Escitalopram vs Citalopram: Which SSRI is Right for You?

Understanding the Differences Between Escitalopram and Citalopram

If you’re deciding between escitalopram and citalopram, you’re not alone. These are two of the most commonly prescribed SSRIs (selective serotonin reuptake inhibitors) in the UK, particularly for anxiety and depression.

They’re closely related medications, and they’re often discussed as if they’re almost interchangeable. In fact, both are influenced by a key drug-metabolising enzyme pathway called CYP2C19, which helps your body process and clear certain SSRIs.

Even though they share similar metabolism pathways, they’re not identical in how they act in the brain. These small differences can create different real-world experiences for people taking the medication.

Escitalopram is the active S-enantiomer of citalopram. Citalopram contains both an active (S) form and an inactive (R) form, whereas escitalopram contains only the active component. This is the primary pharmacological difference between the two medicines.

In this guide, we’ll compare escitalopram vs citalopram in a clear and practical way, including uses, likely side effects, dosing, and how pharmacogenomic (PGx) testing can help personalise overall SSRI decisions.

Quick Overview: What’s the Difference Between Escitalopram and Citalopram?

Both medications are SSRIs, meaning they increase serotonin signalling by reducing reuptake of serotonin in the brain. That serotonin effect is why SSRIs can help with mood, anxiety, and emotional stability. Here are the key differences between them:

• Citalopram is a widely used SSRI antidepressant with a long track record in UK practice.

• Escitalopram is closely related, but contains only the active component of citalopram, making it pharmacologically stronger on a milligram-for-milligram basis.

Many people search “escitalopram use” or “escitalopram uses” because it’s frequently prescribed as a first-line option, and many clinicians consider it a very tolerable SSRI for anxious patients. That said, citalopram uses are also very common, and plenty of people do extremely well on citalopram as their long-term antidepressant.

Escitalopram vs Citalopram: What Are They Used For?

Escitalopram uses

Escitalopram is commonly prescribed for:

• Generalised anxiety disorder (GAD)

• Depression

• Panic symptoms

• Social anxiety

• Persistent stress-related low mood

People often refer to it by brand name too (and some misspell it), so you may see searches like scitalopram or escitaloprame — they’re typically still referring to escitalopram.

Citalopram uses

Citalopram is commonly prescribed for:

• Depression

• Anxiety

• Panic symptoms

• Ongoing low mood and emotional dysregulation

Because it’s so widely prescribed, you’ll also see searches like:

• Citalopram for anxiety

• Citalopram antidepressant

• Antidepressant citalopram

• Is citalopram an SSRI

(Yes — citalopram is an SSRI, just like escitalopram.)

If you’ve had a good experience on it in the past with citalopram, there’s no automatic reason to think escitalopram will be better. And vice versa.

How Long Do Escitalopram and Citalopram Take to Work?

Like most SSRIs, benefits often build gradually. A typical pattern looks like:

• Days 1–7: side effects may show up first

• Weeks 2–4: early shifts (sleep, stability, reduced panic)

• Weeks 4–8: fuller therapeutic effect may become clearer

A frustrating truth is that the early phase can feel messy — and that often pushes people to Google comparisons like:

• “Citalopram or sertraline”

• “Sertraline or citalopram”

• “Is citalopram stronger than sertraline”

Some clinicians observe that escitalopram may begin exerting clinical effects earlier and may be more effective in more severe presentations of depression or anxiety. This difference is subtle at a population level, but meaningful for some patients.

This is one area where pharmacogenomics can help: Giving people confidence that the selected medicine is well-suited to their genes, and that the ‘teething pains’ will ride out with time.

Dosing Differences: Escitalopram vs Citalopram

Dosing is individual and must be guided by a clinician, but these two medications aren’t milligram-for-milligram identical. In general:

• escitalopram is often prescribed at lower milligram doses than citalopram

• the experience can change significantly with small dose adjustments

If you feel “too much” side effect at a standard dose, it doesn’t always mean the medication is wrong — it may mean the dose or titration speed needs adjusting. Your clinician would help you with the dose, especially if they have your PGx report. If you are a rapid or poor metaboliser, they could increase or decrease your dose respectively.

Side Effects Compared: Escitalopram vs Citalopram

Most SSRI side effects overlap, but one may feel more tolerable than the other depending on the person. Escitalopram has been associated with a higher risk of QT interval prolongation than citalopram at equivalent therapeutic doses, particularly at higher doses or in people with additional risk factors.

Common SSRI side effects (both medications)

• Nausea / gut discomfort

• Headaches

• Sleep disturbance (insomnia or vivid dreams)

• Fatigue or “flatness”

• Sweating

• Dry mouth

• Appetite change
  
  

Emotional blunting (“I feel numb”)

Both medications can reduce anxiety and flatten emotional intensity, which can feel like relief… or a loss of spark. People describe:

• Fewer emotional spikes

• Less crying

• Less panic

• Reduced motivation

• Reduced joy or excitement
  
  

Sexual side effects

This is one of the biggest real-world issues with SSRIs, and one of the most common reasons people switch. Both escitalopram and citalopram may cause:

• Reduced libido

• Arousal changes

• Delayed orgasm / difficulty reaching orgasm

If that’s happening, it’s worth raising with a clinician rather than suffering in silence.

