Taking the Antidepressant Citalopram (Celexa)
What Is Citalopram?
Citalopram is a selective serotonin reuptake inhibitor (SSRI), which is currently the most popular and effective class of antidepressant medication. In addition to treating depression, citalopram can also be prescribed to treat obsessive-compulsive disorder, anxiety disorders, panic disorder, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), and some eating disorders. It may be prescribed off label to ease some withdrawal symptoms like depression.
The Food and Drug Administration (FDA) approved citalopram for prescription use in 1998. The medication is most commonly found as the brand name Celexa. However, the generic form is becoming more common, and it is currently manufactured by Teva Pharmaceuticals.
Citalopram tablets come in several doses: 10 mg, 20 mg, and 40 mg. There is also a liquid version of the medication to take orally, for people who cannot swallow tablets well. The liquid form is 10 mg per 5 mL. The FDA released a warning recently that no one should take more than 40 mg of citalopram per day, as the medication can increase electrical activity in the heart and lead to arrhythmias or other cardiovascular problems.
A physician or therapist will likely begin a citalopram prescription at 20 mg once per day. The dose can be adjusted up to 40 mg, or down to 10 mg, as needed. However, it can take several weeks for this medication to become effective, so it is important to continue taking this medication regularly for at least one month.
Conditions Treated by Citalopram
Like other SSRIs, citalopram helps to balance the amount of serotonin in the brain. The drug can influence how much serotonin the brain produces and how quickly it is absorbed by neurons. This neurotransmitter is associated with changes in mood, so when there is less available to the brain for neuron firing, the individual can feel low, depressed, sad, guilty, or lonely. As more serotonin is available to help neurons send messages, the individual will feel better.
Citalopram can be prescribed off label to treat alcohol withdrawal symptoms, such as depression, anxiety, and mood swings. While citalopram is less effective at immediately treating serious side effects of alcohol withdrawal, like seizures or panic attacks, the medication can help to balance brain chemistry enough for the person to experience fewer withdrawal symptoms if they do not develop delirium tremens.
What are the Side Effects of Citalopram?
- Dry mouth
- Appetite loss or changes
- Fatigue or drowsiness
- Blurred vision
- Excessive yawning
However, there are some serious side effects that need to be reported to a doctor immediately. These include:
- Rapid heartbeat
- Black stool
- Vomit that has the appearance of coffee grounds
- Shaking or tremors
- Easy bruising or bleeding
- Symptoms of an allergic reaction, including breathing changes or rash
Some people may experience an increase in suicidal thoughts or actions. Younger individuals are more susceptible to this effect. If suicidal ideation begins while taking citalopram, or the experience continues or worsens, it is important to speak with a doctor immediately.
Citalopram prescriptions have also been linked to a heart condition called QT prolongation. This involves an irregular, rapid, or pounding heartbeat. Although this condition is rarely fatal, symptoms of the condition, like dizziness or fainting, can be a sign of an underlying cardiovascular problem, which citalopram can worsen. Older adults are especially susceptible to QT prolongation.
There are some anecdotal reports of citalopram being used for nonmedical purposes. While the drug has little potential for abuse, people who have a history of struggling with prescription drug abuse may be more susceptible to taking citalopram inappropriately.
What are the Withdrawal Symptoms of Citalopram?
Even if citalopram is taken as directed, the body will eventually get used to the presence of the medication. This can lead to dependence on citalopram to regulate serotonin. When a person stops taking citalopram, even as prescribed, they could experience withdrawal symptoms.
Some of these symptoms include:
- A return of depression or suicidal thinking
- Memory difficulties
- Tremors or shaking
- Vivid dreams or nightmares
- Sexual dysfunction
It is important to speak with a doctor before stopping citalopram. The physician will likely begin a tapering schedule to gradually ease the body off dependence on the antidepressant. This approach helps to reduce or prevent withdrawal symptoms.
Although it is rare, it is possible to overdose on citalopram. Symptoms include:
- Chest pain
- Difficulty breathing
- Shortness of breath
- Dizziness or fainting
- Irregular, rapid heartbeat
- Loss of coordination
- Itching, rash, swelling in the face or lips, or other symptoms indicative of an allergic reaction
- Muscle twitches
It is important to get emergency medical help for anyone suffering an overdose, regardless of the drug. Immediately call 911.
Citalopram Interactions with Other Drugs
It is important not to mix antidepressant medications, especially MAO inhibitors. People who have taken other antidepressants should wait two weeks for the medication to clear their system before beginning a new antidepressant prescription. If antidepressants are mixed, the person could develop serotonin syndrome, which can be dangerous.
Symptoms of serotonin syndrome include:
- Rapid heart rate
- Coordination difficulties
- Severe dizziness
- Serious nausea or vomiting
- Involuntary muscle twitches
Citalopram can interact with other drugs too. NSAID painkillers, such as ibuprofen, blood thinners, and antiplatelet drugs, like clopidogrel, can all interact with citalopram and cause a bleeding disorder. Aspirin can also increase the risk of bleeding.
Dietary supplements like tryptophan and St. John’s wort interact with numerous medications, including citalopram. It is important not to take these while taking prescription medications.
People who take benzodiazepines and citalopram can experience increased drowsiness. It is possible for extreme sedation to occur, so consult a doctor before taking these medications together.
Alcohol and SSRIs like citalopram can interact in negative ways. Antidepressants can increase the effects of alcohol, particularly drowsiness. People who take SSRIs like citalopram report reduced tolerance to alcohol. Although a person can drink alcohol while taking prescription citalopram, the individual may feel drunk faster.
How Citalopram Can Affect Certain Physical Conditions
There are some physical conditions that can interact with citalopram. Some of these conditions include:
- Cardiovascular conditions
- Low potassium levels
- Low magnesium levels
- Kidney disease
- Liver disease
- Seizure disorders
- Allergies to other medications
People who have bipolar disorder may experience worse, or more intense, mania. In some cases, bipolar disorder can begin with depression, so the person may be misdiagnosed with major depression instead of bipolar disorder. If symptoms of hypomania or mania begin, it is important to take the person off the medication as soon as possible.
If a person has a bleeding disorder, citalopram can make this worse. Speak with a doctor before beginning a citalopram prescription to determine the risks.
When a person struggles with a mood disorder, such as depression or anxiety, they may develop a substance abuse disorder to self-medicate the symptoms related to their mental health. However, this can make the mood disorder worse over time, and it can lead to addiction and problems with substance abuse.
It is important to get help overcoming substance abuse, and for people who also struggle with co-occurring disorders, it is important to enter a rehabilitation program that can treat both conditions together. Rehabilitation programs offer individual and group therapy to help the person understand their addiction, the triggers for the condition, and how they can cope with stress better in the future.
If a person’s depression contributes to substance abuse, they may receive a prescription for mood-elevating medications like citalopram. However, prescription medications work best when combined with therapy. Use of antidepressants should be part of a comprehensive treatment program that includes intensive therapy.
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