The most common process utilized when selecting medications to treat mental health conditions is the trial-and-error approach. A quote by Noam Shphancer, PhD, Psychologist explains it best “Mental health is not a destination but a process. It’s about how you drive, not where you are going.” This statement cannot be more relevant when treating mental health conditions and selecting the most appropriate drugs to do just that. A provider simply tries one drug and if it doesn’t work or it results in giving their patient side effects, they simply move on to the next drug. This is not only inefficient, but it also incurs an unnecessary cost, potential side effects, and wasted time for all involved. Pharmacogenomic (PGx) testing can help improve a patient’s mental health journey by providing insight into how they may respond to medications based on their genetics. This tailored approach to selecting medications based on a patient’s PGx testing result can help providers select the right medication from the start.
Zoloft vs Celexa A quote by Noam Shphancer explains it best “Mental health is not a destination but a process. It’s about how you drive, not where you are going.” This statement cannot be more relevant when treating mental health conditions and selecting the most appropriate drugs to do just that. The most common process utilized when selecting medications to treat mental health conditions is the trial-and-error approach. A provider simply tries one drug and if it doesn’t work or it results in giving their patient side effects, they simply move on to the next drug.
Thanks to increasing awareness around mental health, significantly more people are seeking treatment with prescription drugs. According to a National Health and Nutrition Examination Survey conducted from 2015 to 2018, the percentage of adults 18 years of age and older had 13.2% of population use antidepressants in the previous 30 days. It was also found within that survey that antidepressant use was higher in women (17.7%) versus the use in men (8.4%). 1
Ultimately, antidepressants have been clinically observed to be highly effective in treating mental health conditions. Of course, for the best results, you need to find a drug that works well with your body. With so many antidepressant medications out there, this is easier said than done and that’s why this guide has been created to compare two common treatment options. In this article, we’ll review two well-known antidepressants (Zoloft and Celexa) and illustrate some important key points that can help to determine which would be a better option.
Introduction:
Sertraline (Zoloft) and citalopram (Celexa) both belong to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). To put it simply SSRIs function to help with mental health conditions by increasing the amount of serotonin in the brain by 60-80%. By increasing serotonin in the brain, it helps to significantly improve one’s mood. SSRIs are frequently used antidepressants due to their effectiveness, tolerability, and low likelihood of overdosing and are commonly used to treat mental health conditions like major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. 2
Zoloft vs Celexa Label Indications & Off-Label Uses
Sertraline (Zoloft) and citalopram (Celexa) may function similarly; however, they may have different mental health conditions they are labeled to treat. The following chart below indicates what Zoloft and Celexa are indicated to treat and their off-label uses. 3 4
| Labeled Indications | Off-Label Uses | |
| Sertraline (Zoloft) | Major depressive disorder; Obsessive-compulsive disorder; Panic disorder; Posttraumatic stress disorder; Social anxiety disorder | Binge eating disorder; Body dysmorphic disorder; Bulimia nervosa; Generalized anxiety disorder; Premature ejaculation |
| Citalopram (Celexa) | Major Depressive Disorder | Aggressive or agitated behavior associated with dementia; Binge eating disorder; Generalized anxiety disorder; Obsessive-compulsive disorder; Panic disorder; Posttraumatic stress disorder; Premature ejaculation; Premenstrual dysphoric disorder; Social anxiety disorder; Vasomotor symptoms associated with menopause |
Zoloft vs Celexa Formulations and Dosages
While they may belong to the same class of antidepressants, Zoloft and Celexa differ in terms of dosage amounts. This is because they have different potencies (or strengths). The chart below compares their respective starting doses and available formulations:
| Recommended starting dose (Major depressive disorder) | Recommended starting dose (Generalized anxiety disorder) | Available dosage forms | |
| Sertraline (Zoloft) | 50 mg/day (max: 200 mg/day) | 25 mg/day (max: 200 mg/day) | Tablet, oral solution, capsule |
| Citalopram (Celexa) | 20 mg/day (max: 40 mg/day) | 10 mg/day (max: 40 mg/day) | Tablet, oral solution |
It’s important to emphasize that this chart is a general guideline and the precise dosage amounts vary from person to person. Several factors such as age, lifestyle habits, and medication use can influence your recommended dosage. For example, children or people using other medications may be prescribed lower doses than the average adult. Receiving the right dosage amount for your needs can go a long way in preventing adverse effects. 5 6
Zoloft vs Celexa Side Effects
Starting a new medication always comes with the risk of adverse effects. As your body gets accustomed to the drug, these effects can diminish. It’s well documented that it can take up to four to six weeks for antidepressants to begin fully alleviating symptoms associated with mental health conditions. Let’s take a closer look at some of the side effects someone may experience while taking Zoloft or Celexa.
According to product labeling, it has been clinically observed that 10% of patients experienced the following side effects while taking Zoloft: nausea, dizziness, diarrhea, dry mouth, and drowsiness. In rare cases, Zoloft may cause hallucinations, muscle twitches, or tremors. Certain side effects can be worsened when combining Zoloft with alcohol or other drugs such as blood thinners, NSAIDs and MAO inhibitors.
According to product labeling, it has been clinically observed that 10% of patients experienced the following side effects while taking Celexa: headache, nausea, dry mouth, insomnia, and drowsiness. In severe cases, Celexa can cause fainting, vision problems, and irregular heartbeats. Substances like alcohol, marijuana, NSAIDs, opioids, and muscle relaxants can exacerbate side effects and potentially lead to hospitalization.
