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What is the differance between celexa and wellbutrin sr?? Is one better for depression than the other one?



Answered by: David Kahn

Celexa, or citalopram, is a type of antidepressant known as an SSRI, or selective serotonin reuptake inhibitor.It increases the activity of a neurotransmitter in the brain called serotonin. Other medications in this family include Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), and Lexapro (escitalopram). Lexapro is very closely related in its molecular structure; the others share the same mechanism but are very different in their chemical structure.

Wellbutrin, or bupropion, has a different mechanism of action which is not as clearly understood, but it does not directly affect serotonin, working instead on other neurotransmitters such as norepinephrine and adrenalin. Wellbutrin comes in several forms; "SR" means sustained release, while "XL" means extended release - there is little difference here. Without the letters SR or XL, plain bupropion is a tablet that releases the drug into the blood stream a little more rapidly than the others. The slow release forms are no more effective but can be taken just once or twice a day instead of 2 or 3 times a day. There are no other drugs that are related to Wellbutrin.

Both medications will help a similar perecentage of depressed patients, roughly 60% of individuals. Celexa is somewhat better when anxiety is present, and also treats anxiety disorders (panic disorder, obsessive compulsive disorder, generalized anxiety) in individuals who are not especially depressed. Its major side effect is sexual dysfunction in up to 50% of patients, and mild weight gain in perhaps 25%. It is sometime sedating and sometimes can cause upset stomach. Wellbutrin is free of sexual side effects and does not cause weight gain, and is slighly stimulating; it can sometimes cause insomnia or anxiety. Very rarely, it can cause a epileptic seizure if the dose is too high, and for this reason should not be used by people who have epilepsy or any neurological condition that could make a seizure more likely. The slow release forms are believed to be less likely to cause a seizure, but I emphasize again that this is a very rare occurence.

Neither medication is "better" for depression; it just depends on the person, and what types of symptoms or side effects are of greatest concern. Some people will do better on one than the other, and some people do best on the combination if neither medication works perfectly by itself.

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David Kahn, M.D.
 

David A. Kahn, M.D.

Dr. Kahn is the Diane Goldman Kemper Family Clinical Professor of Pyschiatry Emeritus, Columbia University Medical Center; and attending psychiatrist, New York Presbyterian Hospital.

He received his B.A. from Haverford College in 1975, completed medical school and internship in medicine at Columbia, and was resident and chief resident in psychiatry at Columbia Presbyterian Medical Center and the New York State Psychiatric Institute. He then received an NIMH extramural research fellowship at the Psychiatric Institute, where he worked in the area of mood disord...
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