Celexa vs. Cymbalta (Comparison of Differences and Similarities)

  • Medical Reviewer: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Celexa (citalopram) vs. Cymbalta (duloxetine) quick comparison of differences

What is Celexa? How does it work (mechanism of action)?

Celexa (citalopram) is a serotonin reuptake inhibitor (SSRI) antidepressant used to treat depression. Other SSRIs include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Celexa prevents the uptake of the neurotransmitter serotonin by nerve cells after it has been released, which results in more free serotonin in the brain to stimulate nerve cells. Celexa is also used off-label for treating alcoholism, binge-eating disorder, generalized anxiety disorder, panic disorder, hot flashes, and obsessive-compulsive disorder (OCD).

What is Cymbalta? How does it work (mechanism of action)?

Cymbalta (duloxetine) also is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) SNRI antidepressant used for or the treatment of depression, anxiety disorders, and pain. Other SNRIs include milnacipran (Savella), venlafaxine (Effexor), and desvenlafaxine (Pristiq).

Cymbalta prevents the reuptake of the neurotransmitters serotonin and epinephrine by nerves after they have been released, thereby increasing the effect of serotonin and norepinephrine in the brain.

Cymbalta is used to treat major depressive disorder (MDD), generalized anxiety disorder (GAD), diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain.

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What are the uses for Celexa vs. Cymbalta?

Celexa uses

Citalopram is approved for treating depression. It is also used off-label for treating:

Cymbalta uses

Duloxetine is used for the treatment of:

What are the side effects of Celexa vs. Cymbalta?

Celexa side effects

The most common side effects associated with citalopram are

Overall, between 1 in 6 and 1 in 5 persons experience a side effect. Citalopram is also associated with sexual dysfunction.

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of citalopram or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.

Cymbalta side effects

The most common side effects of duloxetine include

Increased blood pressure can occur and should be monitored. Seizures have been reported. Sexual dysfunction (decreased sex drive and delayed orgasm and ejaculation) has been associated with duloxetine.

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of duloxetine or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.

What are withdrawal symptoms of Celexa vs. Cymbalta?

Celexa withdrawal symptoms

Some individuals may experience withdrawal reactions upon stopping citalopram. Symptoms of withdrawal include

  • dizziness,
  • tingling sensations,
  • tiredness, vivid
  • dreams, and
  • irritability or poor mood.

Cymbalta withdrawal symptoms

Some individuals may experience withdrawal reactions upon stopping duloxetine. Symptoms of withdrawal include:

  • dizziness,
  • anxiety,
  • nausea,
  • vomiting,
  • nervousness,
  • diarrhea,
  • irritability, and
  • insomnia.

The dose of Celexa and Cymbalta should be gradually reduced when therapy is discontinued to prevent symptoms of withdrawal.

What is the dosage of Celexa vs. Cymbalta?

Celexa dosage

  • The usual starting dose is 20 mg in the morning or evening. The dose may be increased to 40 mg daily after one week.
  • A dose of 60 mg has not been shown to be more effective than 40 mg.
  • As with all antidepressants, it may take several weeks of treatment before maximum effects are seen. Doses are often slowly adjusted upwards to find the most effective dose.

Cymbalta dosage

The recommended dose for treating depression is 20 or 30 mg twice daily or 60 mg once daily. Patients may be started with 30 mg once daily for one week before the dose is advanced to 60 mg daily.

  • The recommended dose for anxiety disorder, pain associated with diabetic neuropathy, fibromyalgia, or chronic musculoskeletal pain is 60 mg daily. Starting at 30 mg daily for one week before increasing to 60 mg daily may help patients adjust to the drug. There is no evidence that doses greater than 60 mg/day provide additional benefits. However, the maximum dose for depression or anxiety disorder is 120 mg/day.

What drugs interact with Celexa vs. Cymbalta?

