The term "elopram" is not a brand name in the United States, but is utilized in other countries to designate either of two closely related antidepressant medications: citalopram (brand name Celexa) or escitalopram (brand name Lexapro). Both are part of the selective serotonin reuptake inhibitor (SSRI) class and function similarly in the brain, but they have key differences in their chemical structure, potency, and approved uses. Patients prescribed a medication under this name should confirm with their doctor or pharmacist whether they are receiving citalopram or escitalopram.
What is Elopram's Active Ingredient?
Citalopram (Celexa)
Citalopram is a medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD) in adults. Chemically, citalopram is a racemic mixture, meaning it contains two mirror-image isomers: the S-enantiomer and the R-enantiomer. It works by increasing the amount of serotonin in the brain, a neurotransmitter that helps regulate mood.
Escitalopram (Lexapro)
Escitalopram is the purified S-enantiomer of citalopram. This makes it a more selective and potent inhibitor of serotonin reuptake compared to citalopram. The FDA has approved escitalopram for the treatment of major depressive disorder in adults and adolescents, as well as for generalized anxiety disorder (GAD). Some studies suggest escitalopram may have a faster onset of therapeutic effect and slightly better efficacy for depression and anxiety compared to citalopram.
How Do These Medications Work?
Both citalopram and escitalopram belong to the SSRI drug class. They work by selectively inhibiting the reuptake of serotonin by nerve cells in the brain. Normally, serotonin is released into the synaptic cleft, and then some of it is reabsorbed. By blocking this reabsorption, SSRIs increase the concentration of serotonin available to bind to postsynaptic receptors, which helps to improve mood over time. It can take several weeks for the full antidepressant effects to become noticeable, as the brain adapts to the increased serotonin levels.
What Conditions Are Treated with Citalopram and Escitalopram?
While their primary use is for depression, these medications can be prescribed for a variety of conditions. However, the FDA-approved indications differ.
Citalopram (Celexa):
- Major depressive disorder (MDD) in adults.
- Off-label uses: Panic disorder, obsessive-compulsive disorder (OCD), and others.
Escitalopram (Lexapro):
- Major depressive disorder (MDD) in adults and adolescents aged 12 and older.
- Generalized anxiety disorder (GAD) in adults.
- Off-label uses: Social anxiety disorder, panic disorder, and OCD.
Comparison of Citalopram and Escitalopram
| Feature | Citalopram (racemic) | Escitalopram (single isomer) |
|---|---|---|
| Potency | Less potent; contains both active (S) and inactive (R) isomers. | More potent and selective for serotonin reuptake. |
| Dosage | Maximum daily dose is higher (e.g., 40 mg). | Maximum daily dose is lower (e.g., 20 mg). |
| FDA Approval | Adults with MDD. | Adults & adolescents with MDD; adults & adolescents with GAD. |
| Cardiac Risk | Higher risk of dose-dependent QT prolongation, requiring monitoring at higher doses. | Lower risk of QT prolongation, especially at typical doses. |
| Tolerability | Generally well-tolerated, but some studies suggest slightly lower tolerability than escitalopram. | Often better tolerated and with fewer drug interactions. |
| Onset | May take 4–6 weeks for full effect. | Some studies suggest a possibly faster onset. |
Important Considerations and Side Effects
Like all medications, these SSRIs can cause side effects. Many are mild and improve over the first couple of weeks of treatment. It is important to discuss all potential side effects and concerns with a doctor.
Common Side Effects:
- Nausea and gastrointestinal issues like diarrhea or constipation.
- Dizziness, drowsiness, or difficulty sleeping (insomnia).
- Increased sweating and dry mouth.
- Sexual dysfunction, including decreased libido and delayed orgasm or ejaculation.
- Fatigue and weakness.
Serious Warnings and Side Effects:
- Suicidal Thoughts: A boxed warning from the FDA highlights an increased risk of suicidal thoughts and behavior in children, adolescents, and young adults (under 24) who take antidepressants, especially when starting or changing the dose. Close monitoring by a healthcare provider is essential.
- Serotonin Syndrome: A rare but potentially life-threatening condition caused by an excess of serotonin. Symptoms include agitation, hallucinations, racing heartbeat, muscle rigidity, and fever.
- QT Prolongation: Citalopram, especially at higher doses, can cause a dose-dependent prolongation of the QT interval, an electrical measure of heart rhythm. This can lead to potentially serious heart rhythm issues and is a reason for maximum daily dose limitations. Escitalopram has a lower risk.
- Hyponatremia: Low sodium levels in the blood, more common in older adults or those on diuretic medication.
Discontinuation Syndrome
Suddenly stopping citalopram or escitalopram can cause discontinuation syndrome, which is a collection of withdrawal-like symptoms. These symptoms can be unpleasant and include anxiety, irritability, dizziness (often called "brain zaps"), headache, and numbness. To minimize this risk, it is crucial to follow a doctor's guidance on gradually tapering the dose before stopping the medication.
Conclusion
The term elopram generally refers to either citalopram or escitalopram, two SSRI antidepressants prescribed for mood and anxiety disorders. While similar in their mechanism of increasing brain serotonin, they differ in their chemical structure and approved uses. Escitalopram is a purer and more potent version, approved for a broader range of patients and conditions and carrying a lower risk of cardiac issues compared to citalopram. Both require a doctor's prescription, careful dosage management, and monitoring for side effects, particularly regarding suicidal ideation in young adults and cardiac safety. For more detailed pharmacological information, review the Citalopram entry from StatPearls on the NCBI Bookshelf.
(Disclaimer: This article provides general information and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider before starting, stopping, or changing any medication.)
