- Citalopram is a prescription medication primarily used to treat depression.
- It belongs to a class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs).
- Works by increasing serotonin levels in the brain, improving mood and emotional balance.
- Common brand name: Celexa.
How Does Citalopram Work?
- Inhibits the reabsorption (reuptake) of serotonin into nerve cells in the brain.
- Increases serotonin availability, a neurotransmitter associated with mood regulation.
- Enhances communication between brain cells, reducing symptoms of depression and anxiety.
Uses of Citalopram
Approved Uses
- Major Depressive Disorder (MDD): Alleviates symptoms of depression, including sadness, lack of energy, and loss of interest in activities.
Off-Label Uses
- Generalized Anxiety Disorder (GAD): Reduces excessive worry and tension.
- Obsessive-Compulsive Disorder (OCD): Helps manage compulsive thoughts and behaviors.
- Panic Disorder: Decreases the frequency and severity of panic attacks.
- Premenstrual Dysphoric Disorder (PMDD): Alleviates mood-related symptoms associated with the menstrual cycle.
- Post-Traumatic Stress Disorder (PTSD): Reduces symptoms of anxiety and intrusive thoughts.
Dosage and Administration
Dosage Guidelines
- Starting Dose: 20 mg once daily, usually in the morning or evening.
- Maintenance Dose: 20-40 mg daily, based on clinical response.
- Maximum Dose: 40 mg daily for adults, reduced to 20 mg daily for older adults or those with liver impairment.
Administration Tips
- Take with or without food.
- Consistency is key; take at the same time each day.
- Do not crush or chew tablets; swallow them whole.
- Avoid abruptly stopping the medication to prevent withdrawal symptoms.
Benefits of Citalopram
- Improves mood, sleep, and overall quality of life.
- Reduces feelings of hopelessness and anxiety.
- Helps patients re-engage in daily activities and social interactions.
- Well-tolerated with fewer side effects compared to older antidepressants like tricyclics or MAOIs.
Possible Side Effects
Common Side Effects
- Nausea.
- Dry mouth.
- Drowsiness or insomnia.
- Sweating.
- Diarrhea or constipation.
- Fatigue.
Less Common but Serious Side Effects
- Serotonin Syndrome: Symptoms include agitation, confusion, rapid heartbeat, and high fever.
- QT Prolongation: Irregular heartbeat or fainting; more common in higher doses.
- Seizures: Rare but possible in predisposed individuals.
- Allergic Reactions: Rash, itching, swelling, or difficulty breathing.
- Suicidal Thoughts: Particularly in young adults during the initial treatment phase.
Drug Interactions
Medications to Avoid or Use with Caution
- Monoamine Oxidase Inhibitors (MAOIs): Risk of serotonin syndrome; avoid using within 14 days of MAOI discontinuation.
- NSAIDs and Blood Thinners: Increased risk of bleeding.
- Other SSRIs/SNRIs: Heightened risk of serotonin syndrome.
- Antiarrhythmic Drugs: Potential for QT prolongation.
Substances
- Alcohol: May increase drowsiness or impair judgment.
- St. John’s Wort: Can intensify serotonin syndrome risk.
- Grapefruit Juice: No significant interaction but best to consult a doctor.
Contraindications
- History of QT prolongation or congenital long QT syndrome.
- Concurrent use with MAOIs or pimozide.
- Severe liver impairment.
- Allergy to citalopram or its components.
Monitoring and Follow-Up
- Mental Health: Regular assessments for improvement in mood and suicidal ideation.
- ECG Monitoring: For patients at risk of QT prolongation.
- Electrolytes: Check for low potassium or magnesium levels, which may increase cardiac risks.
- Liver and Kidney Function: Periodic tests for long-term users.
Patient Counseling Points
- It may take 2-4 weeks to notice improvements in symptoms.
- Report any new or worsening symptoms, such as agitation, irritability, or suicidal thoughts.
- Avoid driving or operating machinery until you know how citalopram affects you.
- Stay hydrated and use sugar-free gum or candies to manage dry mouth.
- Do not stop taking citalopram suddenly; consult your doctor for a tapering plan.
FAQs About Citalopram
Q1: Can I drink alcohol while taking citalopram?
- It’s best to avoid alcohol, as it can increase drowsiness and impair judgment.
Q2: How long should I take citalopram?
- Treatment duration varies; many patients need 6-12 months or longer, depending on their condition.
Q3: Can I take citalopram during pregnancy?
- Consult your doctor; the benefits must outweigh potential risks, particularly in the third trimester.
Q4: Is weight gain common with citalopram?
- Weight changes are possible but not guaranteed; maintaining a balanced diet and exercise helps.
Q5: What should I do if I miss a dose?
- Take it as soon as you remember, unless it’s close to the next dose. Do not double the dose.
Q6: Can citalopram cause withdrawal symptoms?
- Yes, abrupt discontinuation may cause nausea, dizziness, and irritability; tapering is recommended.
Q7: Is citalopram addictive?
- No, citalopram is not considered addictive, but dependency can develop if stopped improperly
