Citalopram, commonly known as Celexa, is a selective serotonin reuptake inhibitor (SSRI) used to treat depression in adults. This antidepressant medication should be taken under medical supervision to prevent dangerous adverse interactions.

Citalopram brand names

Citalopram is available as generic citalopram or by the brand name Celexa.

What is citalopram prescribed for?

The U.S. Food and Drug Administration (FDA) approved citalopram for treating major depressive disorder in adults. There are additional risk factors to consider when used in the treatment of depression symptoms in pediatric patients.

Less commonly, citalopram is used off-label to treat: [3]

How does citalopram work?

Citalopram is a selective serotonin reuptake inhibitor (SSRI). SSRIs like Celexa work in the body by preventing the reuptake of serotonin in the brain, resulting in a higher serotonin level.

Experts believe that serotonin - a neurotransmitter - is a "feel-good" chemical in the brain that helps regulate multiple bodily functions such as the stress response. Researchers have linked low serotonin levels to depression symptoms in some cases.

Medical monitoring of all prescriptions taken in conjunction with citalopram, or other SSRI medications, is critical, as serotonin syndrome can occur if serotonin levels become too high. Serotonin syndrome can be life threatening.

How is citalopram usually taken?

Citalopram is taken orally in a tablet or liquid solution. This medication is only available by prescription and should be used as prescribed by your doctor or healthcare provider. Never take citalopram without medical advice.

Citalopram is usually taken once a day. It is not necessary to take citalopram at a certain time of day; however, it is important to take it consistently at the same time every day.

It is recommended that Celexa be prescribed at a lower initial dose and gradually increased to a therapeutic dose over at least a week. Dosages typically range between 20-40 mg per day. [1]

Liquid solutions should be measured with the supplied device to ensure the accuracy of the dose. [2]

How long does citalopram stay in your system?

Citalopram has a relatively long half-life of 35 hours. The body will eliminate most of the medication within seven days of the last dose. However, for some people, it may still be detectable in their system for up to 14 days.

Citalopram can take up to four weeks for its benefits to be felt as its level within the body builds to a therapeutic level. [3] It is likely the doctor will gradually lower the daily dosage when discontinuing the use of this medication to avoid withdrawal symptoms.

Celexa withdrawal symptoms include: [1]

  • Nausea
  • Depressed mood
  • Irritability/agitation
  • Dizziness
  • Paresthesia
  • Tremors
  • Anxiety
  • Headache
  • Lethargy
  • Insomnia
  • Tinnitus
  • Seizures

Citalopram side effects

Citalopram side effects include mild symptoms and more serious complications. Mild side effects typically resolve on their own.

Common side effects include: [3]

  • Gastrointestinal upset: nausea, vomiting, diarrhea, constipation, stomach pain, heartburn
  • Appetite and weight change
  • Dry mouth, increased thirst
  • Sleep disturbance
  • Daytime sleepiness
  • Changes in menstrual periods
  • Runny nose or nosebleeds
  • Uncontrollable muscle movements
  • Muscle and joint pain

SSRIs, including Celexa and its generic version, have been known to cause sexual dysfunction such as decreased libido for all genders. [1] It is important to discuss changes in sexual functioning with the doctor to manage these adverse effects and rule out other potential causes.

People experiencing severe citalopram side effects should immediately discuss their concerns with the doctor.

Severe citalopram side effects include: [3]

  • Chest pain
  • Dizziness, fainting, or loss of consciousness
  • Irregular heart rate or changes in heart rate
  • Unusual bleeding or bruising
  • Headache
  • Confusion or memory lapse
  • Seizures
  • Respiratory depression
  • Changes in mood including agitation or thoughts of suicide
  • Loss of coordination
  • Muscle weakness

Seek emergency medical assistance if any symptoms of an allergic reaction occur. Symptoms of an allergic reaction to citalopram include: [2]

  • Hives
  • Rash
  • Blisters
  • Fever
  • Joint pain
  • Respiratory difficulty
  • Swelling of the face, throat, lips, or tongue

Citalopram precautions

Preexisting medical conditions need to be discussed with a doctor or healthcare professional before taking citalopram to avoid dangerous adverse reactions.

Citalopram may not be safe for people who have ever had: [2]

  • Heart problems, including irregular heart rhythm
  • High blood pressure
  • Stroke
  • Liver or kidney disease
  • Glaucoma
  • Seizures
  • Bipolar disorder
  • Low sodium
  • Bleeding disorders
  • Long QT syndrome (a heart rhythm disorder)

Citalopram, and other SSRI medications, can sometimes cause thoughts of suicide. There is an increased risk of suicide thoughts for children and teens. [2]

Citalopram is linked to mania symptoms in those with bipolar disorder. It is important to discuss any sudden changes in mood or behavior with the doctor while taking citalopram.

