger and body temperature among others. There's a prevailing theory that individuals with depression may have relatively lower levels of serotonin in their brains. Therefore, Trintellix can help mitigate depressive symptoms and assist patients in managing their condition and stabilizing their moods through boosting serotonin availability.
On the other hand, Celexa or citalopram is another type of antidepressant known as Selective Serotonin Reuptake Inhibitors (SSRIs). As opposed to Trintellix which stimulates release while preventing reabsorption of serotonin; Celexa works primarily by blocking its reuptake into neurons after it has been released to ensure more prolonged action at synaptic junctions thereby enhancing mood regulation.
What is Celexa?
Celexa, known generically as citalopram, is a selective serotonin reuptake inhibitor (SSRI), which means it increases the levels of serotonin in the brain by reducing its reabsorption. It does not significantly affect levels of other neurotransmitters such as norepinephrine or dopamine. First approved by the FDA in 1998, Celexa has become one of the most commonly prescribed antidepressants due to its efficacy and tolerability.
Unlike Trintellix (vortioxetine), which is thought to work through several mechanisms including serotonin modulation and receptor activity, Celexa primarily works by increasing serotonin availability. This focus on a single neurotransmitter gives Celexa a different side-effect profile from drugs like Trintellix that have multiple actions: while both can cause nausea and sexual dysfunction among other side effects, only Trintellix has been associated with abnormal dreams.
The effects on serotonin alone can be beneficial for treating depression, particularly for patients who do not respond well to multi-action drugs like Trintellix.
What conditions is Celexa approved to treat?
Celexa, also known as Citalopram, is a widely used antidepressant that is approved by the FDA for the treatment of:
- Major depressive disorder (MDD)
- Panic disorder with or without agoraphobia
How does Celexa help with these illnesses?
Serotonin is a neurotransmitter that plays crucial roles in mood regulation, memory processing, and sleep. Similar to norepinephrine, it's also hypothesized that low levels of serotonin may contribute to depression. Celexa works by increasing the levels of serotonin available in the brain, thereby easing some of the symptoms of depression. Its function on other neurotransmitters may also play roles in its action as an antidepressant. Since it primarily affects serotonin levels, it is often prescribed when patients do not respond well to newer generation antidepressants (like Trintellix), or can be combined with them for more comprehensive treatment options.
How effective are both Trintellix and Celexa?
Both vortioxetine (Trintellix) and citalopram (Celexa) have been proven effective in treating patients with depression, though they were approved by the FDA nearly a decade apart. They act on different neurotransmitters, which means they may be prescribed under distinct circumstances. The effectiveness of Trintellix and Celexa for alleviating depressive symptoms was directly studied in several double-blind clinical trials; both medications demonstrated similar efficacy in managing depression symptoms with comparable safety profiles.
A 2014 review of meta-analysis reports on Trintellix indicated that it is effective at relieving depressive symptoms from the very onset of treatment. Its side effect profile is relatively favorable compared to many other antidepressants, showing fewer sexual side effects than SSRIs like Celexa, making it well-tolerated among various populations including elderly individuals.
On the other hand, a 2009 review and meta-analysis suggested that Celexa appears to be more effective than placebo in dealing with depression while being similar or slightly superior to other common antidepressants regarding its effectiveness. Despite this, significant research on its use involves co-prescribing along an SSRI such as fluoxetine or sertraline. Therefore data confirming its efficacy as stand-alone treatment are less abundant than those for Trintellix. Nonetheless due to its unique pharmacology and cost-effectiveness being generic medication now available since patent expiration–citalopram might be considered optimal for patients who did not respond well to initial treatments or need more affordable options.
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At what dose is Trintellix typically prescribed?
Oral dosages of Trintellix range from 5–20 mg/day, with studies indicating that a dose of 10 mg/day can effectively manage major depressive disorder in many individuals. On the other hand, Celexa is typically started at 20 mg per day and can be increased to a maximum daily dosage of 40 mg if there's no response after a few weeks. It's important to note that these are general guidelines and individual needs may vary; always consult your healthcare provider for personalized advice regarding medication dosage and use.
At what dose is Celexa typically prescribed?
Celexa treatment is typically initiated at a dosage of 20 mg/day, taken once daily. Depending on the individual's tolerance and response to the drug, this dose may be increased up to a maximum of 40 mg/day. The increment should not exceed an additional 20 mg/day in any given week. For elderly patients or those with liver impairment, the recommended starting dose is lower: 10 mg per day. It's important to note that full therapeutic effect may not be seen until after a few weeks of treatment; if there are no signs of improvement after several weeks on the maximum dosage, it may be worth discussing alternative treatments with your healthcare provider.
