Sertraline vs Citalopram (A brief guide)

In this brief guide, we will discuss “Sertraline vs Citalopram”, what is sertraline, what is Citalopram, side effects, drug overdose, things to consider and when to seek medical assistance.

Sertraline vs Citalopram: Are they the same?

Sertraline vs Citalopram is a hot topic of discussion for many people.

They are both antidepressants that belong to the family of Selective Serotonin Reuptake Inhibitors (SSRIs) and they are usually prescribed to treat depression. 

However, researchers from University College London found in a recent study (2019)  that sertraline was more effective reducing anxiety symptoms in 6 weeks than the modest improvements in depressive symptoms after 12 weeks. 

What is Sertraline?

Sertraline (Zoloft) is a drug used mainly for the treatment of Major Depressive Disorder (MDD).

In addition, Zoloft is also used to treat Obsessive-Compulsive Disorder (OCD), Panic Disorder, Post-traumatic Stress Disorder (PTSD), Social anxiety Disorder and Premenstrual Dysphoric Disorder (PMDD). 

Sertraline is available in the following strengths:

• 50 mg film-coated tablets
• 100 mg film-coated tablets

Recommendations before/after taking Sertraline

Avoid taking Sertraline:

• If you are allergic or suspect you could be. 
• If you are currently taking monoamine oxidase inhibitors (MAOIs) such as selegiline or moclobemide or similar drugs like linezolid. You should start the treatment with a MAOI after at least one week of stopping sertraline and after MAOI treatment you must wait at least 2 weeks to start taking sertraline. 
• If you are taking pimozide.

Hot to take Sertraline?

Always follow the direct instructions from your doctor on how to take sertraline.

Here we mention the recommended doses according to the Pfizer medication guide:

• In adults with Depression and Obsessive-Compulsive Disorder: the recommended dose for both disorders is 50 mg a day and the daily dose may be increased in 50 mg increments (intervals of at least 1 week over a period of weeks). The maximum recommended dose is 200 mg a day/ 

• In adults with panic disorder, social anxiety disorder, and post-traumatic disorder: the treatment should start at 25 mg a day and increased to 50 mg a day after the first week. The daily dose then may be increased in 50 mg increments over a period of weeks. The maximum recommended dose is 200 mg a day.

• In children and adolescents: it can only be administered to children and adolescents aged 6-17 years old. 

• The recommended dose for children aged 6-12 is 25 mg a day. After one week the doctor may increase it to 50 mg a day. The maximum is 200 mg a day. 

• The recommended dose for adolescents aged 13-17 is 50 mg a day. The maximum is 200 mg a day.

What if I miss a dose?

Don’t panic, just take the next dose at scheduled. Do not take a double dose to make up for the one you forgot. 

Side effects 

According to the most common side effects according to rxlist.com include:

• sleepiness
• drowsiness
• tired feeling
• nervousness
• sleep problems (insomnia)
• dizziness
• nausea
• skin rash
• headache
• diarrhea
• constipation
• upset stomach
• stomach pain
• dry mouth
• changes in appetite
• abnormal sexual release
• impotence
• decreased sex drive
• difficulty having a sexual release
• dry mouth, and
• weight loss.

Serious side effects

Serious side effects for sertraline intake (rxlist.com) include:

• very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, feeling like you might pass out;
• agitation, hallucinations, fever, overactive reflexes, tremors;
• nausea, vomiting, loss of appetite, feeling unsteady, loss of coordination;
• trouble concentrating, memory problems, weakness, fainting, seizure, shallow breathing, or breathing that stops.

Sertraline interaction with other substances 

Sertraline may interact with:

• Non-steroidal anti-inflammatory drugs
• Other medicines that can make you sleepy: cold or allergy medicine, sedatives, narcotics, sleeping pills, muscle relaxants and medicines for seizures or anxiety. 

What happens if I stop taking Sertraline?

Do not stop taking the medication unless you are instructed by your physician.

It is necessary to reduce gradually your dose of sertraline over a period of several weeks before you can stop the medication.

If you stop taking it suddenly, you may experience side effects such as:

• Dizziness
• Numbness
• Sleeping problems
• Agitation or anxiety
• Headaches 
• Feeling sick
• Shaking

It is recommended to speak to your doctor if you experience any of the symptoms while stopping the medication. 

Sertraline overdose

If you or someone you know take more sertraline than the original amount prescribed, you should contact your doctor immediately or contact emergency services.

Symptoms of overdose may include:

• Drowsiness 
• Nausea and vomiting
• Rapid heart rate
• Shaking 
• Agitation 
• Dizziness
• Unconsciousness (rare occasions)

Sertraline and alcohol

Alcohol intake should be avoided while being treated with sertraline.

What is Citalopram?

Citalopram is a type of antidepressant (Selective Serotonin Reuptake Inhibitor or SSRI), as we discussed previously, often used to treat depression and also sometimes it is prescribed to treat panic attacks. 

Research has suggested its effectiveness in helping people recover from depression and has been shown fewer side effects compared to other antidepressants.

However, it is only available on prescription, in the form of tablets or liquid drops for faster intake.

It usually takes between 4 to 6 weeks for Citalopram to start working and as with any other drug, it poses the risk of experiencing side effects.

