Citalopram is in effect escitalopram that is more sedating and prolongs QTc more, so there is little reason to pick it first. Still, some patients who did badly on escitalopram do well on citalopram, so keep an open mind.
Compared with others
It is basically escitalopram that makes people sleepier and prolongs the heart rhythm. Not a bad medication, it just has downsides.
“It's again, just Lexapro, but it makes you more sleepy and it prolongs your heart rhythm. It's not a bad medication by any means. It's just got some downsides”
32:11Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDDMay 2026 There is little point to it: escitalopram is the active enantiomer. The one thing citalopram does better is prolong QTc. On the FDA data, escitalopram up to 20 mg did not significantly raise QTc.
“I never use Celexa citalopram. There is no point. The active enantiomer is Lexapro, okay? There is no point. Well, there's one point. If you want to prolong someone's QTC, you should use Celexa over Lexapro. If you actually look at the FDA data, Lexapro up to its... 20 milligram dose did not significantly increase QTC”
31:35Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025
Pearls
Some patients tolerate citalopram better than escitalopram, against what we are taught. One patient felt very uncomfortable on escitalopram with bad sexual side effects, then did great on citalopram.
“I find that sertraline has less side effects overall and sertraline is a little bit better tolerated even though it is the quote unquote most pure SSRI. I've had patients who tolerate citalopram better than escitalopram which goes against what we're taught”
10:00Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDDMay 2026 Also said in 1 more episode
“she's seen a ton of patients that had tried Lexapro in the past and had completely different response to Celexa. She brought up one case that like the patient felt super uncomfortable on Lexapro, had terrible sexual side effects, and then Celexa worked great for them”
33:11Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025 When the same drug works differently at different times, that is usually because a lot more is going on in the person's life than one medication.
“a lot of people's different responses at different times to the same medications, and you see this all the time with many different medications, It's more because there's a lot more going on with patients, with people than a single medication”
34:11Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025
From these episodes
- Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDDMay 2026 · 2 points
- Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025 · 3 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.