What are the most common side effects for Trintellix?
Common side effects of Trintellix include:
- Nausea
- Diarrhea
- Dry mouth
- Constipation
- Vomiting
- Gas and bloating (dyspepsia)
- Dizziness
- Unusual dreams
In contrast, Celexa's common side effects are quite similar but may also include:
- Excessive sweating (hyperhidrosis)
- Insomnia or other sleep disturbances,
- Fatigue and somnolence (sleepiness/drowsiness),
- Decreased libido (sex drive), abnormal ejaculation, impotence in men,
- Tremor (unintentional trembling or shaking),
- Anxiety, nervousness.
Both medications can cause weight changes as well. Always consult with your healthcare provider for any symptoms you experience while on medication.
Are there any potential serious side effects for Trintellix?
Similar to other antidepressants, Trintellix and Celexa have the potential for severe side effects in some patients. These can include:
- Thoughts about suicide or self-harm: Especially among young adults and teenagers
- Allergic reactions: Signs of this can be hives, difficulty breathing, swelling in your face or throat
- Vision changes: This might include blurred vision, tunnel vision, eye pain or swelling
- Heart-related issues: Fast or pounding heartbeats, fluttering in your chest, shortness of breath and sudden dizziness could signify a problem.
- Low sodium levels (hyponatremia): Symptoms might include headache, confusion, slurred speech, severe weakness, vomiting and loss of coordination.
If you experience any symptoms that suggest a serious nervous system reaction such as very stiff muscles; high fever; sweating; confusion; fast or uneven heartbeats; tremors – seek medical help immediately.
The occurrence of Serotonin Syndrome is rare but potentially life-threatening. Look out for symptoms like agitation hallucinations fever sweating shivering fast heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea. If you notice these signs after starting treatment with either Trintellix or Celexa it's vital to seek immediate emergency attention.
What are the most common side effects for Celexa?
Celexa, an antidepressant medication, may cause a range of side effects in some individuals including:
- Dry mouth or increased sweating
- Nausea, vomiting and upset stomach
- Changes in appetite, potentially leading to weight changes
- Sleep disturbances such as insomnia or excessive sleepiness
- Frequent urination
- Blurred vision
- Feeling nervous or experiencing tremors
- Muscle or joint pain
It's also important to note that Celexa can sometimes lead to more severe side effects like confusion, agitation and fast heartbeat. If you experience these symptoms while taking Celexa, it is vital that you seek immediate medical attention.
Are there any potential serious side effects for Celexa?
While Celexa is generally well-tolerated, it can cause some serious side effects in rare cases. These might include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Unusual changes in mood or behavior: agitation, hallucinations, fever, fast heart rate
- Increased risk of suicidal thoughts especially among teenagers and young adults
- Serotonin syndrome: symptoms may include agitation, hallucinations (seeing things that are not there), coma (loss of consciousness for a period of time), dizziness that does not go away or that is very bad.
- Changes to vision including eye pain/swelling/redness and blurred vision
- Problems with coordination/balance which could lead to falls
- Symptoms indicative of hyponatremia like headache, trouble concentrating/memory problems/weakness/unsteady feeling.
If any such adverse reactions appear while taking Celexa medication stop the use immediately and consult a healthcare professional.
Contraindications for Trintellix and Celexa?
Just like Prozac and Wellbutrin, both Trintellix and Celexa can potentially exacerbate symptoms of depression in certain individuals. If you notice a worsening of your depression, or an increase in suicidal thoughts or behaviors while on these medications, it's crucial to seek immediate medical attention.
Neither Trintellix nor Celexa should be taken if you are using or have been using monoamine oxidase inhibitors (MAOIs). It is important to always disclose all the medications you are taking to your doctor; MAOIs will require a period of about 2 weeks after discontinuation before starting treatment with either Trintellix or Celexa to avoid dangerous drug interactions.
How much do Trintellix and Celexa cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Trintellix (10 mg) averages around $450, which works out to about $15 a day.
- The price for Celexa (20 mg), sold as Citalopram in generic form, is significantly lower. A bottle containing 30 tablets costs around $8-$50 depending on the pharmacy, averaging at less than $2 per day.
