Citalopram

Citalopram is a prescription antidepressant medication that belongs to a class of drugs called selective serotonin reuptake inhibitors, or SSRIs. It works by increasing the amount of serotonin, a natural mood-regulating chemical, in your brain. Doctors prescribe citalopram primarily to treat major depressive disorder in adults.

This medication comes in tablet form and is taken once daily, usually in the morning or evening. Citalopram is sold under the brand name Celexa, but generic versions are widely available and more affordable. The medication typically takes 1 to 4 weeks to start improving symptoms, though some people may need 6 to 8 weeks to feel the full benefit.

Citalopram requires a prescription from a licensed healthcare provider. Your doctor will determine if this medication is right for you based on your symptoms, medical history, and other medications you take. Regular follow-up appointments help ensure the medication is working properly and not causing concerning side effects.

• Major depressive disorder in adults
• Generalized anxiety disorder, though not FDA-approved for this use
• Panic disorder, as an off-label treatment option
• Obsessive-compulsive disorder, when other treatments have not worked
• Social anxiety disorder, as an alternative SSRI option

Citalopram works by blocking the reabsorption of serotonin in your brain. Serotonin is a chemical messenger that helps regulate mood, sleep, appetite, and emotional responses. When brain cells release serotonin, they normally reabsorb it quickly through transporters. Citalopram blocks these transporters, allowing more serotonin to remain available between brain cells.

This increased serotonin activity helps improve communication between nerve cells. Over time, this can reduce symptoms of depression like persistent sadness, loss of interest, and low energy. The medication does not work instantly because your brain needs time to adjust to the higher serotonin levels and form new neural pathways.

The typical starting dose for adults is 20 mg taken once daily. Your doctor may increase the dose to 40 mg per day based on your response and tolerance. The maximum recommended dose is 40 mg daily due to risk of heart rhythm problems at higher doses. Older adults over 60 typically start at 20 mg and should not exceed 20 mg daily. Your doctor determines your exact dose based on your age, medical conditions, and how you respond to treatment.

• Nausea or upset stomach, especially during the first few weeks
• Dry mouth and increased thirst
• Drowsiness or feeling tired during the day
• Trouble sleeping or unusual dreams
• Increased sweating, particularly at night
• Sexual side effects, including decreased desire or difficulty with orgasm
• Weight changes, either loss or gain
• Dizziness or lightheadedness when standing up

Serious side effects require immediate medical attention. These include irregular heartbeat, severe dizziness or fainting, seizures, unusual bleeding or bruising, and eye pain or vision changes. Contact your doctor right away if you experience worsening depression, suicidal thoughts, severe anxiety, panic attacks, or unusual behavior changes. A rare but serious condition called serotonin syndrome can occur, causing fever, confusion, rapid heart rate, and muscle stiffness.

• Monoamine oxidase inhibitors, or MAOIs, which can cause dangerous serotonin syndrome. Wait at least 14 days after stopping MAOIs before starting citalopram.
• Other antidepressants, including SSRIs, SNRIs, and tricyclics, which increase serotonin syndrome risk
• Blood thinners like warfarin, as citalopram may increase bleeding risk
• NSAIDs and aspirin, which can increase bleeding when combined with citalopram
• Medications that affect heart rhythm, including certain antibiotics and antipsychotics
• Tramadol and other opioid pain medications, which increase seizure and serotonin syndrome risk
• St. John's Wort, an herbal supplement that can cause dangerous interactions
• Drugs that affect liver enzymes, which may change how your body processes citalopram
• Alcohol, which can worsen side effects like drowsiness and dizziness

Your doctor should monitor your sodium levels while taking citalopram, especially if you are older than 65 or taking diuretics. Low sodium, also called hyponatremia, is a known side effect that can cause confusion, weakness, and seizures. Liver enzyme tests help ensure the medication is not affecting your liver function. Your doctor will likely check these before starting treatment and periodically while you take the medication. Regular appointments also allow your doctor to monitor your mood, suicide risk, and heart rhythm, particularly at higher doses.