Citalopram is not safe for use during pregnancy or while breastfeeding. However, before stopping citalopram due to pregnancy, it is important to speak with the doctor about gradually decreasing the dose. [1]

Alcohol used in conjunction with citalopram may cause worsening of its side effects.

Citalopram may cause increased drowsiness during the day. Caution should be taken before operating heavy machinery, including driving a car, until the effects of citalopram are known. [3]

Citalopram interactions

Citalopram is not safe in conjunction with certain other medications. This risk is not limited to only other prescription medications.

Speak with the doctor about all over-the-counter medications and herbal products or supplements used before taking citalopram.

Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided while taking citalopram due to the potential risk of bleeding or bruising. This includes aspirin, ibuprofen, naproxen, Advil, Aleve, and Motrin. [2]

Celexa is unsafe for use while taking monoamine oxidase inhibitors [MAOI] due to an increased risk of serotonin syndrome. Citalopram and MAOIs should not be used within 14 days of each other. [1]

Using Celexa while taking an anti-platelet agent or anticoagulant medication, such as warfarin, can increase the risk of bleeding. [1]

Additionally, citalopram and the following medications or supplements have had adverse reactions: [2]

  • Cimetidine
  • Diuretics
  • Lithium
  • St. John's wort
  • Tramadol
  • Tryptophan/L-tryptophan

Citalopram should not be taken in conjunction with any other SSRI medications. Doing so greatly increases the risk of serotonin syndrome.

Serotonin syndrome is a life-threatening situation caused by too much serotonin in the body. The risk of serotonin syndrome is higher when two or more medications affecting serotonin are used together.

Symptoms of serotonin syndrome include: [4]

  • Agitation
  • Restlessness
  • Irregular eye movement
  • Diarrhea, nausea, vomiting
  • Heartrate changes, high blood pressure, rapid changes in blood pressure
  • Fever
  • Loss of coordination
  • Overactive reflexes

If any of these warning signs occur while taking citalopram, immediately seek medical attention.

Storing citalopram

Citalopram should be stored in a closed container, at room temperature, away from moisture. [3]

Carefully store prescription medication away from the access of children and teenagers to prevent prescription misuse.

Do not dispose of citalopram by flushing it down the toilet. [3] A pharmacist can advise on the best method for disposing of any unused medication.

What to do if you overdose on citalopram

An overdose on citalopram requires immediate emergency medical attention, especially if severe symptoms occur. The poison control helpline at 1-800-222-1222 can also help determine what steps need to be taken.

Signs of citalopram overdose include: [3]

  • Seizures
  • Loss of consciousness
  • Dizziness
  • Sweating
  • Vomiting, nausea
  • Dark-colored urine
  • Fast breathing
  • Irregular, pounding heart rate
  • Memory loss, confusion, drowsiness
  • Muscle pain, uncontrolled spasms
  • Bluish coloring around the mouth, fingers, or fingernails

Medically severe complications can occur, including death or long-term effects on bodily systems, if immediate medical care is not obtained.

Frequently asked questions about citalopram

How long does it take citalopram to kick in?

It takes between 1-4 weeks to feel the full effects of citalopram.

How long can you continue taking citalopram?

There is no established timeframe for how long citalopram should be taken. The doctor may recommend continuing the medication for at least four months after symptoms have improved to prevent relapse.

Experts suggest remaining on an SSRI for at least six months to a year for stabilization.

What are the alternatives to citalopram?

There are many alternatives to citalopram for treating depression symptoms, including other SSRI medications. If certain risk factors make it unsafe for an SSRI to be used, alternative classes of antidepressant drugs may be offered.

Alternatives to SSRI medications include Serotonin-noradrenaline reuptake inhibitors (SNRIs), MAOIs, and others. If you believe citalopram is not working for you or you are concerned about adverse effects, speak with your doctor about alternative options based on your personal needs.

Resources:

  1. 1. Allergan USA, Inc. (2022, February). Citalopram medication guide. U.S. Food and Drug Administration. Retrieved October 21, 2022, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020822s041lbl.pdf
  2. Citalopram. (n.d.). Drugs.com. Retrieved October 20, 2022, from https://www.drugs.com/citalopram.html
  3. Citalopram: MedlinePlus Drug Information. (n.d.). Retrieved October 20, 2022, from https://medlineplus.gov/druginfo/meds/a699001.html
  4. Serotonin syndrome. (n.d.). Retrieved October 20, 2022, from https://medlineplus.gov/ency/article/007272.htm