Some of the common side effects include but are not limited to tiredness, dry mouth, and sweating excessively.

How and when to take it?

You need to take it once a day (at any time of the day but it is recommended to take it in the morning if you have trouble sleeping) and it won’t make a difference if you take it with or without having food.

What are the Common Side effects of Citalopram?

Some of the most common side effects can include feeling nauseous, dry mouth, loss of appetite, fatigue, drowsiness, sweating excessively, blurred vision and constant yawning. 

How much do I have to take?

Citalopram tablets come in different doses ranging from 10mg to 40mg and the usual recommended dose for adults is 20mg a day (max dose of 40mg a day).

In children, the usual dose is 10mg a day, but it may get increased to 40mg a day as it is the case for adults. 

If you take too much by accident or get to experience symptoms such as the following, contact your doctor straight away:

• Being sick (vomiting)
• Shaking
• Feeling sleepy
• Fast heart rate
• Seizures

Be aware that your body needs to gradually get used to the medicine, as soon as this happens, some of the side effects might disappear.

However, if they are persistent in time or get worse, you need to seek medical assistance. 

Some of the serious effects are listed as follows:

• Chest pain or pressure or shortness of breath
• Severe dizziness or passing out (fainting)
• Black stools
• Painful erections that last longer than 4 hours – this may happen even when you’re not having sex
• Vomit that looks like coffee beans
• Having seizures
• Easy bruising or bleeding
• Any bleeding that’s very bad or you can’t stop, such as cuts or nosebleeds that won’t stop within 10 minutes

Sertraline vs Citalopram serotonin syndrome

Both drugs can increase the serotonin levels and in some cases (very rare) it can cause a condition called serotonin syndrome.

Some of the symptoms include but are not limited to:

• Having a very fast heart rate
• Having hallucinations
• Losing your coordination easily
• Severe dizziness
• Severe nausea or vomiting
• Severe diarrhea
• Twitches in your muscles
• High fever
• Feeling agitated or restless

What are the symptoms related to Citalopram Overdose?

These are some of the symptoms that have been reported in cases of citalopram overdose:

• Convulsion or seizures
• Tachycardia or an accelerated heart rate
• Somnolence (feeling sleepy)
• QT prolongation 
• Coma
• Vomiting
• Tremors
• Hypotension
•   Cardiac arrest
• Nausea
• Serotonin syndrome
• Agitation or restlessness 
• Bradycardia or having a very low heart rate
• Feeling dizzy
• Hypertension
• Sweating excessively
• Hyperventilation 

Can I die from a Citalopram Overdose?

There are conflicting facts about dying from citalopram overdose.

Most of the studies suggest that you are not actually able to die from a citalopram overdose but from the interaction of citalopram with other substances like alcohol or other drugs.

Antidepressants: Suicidal Risk

Some studies have shown that taking antidepressants is associated with a higher risk of suicidal behavior (suicidal thinking or attempts) when compared to placebo drugs.

This risk has been associated with age in the case in children, adolescents, and adults with major depressive disorder (MDD) or related psychiatric disorders. 

One study conducted by the Centre for Suicide Research in Oxford, England attempted to identify which antidepressant drugs were more closely related to suicides or suicide attempts using coroners reports and hospital admissions from six hospitals across the United Kingdom and Wales (between 2000 and 2006). 

They found that Tricyclic antidepressants or TCAs had the highest toxicity and rate of fatality compared to other classes of antidepressants.

Additionally from the SSRIs group, Citalopram indicated to be the one with the highest toxicity and fatality rates. 

Besides being a treatment often used for depression, it can also be prescribed for the treatment of other major psychiatric disorders such as Obsessive-compulsive disorder (ODD), Panic disorder, premenstrual dysphoric syndrome (PMDD), anxiety disorders, post-traumatic stress disorder (PTSD) and eating disorders. 

People under antidepressant medication should always be monitored and observed closely to help reduce or prevent suicidal behavior.  

Sertraline vs Citalopram: bottom line commonalities and differences

• Citalopram is prescribed for depression while sertraline is prescribed for depression and additional mental disorders.
• Sertraline is metabolized with an average half-life of 22 to 36 hours while Citalopram has an average half-life of about 36 hours meaning Sertraline gets metabolized faster than citalopram.
• Citalopram may contain lactose while sertraline does not.
• They both have similar side effects.
• Drug interactions for both are also similar and can potentially cause serotonin syndrome.
• They are both associated with the risk of suicidal behavior.

Why is this blog about Sertraline vs Citalopram important?

This sertraline vs citalopram guide can help you answer some questions of whether you should start taking one or the other.

Either way, precautions, and recommendations need to be taken into consideration when starting to take a new drug.

Always follow you, doctors, instructions, if he or she prescribed is because it was the best option for you and your health. 

Please feel free to comment in the comments section below!

Frequently Asked Questions (FAQs) about Sertraline vs Citalopram 

References

Rxlist: Celexa

Everyday Health: What is Citalopram (Celexa)?

Medicines.org.uk

NHS: Citalopram

Very Well Mind: How to tell if someone Has overdosed on antidepressants

Rxlist.com

Pfizer Zoloft Medication Guide

Singlecare.com