Hence, if you're prescribed a standard dose for each medication, generic Celexa or citalopram is more cost-effective on a daily basis compared to Trintellix. However, remember that cost shouldn't be your primary concern when choosing between these two antidepressants; effectiveness and side effects should also be considered.
When it comes to their respective generics:
- Vortioxetine is the active ingredient in Trintellix but currently no generic version exists due to patent rights. Therefore prices remain high.
- Citalopram however has been available as a cheaper alternative for quite some time now with prices ranging from approximately $0.10 - $1 per tablet depending on the strength and quantity purchased. This can translate into significant savings over time.
Please consult your healthcare provider before making any decisions regarding your medication based purely on cost factors!
Popularity of Trintellix and Celexa
Vortioxetine, in generic form as well as brand names such as Trintellix, was prescribed to approximately 1.5 million people in the US in 2020. Vortioxetine accounted for just over 3% of antidepressant prescriptions in the US that year. As an atypical antidepressant (not classified as an SSRI or other broad class of antidepressants), vortioxetine has been generally increasing in prevalence since its introduction.
Citalopram, including brand versions such as Celexa, was prescribed to nearly 24 million people in the USA during the same period. In the US, citalopram accounts for around 25% of SSRI prescriptions and about 13% of overall antidepressant prescriptions. The prevalence of citalopram has remained relatively steady over the last decade.
Conclusion
Trintellix (vortioxetine) and Celexa (citalopram) are both effective treatments for patients with depression, supported by multiple clinical trials that demonstrate their greater efficacy compared to placebo. Similar to Prozac and Wellbutrin, these drugs can sometimes be used concurrently, but this requires meticulous monitoring from a healthcare professional due to potential drug interactions.
Trintellix acts on several different serotonin receptors as well as inhibiting the reuptake of serotonin, while Celexa is a selective serotonin reuptake inhibitor (SSRI). This difference in pharmacological activity may lead them to be prescribed under different circumstances: Trintellix is often given when other antidepressants have not been effective or have caused side effects.
Both Trintellix and Celexa are available in generic forms which offer significant cost savings for patients paying out-of-pocket. There might also be an adjustment period needed for both medications whereby the therapeutic effect may not appear immediately after starting treatment.
The side effect profile between the two drugs varies slightly; though they are generally well-tolerated, some patients taking Trintellix report experiencing nausea more frequently than those on Celexa. However, sexual dysfunction – common among SSRIs like Celexa – appears less frequent with Trintellix use. As with all antidepressant therapies, it's crucial that patients closely monitor their moods when initiating treatment and seek immediate medical help if there's any worsening of depressive symptoms or emergence of suicidal thoughts.
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Refrences
- Stahl, S. M. (2015, June 11). Modes and nodes explain the mechanism of action of vortioxetine, a multimodal agent (MMA): actions at serotonin receptors may enhance downstream release of four pro-cognitive neurotransmitters. CNS Spectrums. Cambridge University Press (CUP).http://doi.org/10.1017/s1092852915000358
- Kusturica, J., Zulić, I., Loga-Zec, S., Mulabegović, N., Loga, S., & Kapić, E. (2002, February 20). Frequency and characteristics of side effects associated with antidepressant drugs. Bosnian Journal of Basic Medical Sciences. Association of Basic Medical Sciences of FBIH.http://doi.org/10.17305/bjbms.2002.3575
- Feighner, J. P., & Overø, K. (1999, December 15). Multicenter, Placebo-Controlled, Fixed-Dose Study of Citalopram in Moderate-to-Severe Depression. The Journal of Clinical Psychiatry. Physicians Postgraduate Press, Inc.http://doi.org/10.4088/jcp.v60n1204
- Munari, L., Provensi, G., Passani, M. B., Galeotti, N., Cassano, T., Benetti, F., … Blandina, P. (2015, April 21). Brain Histamine Is Crucial for Selective Serotonin Reuptake Inhibitors‘ Behavioral and Neurochemical Effects. International Journal of Neuropsychopharmacology. Oxford University Press (OUP).http://doi.org/10.1093/ijnp/pyv045
- Zhang, X., Cai, Y., Hu, X., Lu, C. Y., Nie, X., & Shi, L. (2022, June 24). Systematic Review and Meta-Analysis of Vortioxetine for the Treatment of Major Depressive Disorder in Adults. Frontiers in Psychiatry. Frontiers Media SA.http://doi.org/10.3389/fpsyt.2022.922648
- Frampton, J. E. (2016, November). Vortioxetine: A Review in Cognitive Dysfunction in Depression. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-016-0655-3