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Best SSRI for anxiety

18 replies

Fedup99990 · 25/02/2020 18:29

I’ve been on citalopram on and off for a few years. I have read that escitalopram is more effective in treating anxiety than citalopram and also is less likely to cause weight gain.
I spoke to my gp about changing and she said this was untrue and the are the same drug. She suggested either increasing my dose of citalopram or changing to sertraline.
I’m wondering why she was so against escitalopram and if it really is better.
Maybe escitalopram is more expensive as it’s a newer drug therefore she didn’t want to prescribe it?
I’d appreciate any views and experiences.
TIA 😊

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FakeFraudSquad · 25/02/2020 18:35

I found escitalopram and citalopram absolutely useless but Sertraline has been incredible. The first two weeks while it was getting into my system were very difficult and initially things were a bit worse but I was told this would be the case and given support to get through it. I’d definitely recommend Sertraline over escitalopram any day of the week. I’ve not been on it that long so far but it already feels life changing in a very positive way.

Also, shallow but I gained loads of weight on citalopram and escitalopram quite rapidly. My weight has remained really stable and if anything I could lose weight on Sertraline if I put my mind to it.

Fedup99990 · 25/02/2020 18:42

That’s really interesting, thank you. Can I ask how you’ve been on sertraline with no weight gain?

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FakeFraudSquad · 25/02/2020 18:44

Did you mean how long? Since November. I was putting on 7lbs a month with no dietary changes on citalopram! It was awful. I lost two stone over a year and a half after stopping citalopram and escitalopram.

Fedup99990 · 25/02/2020 18:58

Sorry, yes I meant how long!

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Fedup99990 · 25/02/2020 18:59

Wow, that’s even worse than my weight gain when I took setoxat years ago. I put on nearly 3 stone in 2 years.

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Ilovewheelychairs · 25/02/2020 19:17

I switched from Citalopram to Escitalopram for the same reason and it was life changing! They aren't the same drug, my doctor explained it as the drugs being a mirror image of each other. Escitalopram is also stronger; 10mg of Escitalopram is equivalent to 20mg of Citalopram.

However, it really does depend on you and your body. I've tried Sertraline twice and it's absolutely useless for me; makes me so foggy headed I actually do things like drive to the wrong places because I can't think straight! Citalopram only had any effect for me at a 60mg dose (which used to be the upper limit but has since been reduced to 40mg).

For me, Escitalopram is the drug that has changed my life. It works completely differently for me than Citalopram. Escitalopram is more expensive than both Sertraline and Citalopram which may be why your doctor is unwilling to prescribe it. Maybe try another GP?

Hope you get the right drug for you soon!

Fedup99990 · 25/02/2020 19:25

Thank you. I think I might try a different gp. She was very dismissive of escitalopram and said it was the same drug once it was broken down.

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lennyhenryslaugh · 25/02/2020 19:30

What about fluoxetine ?

Fedup99990 · 25/02/2020 20:16

I thinks that’s probably not suitable for me.

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Fedup99990 · 26/02/2020 07:04

Anyone else got any thoughts?

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Fedup99990 · 27/02/2020 18:37

Bump..

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delfaye133 · 28/02/2020 05:42

Sertraline is the best SSRI.

delfaye133 · 28/02/2020 05:44

Plus you can take it whilst being pregnant. However I will warn you, the baby does experience some withdrawal upset - something doctors & midwives will never tell you!

Missushbb · 28/02/2020 09:47

I have put on about 2.5 stone since starting citalopram and I was overweight to begin with. W

Fedup99990 · 29/02/2020 17:35

Spoke to a different doctor and now have escitalopram - 5mg for the first month.

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Zinco · 29/02/2020 21:26

There was a 2018 meta review of antidepressants that got a lot of media attention at the time: it was supposed to be proved that they do work better than placebo.

Anyway, from memory, Escitalopram came out as the best SSRI taking into account both tolerability and effectiveness. However, it's a matter of individual response, so you just have to try it vs Sertraline to know for sure.

Citalopram just is Escitalopram in one sense, but in another sense they are different. Mirror images is kind of it, but Citalopram is a mix of two stereoisomers (one of which is the Escitalopram form), whereas Escitalopram just has that one form by itself.

So 20mg of Citalopram contains, in a sense, 10mg of Escitalopram. Are they really any different to take? Possibly they are, as it is theorized that the other stereoisomer isn't merely inert, but actually gets in the way of the active form working.

As for price, a few years back Escitalopram was twenty times the price of Citalopram, so understandably it may have been harder to get on the NHS. The price came down to about the same, but has now gone up a little bit. Nevertheless, it's still today a cheap drug for the NHS and if you are paying a prescription charge the cost is likely completely covered. I don't know a reason today why you wouldn't use escitalopram in favour of citalopram. Less QT interval prolongation also, which is a minor concern in using them.

Zinco · 29/02/2020 21:33

"Thank you. I think I might try a different gp. She was very dismissive of escitalopram and said it was the same drug once it was broken down."

That's half-true, but also possibly half-false as I just mentioned. You can't argue with doctors however... I like to try sometimes...

Elliejane · 22/06/2022 07:03

@Fedup99990 I know this is old post but just wondering how you got on
I am struggling with anxiety big time and used to be on citropram last year and my gp suggested trying escitalopram but I am so scared as had such horrible start up last time

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