Zoloft vs Celexa Drug Metabolism
Of course, every patient has their own experience with medications. Some may undergo extensive side effects, while others respond with the desired outcomes. Many times, effects are directly connected to how enzymes (CYP450 enzymes) in the body responsible for metabolizing (eliminating or activating) drugs are impacted by an individual’s genetics.
Sertraline (Zoloft) is primarily metabolized by CYP2C19 and CYP2D6. An individual’s genetics can affect how these enzymes metabolize medications. For example, in a person who genetically is found to have poor metabolizing function of CYP2C19 this can significantly slow the breakdown of Zoloft in the body. This can lead to a buildup of the drug in the body and produce unwanted side effects or adverse events (hospitalizations). It is clinically recommended to either consider an alternative or reduce the starting dose of Zoloft by 50% with continued monitoring for side effects.
Citalopram (Celexa) is also primarily metabolized by CYP2C19 and CYP2D6. If a person’s genetics indicate that CYP2C19 has ultra-rapid metabolizing function, this can ultimately eliminate Celexa out of the body too quickly to have any benefit. Therefore, a drug metabolized by CYP2C19 would not be the best choice for this individual.
ClarityX Pharmacogenomic (PGx) Testing
Trying to decide between two different medications can be overwhelming. ClarityX can help people make well-informed choices about their medications through pharmacogenetic (PGx) testing. Put simply, pharmacogenomic (PGx) testing evaluates your genes for variations that may affect how you metabolize certain drugs. With this information, you’ll know whether you need to adjust your dosage or avoid a drug entirely. The Mindwell test can help provide information on treatments designed for mental health conditions, including antidepressants, antipsychotics, and anxiolytics.
The Mindwell test from ClarityX provides a seamless in-home testing experience. Simply visit the website https://www.clarityxdna.com, select the Mindwell test option from the drop-down menu, and complete the checkout process. Once the kit is received follow the package instructions, perform a simple cheek swab, then mail the sample back using the prepaid envelope. The sample is then sent to the lab for processing and the results are received by the patient or provider in 7-14 days on average.
One of the most important facts about pharmacogenetic (PGx) testing is the results can be reevaluated for future medication changes as this test does not have to be repeated for those specific genes tested. Another key function of the Mindwell test is specific medications can be entered to be evaluated to see how an individual’s genetic makeup can affect those therapies. Pharmacogenetic (PGx) testing can provide a lifetime of knowledgeable decisions about medication selection for healthcare teams.
When trial and error isn’t practical or simply too time-consuming and inconvenient, pharmacogenetic (PGx) testing for mental health medications can help providers prescribe proper dosages and determine which drugs will have the most benefit or potentially cause the most side effects. Having the proper mental health medication along with its appropriate dosage can have a huge impact on those with mental illnesses. It’s well documented that antidepressants can take up to four to six weeks before they provide any relief to mental health conditions like depression. More often than not patients will stop taking antidepressants usually within a few months because of negative side effects or the medication wasn’t working at all to resolve their symptoms. Patient’s abruptly stopping their mental health medications can produce other problems on top of their current mental health diagnosis such as withdrawal symptoms. Many of these complications can be avoided by simply having knowledge of how a patient uniquely reacts to mental health medications.
Resources:
1 Centers for Disease Control and Prevention. (2022, May 6). Nhanes - National Health and Nutrition Examination Survey homepage. Centers for Disease Control and Prevention. Retrieved May 16, 2022, from https://www.cdc.gov/nchs/nhanes/index.htm
2 Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects. UpToDate. (n.d.). Retrieved May 16, 2022, from https://www.uptodate.com/contents/selective-serotonin-reuptake-inhibitors-pharmacology-administration-and-side-effects#H399779781
3 Sertraline: drug information. UpToDate. (n.d.). Retrieved May 18, 2022, from https://www.uptodate.com/contents/sertraline-drug-information?source=auto_suggest&selectedTitle=1~1---1~4---zoloft&search=zoloft#F220661
4 Citalopram: drug information. UpToDate. (n.d.). Retrieved May 18, 2022, from https://www.uptodate.com/contents/citalopram-drug-information?search=citalopram&source=panel_search_result&selectedTitle=1~105&usage_type=panel&kp_tab=drug_general&display_rank=1#F151962
5 Sertraline: drug information. UpToDate. (n.d.). Retrieved May 18, 2022, from https://www.uptodate.com/contents/sertraline-drug-information?source=auto_suggest&selectedTitle=1~1---1~4---zoloft&search=zoloft#F220661
6 Citalopram: drug information. UpToDate. (n.d.). Retrieved May 18, 2022, from https://www.uptodate.com/contents/citalopram-drug-information?search=citalopram&source=panel_search_result&selectedTitle=1~105&usage_type=panel&kp_tab=drug_general&display_rank=1#F151962
7 Sertraline: drug information. UpToDate. (n.d.). Retrieved May 18, 2022, from https://www.uptodate.com/contents/sertraline-drug-information?source=auto_suggest&selectedTitle=1~1---1~4---zoloft&search=zoloft#F220661
8 Citalopram: drug information. UpToDate. (n.d.). Retrieved May 18, 2022, from https://www.uptodate.com/contents/citalopram-drug-information?search=citalopram&source=panel_search_result&selectedTitle=1~105&usage_type=panel&kp_tab=drug_general&display_rank=1#F151962
9 Annotation of CPIC Guideline for sertraline and CYP2C19. PharmGKB. (n.d.). Retrieved May 18, 2022, from https://www.pharmgkb.org/chemical/PA451333/guidelineAnnotation/PA166127639
10 Annotation of CPIC Guideline for citalopram and CYP2C19. PharmGKB. (n.d.). Retrieved May 18, 2022, from https://www.pharmgkb.org/chemical/PA449015/guidelineAnnotation/PA166127638
