Citalopram vs Escitalopram: What You Need to Know

If you’ve been prescribed an SSRI, chances are the doctor mentioned citalopram or escitalopram. They sound similar, but they’re not identical. Knowing the practical differences can save you trips to the doctor and help you feel better faster.

How They Work

Both drugs belong to the selective serotonin reuptake inhibitor (SSRI) family. They increase serotonin levels in the brain, which lifts mood and eases anxiety. The chemistry is where the split happens: escitalopram is the pure “S‑enantiomer” of citalopram, meaning it’s the active part of the molecule without the extra “R‑enantiomer” that sits in citalopram. In simple terms, escitalopram is a cleaner version of the same recipe.

Because of that extra purity, escitalopram often works at lower doses. Where citalopram might start at 20 mg a day, escitalopram can be effective at 10 mg. The lower dose can mean fewer side effects for some people, but it also depends on how your body reacts.

Practical Differences

Dosage and potency. Escitalopram is roughly twice as potent as citalopram. That’s why doctors may start you on a smaller pill count. If you switch from citalopram to escitalopram, the dose usually gets cut in half.

Side effects. Both meds share common SSRI complaints—nausea, dry mouth, and mild sexual changes. Some patients report that escitalopram causes less weight gain and fewer sleep disturbances, but the evidence isn’t universal. If you’ve tried citalopram and felt foggy, escitalopram might feel a bit clearer.

Onset of action. Users often notice mood improvement within 1‑2 weeks for either drug, but a few people say escitalopram gives a quicker lift. The difference is usually small, about a few days.

Drug interactions. Both interact with other serotonergic meds (like tramadol or certain migraine treatments) and can raise the risk of serotonin syndrome. Because escitalopram is taken at a lower dose, some doctors view it as a safer choice when you’re on multiple meds.

Cost and availability. Citalopram is older and often cheaper, especially as a generic. Escitalopram generics have become more common, but the price gap can still exist depending on your pharmacy.

So, which one should you pick? If you’re sensitive to side effects or need a lower pill count, escitalopram might be worth a try. If cost is a big factor and you’ve tolerated citalopram well, staying with it could make sense. Always talk to your prescriber before swapping; they’ll consider your health history and any other meds you take.

Bottom line: both drugs aim to boost serotonin and lift mood, but escitalopram is a more refined, often lower‑dose version of citalopram. The choice comes down to how you react, your budget, and what your doctor recommends.