Celexa drug interactions

  • All SSRIs, including citalopram, should not be taken with any of the mono-amine oxidase (MAO) inhibitor-class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure, tremor, and hyperactivity. If treatment is to be changed from citalopram to an MAOI or vice-versa, there should be a 14 day period without either drug before the alternative drug is started.
  • Tryptophan, a common dietary supplement, can cause headaches, nausea, sweating, and dizziness when taken with any SSRI.
  • Linezolid and intravenous methylene blue are also MAO inhibitors and should not be combined with citalopram.
  • Use of an SSRI with aspirin, nonsteroidal anti-inflammatory drugs or other drugs that affect bleeding may increase the likelihood of upper gastrointestinal bleeding.

Cymbalta drug interactions

  • Duloxetine should not be used in combination with a monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl), or within 14 days of discontinuing the MAOI. At least 5 days should be allowed after stopping duloxetine before starting an MAOI. Combinations of SNRIs and MAOIs may lead to serious, sometimes fatal, reactions including very high body temperature, muscle rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium, and coma. Similar reactions may occur if duloxetine is combined with antipsychotics, tricyclic antidepressants or other drugs that affect serotonin in the brain. Examples include tryptophan, sumatriptan (Imitrex), lithium, linezolid (Zyvox), tramadol (Ultram), and St. John’s Wort.
  • Fluoxetine (Prozac, Serafem), paroxetine (Paxil, Paxil CR, Pexeva), fluvoxamine (Luvox), and quinidine increase blood levels of duloxetine by reducing its metabolism in the liver. Such combinations may increase adverse effects of duloxetine.
  • Combining duloxetine with aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), warfarin (Coumadin) or other drugs that are associated with bleeding may increase the risk of bleeding, because duloxetine itself is associated with bleeding.
  • Duloxetine has an enteric coating that prevents dissolution until it reaches a segment of the gastrointestinal that has a pH higher than 5.5. In theory, drugs that raise the pH in the gastrointestinal system (for example, Prilosec) may cause duloxetine to be released early while conditions that slow gastric empyting (for example, diabetes) may cause premature breakdown of duloxetine. Nevertheless, administration of duloxetine with an antacid or famotidine (Axid) did not significantly affect the absorption of duloxetine.
  • Duloxetine may reduce the breakdown of desipramine (Norpramine), leading to increased blood concentrations of desipramine and potential side effects.

Are Celexa and Cymbalta safe to take if I am pregnant or breastfeeding?

Celexa safety

  • Exposure of neonates to citalopram in the third trimester may cause complications.
  • Citalopram is excreted in breast milk. Breastfeeding by a citalopram treated woman may cause adverse effects in the infant.

Cymbalta safety

  • Duloxetine is excreted into the milk of lactating women. Because the safety of duloxetine in infants is not known, breastfeeding while on duloxetine is not recommended.

REFERENCE: FDA Prescribing Information.

Summary

Celexa (citalopram) and Cymbalta (duloxetine) are drugs used to treat depression. Celexa belongs to the antidepressant drug class called selective serotonin reuptake inhibitors (SSRIs), and Cymbalta belongs to the selective serotonin and norepinephrine reuptake inhibitor (SSNRI) drug class. The main difference between the two drugs is that Celexa prevents the reuptake of one neurotransmitter, and Cymbalta prevents the reuptake of two.

Celexa is approved for the treatment of depression. Non-FDA approved uses for Celexa include hot flashes, obsessive compulsive disorder (OCD), panic disorder, general anxiety disorder (GAD), bing-eating disorder, and alcoholism.

Cymbalta is approved for the treatment of major depressive disorder, generalized anxiety disorder (GAD), pain from diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain.

Both Celexa and Cymbalta have FDA black box warnings because antidepressants increase the increase risk of suicidal thoughts and behavior in children, adolescents, and young adults.

Common side effects of Celexa and Cymbalta include insomnia, dry mouth, and nausea. Side effects unique to Celexa include headache, tremor, and vomiting. Side effects unique to Cymbalta include constipation, diarrhea, fatigue, high blood pressure, sexual dysfunction, and seizures.

Examples of withdrawal symptoms from Celexa and Cymbalta include anxiety, nervousness, irritability, poor mood, and insomnia.

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Quick GuidePhysical Symptoms of Depression in Pictures

Physical Symptoms of Depression in Pictures

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Reviewed on 12/13/2017
References
REFERENCE: FDA Prescribing Information.

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