Monday, April 16, 2007

Lexapro is Waaaaaay Better than Celexa (?)

...according to Forest Labs. Dr. Roy Poses at Health Care Renewal received a letter telling him about the dangers of using citalopram versus using Lexapro. As you may recall, Lexapro (escitalopram) is essentially a one-off copycat of Celexa (citalopram). An urgent letter was recently sent out from a marketing firm (which was hired by Forest) to inform doctors that evil managed care firms may attempt to switch their patients from Lexapro to generic citalopram. Now, I'll agree that if someone seems to be doing well on a medication, it would seem odd to change their medication. I don't think there is any firm evidence on what would happen if you switch someone from a drug A to drug B, which is nearly identical to drug A (i.e., escitalopram to citalopram), but one could certainly wonder about the merits of drug switching.

In any case, the letter then goes on to make some astounding claims, including [bold font in original letter]
The clinical profile of Lexapro and citalopram are distinct, as illustrated by the following:

- Lexapro is effective in the treatment of major depressive disorder (MD) and generalized anxiety disorder (GAD). In contrast, citalopram is not indicated for GAD, or for any other anxiety disorder. [citations were to the respective drug labels.]

- There is clinical evidence for the greater efficacy of Lexapro vs. Celexa

...among others. For a very nice analysis of why these claims are misleading, please read the full post at Health Care Renewal. My two cents on why the claims are misleading is as follows:

  • Since its patent was running out, Forest opted to not seek FDA approval for any anxiety disorders. No study has ever compared the two compounds in treating anxiety. While true that citalopram is not FDA-indicated, this should not be taken as a sign that it would perform worse than escitalopram in anxiety. Indeed, across the class, SSRIs are efficacious (in the short-term, and not a lot better than placebo) for anxiety.
  • The evidence cited to support the greater efficacy of escitalopram over citalopram is very weak. It comes from looking only at the few instances where escitalopram showed a very small advantage over citalopram and ignoring the great majority of the evidence that suggests equivalent efficacy of the two compounds. An excellent article by Svensson and Mansfield laid this issue to rest years ago. Here's what they said regarding Forest's prior advertising claims that Lexapro is more effective than Celexa:
"The advertising claims are not justified because they are based on secondary outcomes, non-intention-to-treat analyses and arbitrarily defined subgroups. The subgroup results are inconsistent. Methodological flaws in the trials could account for the differences found. Even if the differences claimed were real they appear too small to justify higher prices."

My thought is that the letter may have something to do with managed care policies, but it is also a stealth advertisement for Lexapro as being the most efficacious SSRI. After all, if it is "better" than Celexa, then maybe it is "better" than other SSRIs. Of course, this would not be the first time that something Lexapro-related was looking at the scientific evidence through rose colored glasses.


Anonymous said...

My name is Daniel Wilson and i would like to show you my personal experience with Celexa.

I am 27 years old. I took this drug on and off for 3 years (2 years on, 1 off). It definetely helped my anxiety. The major side effect was the weight gain. Trying the new version (Lexapro) now. I'm hoping it will have better side effects.

I have experienced some of these side effects-
Weight Gain, diarrhea.

I hope this information will be useful to others,
Daniel Wilson

Juicey said...

I have recently switched to the generic Citalopram after having been on Lexapro for over a year. My main reason for the change was the cost. Even with insurance I was paying $90.00 for a 30-day supply of Lexapro. I was on 10mg. I can get Citalopram for $4.00 for a 30/day supply. Since I am now unemployed, I almost had no choice. Well today is my second day on Citalopram and I noticed that immmediately after taking it I feel confused, tired, and paranoid. It sort of goes away after a little while but I don't like the feeling. I was prescribed 20mg Citalopram instead of 10mg Lexapro, but don't know why.

Jedierica said...

It sounds like when you switch from 20 mg of Lexapro to Celexa you need to take 20 mg of Celexa. I was on 10mg of Celexa for 3 years until I was unemployed and experiencing some major depression as a result. I talked the doc into letting me try Lexapro. It helped but getting a job right around the same time also probably helped. I took Lexapro for close to 2 years and switched back to Celexa due to my temp agency insurance at the time and cost. My dose of Celexa changed to 20mg to equal that of the Lexapro that I was taking and saw no difference in symptoms. That was 2005 it is now 2009 and again I am experiencing some upswings in the anxiety department. I asked my doc if I can go back on Lexapro. He says they are no different and that Forest is just saying so to keep people from using Generic Celexa.

Anonymous said...

Careful! 20 mg of Lexapro equals 40 mg of Celexa!