Weight changes

Weight gain isn’t guaranteed, but it’s often searched. SSRI-associated weight changes can happen due to:

• Appetite shifting up

• Reduced energy

• Improved mood → more eating/socialising

• Changes in sleep patterns
  
  

What Is Pharmacogenetic Testing?

Pharmacogenetic or PGx testing can be described as a DNA test for medications and looks how your genes affect the enzymes that process medicines. In the case of escitalopram and citalopram, it’s an enzymatic pathway called CYP2C19.

Even though both escitalopram and citalopram are influenced by CYP2C19 metabolism, but the experience can still differ because:

1) They’re related, but not identical in action

This difference is not due to separate molecular targets, but to the presence or absence of the inactive R-enantiomer in citalopram. Escitalopram contains only the active S-enantiomer of citalopram, which results in a stronger serotonin reuptake–inhibiting effect per milligram and can shift the balance of:

• Benefits

• Side effects

• Tolerability
  
  

2) Your nervous system sensitivity matters in addition to your metabolism

Two people can have the same CYP2C19 metaboliser status and still experience:

• Different side effects

• Different levels of benefit

That’s because anxiety sensitivity, sleep quality, stress load, and neurotransmitter balance all change how SSRIs “feel”.

Pharmacogenomics (PGx): Can a DNA Test Help Choose Between Escitalopram and Citalopram?

Pharmacogenomic (PGx) testing helps explain why people respond differently to medications. For SSRIs, PGx can provide insight into whether you’re likely to metabolise a drug faster or slower than expected. For escitalopram and citalopram, one of the key genes often considered is CYP2C19. Depending on your CYP2C19 profile, you may be more likely to:

• Process the medication quickly → reduced effect at standard dosing, or

• Process it more slowly → higher exposure and more side effects.

Other SSRIs (such as sertraline) can involve more than one metabolism pathway (for example, CYP2C19 and CYP2B6). In this instance, if your CYP2C19 pathway is less active but your CYP2B6 pathway is functioning normally, switching from escitalopram or citalopram to sertraline could be the sort of decision that PGx-guided therapy could support.

Many people land on this article because they’re also medicine checking SSRIs more broadly, especially:

• citalopram or sertraline

• sertraline or citalopram

• is citalopram stronger than sertraline

• citalopram vs zoloft

• zoloft vs citalopram

From the example above, you can see these are more likely to be PGx influenced swaps than escitalopram vs. citalopram. PGx doesn’t replace clinical judgement, but it can be a valuable piece of information when:

• You’ve had failed SSRI trials

• You’re sensitive to side effects

• You want more personalised prescribing from the start
  
  

FAQs: Escitalopram vs Citalopram

Is escitalopram an SSRI?

Yes. Escitalopram is an SSRI (selective serotonin reuptake inhibitor), commonly prescribed for anxiety and depression.

Is citalopram an SSRI?

Yes. Citalopram is also an SSRI antidepressant, widely prescribed in the UK for depression and anxiety.

Is escitalopram stronger than citalopram?

This is not just a perception: escitalopram is stronger per milligram because it contains only the active form of the drug, whereas citalopram is approximately 50% inactive.

What are escitalopram uses?

Escitalopram is used for depression and anxiety disorders, including generalised anxiety and panic symptoms, depending on clinician choice and patient needs.

What are citalopram uses?

Citalopram is commonly used as an antidepressant and is often prescribed for depression and anxiety, including citalopram for anxiety in many patients.

Why do escitalopram and citalopram feel different if both use CYP2C19?

Because CYP2C19 is only one part of the story. The medications are not identical in how they act in the brain, and people vary in nervous system sensitivity, dose tolerance, and side effect susceptibility.

I searched “escitalopram10” — what does that mean?

“10” refers to the dose in mg. Many people search using dose-based terms like “escitalopram 10” (often written as “escitalopram10”). Your dose should always be confirmed with a clinician and taken exactly as prescribed.

Final takeaway

Escitalopram and citalopram are closely related SSRIs, and both are influenced by CYP2C19 metabolism, but they can still feel very different in everyday life. If you’re choosing between them, focus on what matters most:

• Anxiety relief vs mood improvement

• Sleep impact

• Side effect tolerance (especially sexual side effects and emotional blunting)

• Whether you’ve struggled with SSRI trial-and-error before

And if you’re tired of guessing, pharmacogenomic (PGx) testing can add a valuable layer of clarity, helping move SSRI prescribing towards a more personalised approach. In practice, the choice between escitalopram and citalopram is less about “which is better” and more about dose tolerance, side-effect sensitivity, severity of symptoms, and individual response over the first few weeks of treatment.

 

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