Is prozac stronger than citalopram?

[Janey86]

Chloe: that is a very bad idea. If you feel the current dose isn't working, why not go see your doctor? What dose are you currently taking and how long have you been on it?

[LAURA48]

No - you cannot increase the dose of any medication without speaking to your doctor first.

[Ferdy]

There is no exact method to quantify "strength" of the SSRIs per se, but there are studies that show the potency and selectivity of each SSRI. After all, they are, by definition, "selective" seratonin reuptake inhibitors--some MUCH more selective than others.

Here are the results of an in vitro (in the lab) study done by Preskorn et al clinical pharmacologist to determine potency/selectivity of each one---this is in decending order from most selective to least selective. Note that these results are from standard recommended daily adult doses for each:

1. paroxetine (Paxil) 20-40mg
2. escitalopram (Lexapro) 10-20mg
3. sertraline (Zoloft) 50-100mg
4. citalopram (Celexa) 20-40mg
5. fluvoxamine (Luvox) ???
6. fluoxetine (Prozac) 20-40mg

The higher on this list the drug is, the more direct its action on selectively inhibiting seratonin reuptake. As you go down in the list, each drug gets progressively less selective, meaning that it also has more action at other receptors sites, such as dopamine, norephenephrine, histamine, muscanaric, etc.

I think you should note, that the less selective, the more "sloppy" the drug is---which usually always means "more side effects" because it's hitting more receptors. I know from personal experience with all of them (except Luvox), that this is definitely the case. Lexapro, Celexa's younger brother, is definitely a much "cleaner" SSRI than is Celexa---I had lots of side effects from taking Celexa, but very few from Lexapo. Prozac nearly always tops everyone's list as the one with the most side effects, generally speaking. But again, you must remember that most, but not all, people adjust to the side effects, and as they go away, the drug starts "kicking in and doing its thing".

Another thing to note, just because one is more selective than another, doesn't mean its not as effective (effacacious)--in other words, one is not necessarily better than another. Everyone's brain makup is different, and some of the less selective (sloppier) ones, hit just enough of the other receptors to make them the best choice for each individual. This is why some work great for some people, while others will work better for the rest of the people. And that's why doctors are continually switching patients because of side effects that won't go away or are intolerable from the start.

Hope this helps clear up the OP's question-----

[LAURA48]

Hi Ferdy

Very interesting read - I was amazed Prozac was bottom as was on it for years and found it excellent - thought it was the most potent one! am on Citalopram and thought it was a much weaker drug?

Good post - will save it!

Laura

[Ferdy]

Hi Ferdy

Very interesting read - I was amazed Prozac was bottom as was on it for years and found it excellent - thought it was the most potent one! am on Citalopram and thought it was a much weaker drug?

Good post - will save it!

Laura

Hi Laura,

Glad you found this interesting. Again, there is no one SSRI that is "stronger" or "weaker". They just differ in their selectivity. In your case with Prozac, it was hitting all of your receptors just right. If it was working so well, why did you stop it and switch to citalopram?

[LAURA48]

Hi Ferdy

Good question was on Prozac for 15 years - side effects horrific! basically I had a very traumatic time back in Oct 2011 and it stopped working - was on 20mg GP doubled nearly went crackers - was so so ill. GP then put me on Mirtazipine - no good at all, GP then tried me on Sertraline - nothing.

Thought enough is enough and paying to see a psychiatrist - very costly - but worth it - diagnosed with Pure OCD and wanted to try me on another SSRI, eg, Citalopram.
Been on it 7 weeks think he will up me to 40mg but still having constant anxiety! but it was bad anyway. Plan B Effexor XL? Just wondering why he did not put me on Escitalopram?

Do you know much about Effexor?

Thanks Laura

---------- Post added at 17:04 ---------- Previous post was at 17:02 ----------

Ferdy - out of curiosity what were your side effects on Citalopram?

[joy]

Citalopram is cheaper

Joy

[LAURA48]

I know Joy but he said cost was not an issue - Plan B was Effexor SR capsules and they are expensive? and at the end of the day I am private.

[Ferdy]

Hi Ferdy

Good question was on Prozac for 15 years - side effects horrific! basically I had a very traumatic time back in Oct 2011 and it stopped working - was on 20mg GP doubled nearly went crackers - was so so ill. GP then put me on Mirtazipine - no good at all, GP then tried me on Sertraline - nothing.

Thought enough is enough and paying to see a psychiatrist - very costly - but worth it - diagnosed with Pure OCD and wanted to try me on another SSRI, eg, Citalopram.
Been on it 7 weeks think he will up me to 40mg but still having constant anxiety! but it was bad anyway. Plan B Effexor XL? Just wondering why he did not put me on Escitalopram?

Do you know much about Effexor?

Thanks Laura

---------- Post added at 17:04 ---------- Previous post was at 17:02 ----------

Ferdy - out of curiosity what were your side effects on Citalopram?

Hi Laura,

Effexor is from the newest family of ADs---the SNRIs. (Serotonin Norephenephrine Reuptake Inhibitors). Cymbalta, Effexor, and Pristiq are in this family of drugs. I've never used Effexor, but I have taken another one in that family----Cymbalta. Simply AWFUL drug for me (I also have a severe anxiety disorder). I literally thought I was going to crawl out of my skin it made me so jittery, nauseous and anxious---and I suffered THE MOST SEVERE panic attack one could imagine whilst taking it. It was actually the first drug that I was prescribed, and since I've been on every other one with the exception of Effexor, Luvox and the TCAs/MAOIs. The TCAs and MAOIs are out of the question for me---they have too many cardiac risks associated with them, and I have an arrythmia problem in addition to hypertension (high blood pressure) that counts me out. I (and my doctor) have completely ruled out any of the SNRIs in my case, but many people have had good success with them. By the way, my doc also told me that Effexor, BY FAR, has the most severe withdrawal syndrome of ANY of the psych medications---Effexor XR may be better in that respect, don't know---

For me, the best of my prior meds for anxiety was escitalopram (by FAR). It is a totally different drug (for me) than is citalopram. The side effects I suffered from citalopram are kinda hard to describe---it was just an overall feeling of malaise and an unpleasant general all around feeling of not being well---nothing that I can exactly put a finger on. No nausea, insomnia or any of the "standard" side effects. Lexapro, on the other hand, had no real unpleasant side effects---as I said before, it seems much "cleaner" than citalopram. The only reason I've switched to Prozac, is that escitalopram kept me in a stoned. zoned, tired state---completely unmotivated and "blah"---so my doctor wanted me to try Prozac--says it's more activating and has been shown to decrease anxiety as well. If it doesn't work out, we'll go back to Lexapro. It really is a calming drug---too much so for me---but may go back and try it again if the Prozac don't work out. He did mention stopping the mirtazapine and adding buproprion (Wellbutrin) to the escitalopram to try to counteract the down effect since buproprion is KNOWN to be a stimulating drug---and in some people REALLY cranks up anxiety---so I'm loathe to try it. Plus, I've had fairly good results with the mirtazapine---it sorta stopped working after a year or so (I've been taking it for 5 years now)---but it still gives me a good nights sleep and must be doing SOMETHING, because the doctor has never stopped it.

You know, if you're main diagnoses is OCD, Luvox (fluvoxamine) is the ONLY drug in the SSRI family that is specifically indicated in the treatment of OCD---at least here is the USA by the FDA. Is it not available in the UK? I think I would try it before Effexor, and even try escitalopram, before the Effexor as well---