Our expert says:
Brilliant question, boo old mate. I haven't seen a good answer to it. Of course the guys who sold the racemic mixture as citalopram in those days didn't emphasize side-effects as worrisome. Until they lost the exclusive patent on that form, and switched to escitalopram. Many drugs seem to be discovered in a racemic form, and its intiguing that its usually only when the patent on that version is about to run out, that companies find the non-racemic version ( on which they can get a fresh patent ) and market it instead.
I like your argument, that the non-racemic ( left AND right-handed versions of the molecules, for folks not into such chemistry ) form being the more active may well have the more side-effects. Not necessarily so, however, as even drugs / chemicals which have no useful benefits may have side-effects. But only if the sexual side-effects and fatigue were caused only by the less effective version, would the escitalopram be free of these effects.
Also, the extent to which any of us is bothered by side-effects is very individual, and on the same drug, one person may have no complaitns and another is severely troubled by them.
The ultimate test is actually trying them both, as you haven. And if you experienced the benefits you needed, with less troublesome side-effects on the citalopram, I'd go with that.
A benefit of citalopram is that it is available in cheaper but equally effective generic forms.
As apparently ou didn't have the paic atacks on citalopram, they shouldn't return when you return to that drug.
Sadly, what we absolutely know for sure about drugs is never as certain as we'd like
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