Citalopram
Brand name
- Celexa®
- Tablets: 10 mg, 20 mg, and 40 mg
- Liquid: 2 mg per mL
Generic name
What is Celexa and what does it treat?
Citalopram is an antidepressant medication that works in the brain. It is approved for the treatment of major depressive disorder (MDD) in adults. Major depression occurs when a person experiences several of the following symptoms concurrently, for at least two weeks: "low" or depressed mood (for example, sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/hopeless/helpless, psychomotor agitation or retardation (i.e., thoughts/movements speeding up or slowing down), difficulty concentrating, and thoughts of death (suicidal thinking).
What is the most important information I should know about Celexa?
After starting citalopram, symptoms gradually decrease over a period of weeks. Sleep and other physical symptoms may improve before there is noticeable improvement in mood or interest in activities. Once symptoms are under control, MDD usually requires long-term treatment to help prevent the return of depressive symptoms. Only your healthcare provider can determine the length of citalopram treatment that is right for you.
Do not stop taking citalopram or change your dose without talking to with your healthcare provider first.
Stopping citalopram abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, dizziness, vomiting, nightmares, headache, and paresthesias (prickling, tingling sensation on the skin).
Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for "switching" from depression into mania. Symptoms of mania include "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).
Are there specific concerns about Celexa and pregnancy?
If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with MDD who wish to become pregnant face important decisions, each with risks and benefits as they relate to how the illness, medications, and risks to the fetus may interact. This is a complex decision as untreated MDD has risks to the fetus as well as the mother. There are many dimensions to these choices, so be sure to confer with your doctor and caregivers.
For mothers who have taken SSRIs during their pregnancy, there appears to be less than a 1% chance of infants developing persistent pulmonary hypertension. This is a potentially fatal condition that is associated with use of the antidepressant in the second half of pregnancy. However, women who discontinued antidepressant therapy were five times more likely to have a depression relapse than those who continued their antidepressant. If you are pregnant, please discuss the risks and benefits of antidepressant use with your healthcare provider.
Regarding breast-feeding, caution is advised since citalopram does pass into breast milk.
What should I discuss with my healthcare provider before taking Celexa?
- The most bothersome symptoms of your condition
- If you have thoughts of suicide
- Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
- If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require an adjustment in the medication.
- Any other psychiatric or medical problems you have, including a history of bipolar disorder
- All other medications you are currently taking and any medication allergies you have. This will help your prescriber assess for potential drug interactions.
- Other non-medication treatment you are receiving (such as psychotherapy (i.e., talk therapy) or substance abuse treatment). Your provider can explain how these different treatments work with the medication.
- If you are pregnant, plan to become pregnant, or are breast-feeding
- If you drink alcohol or use drugs
How should I take Celexa?
Citalopram is usually taken once per day with or without food.
While the dose usually ranges from 20 mg to 60 mg, your healthcare provider will determine the dose that is right for you based upon your response.
What happens if I miss a dose of Celexa?
If you miss a dose of citalopram, take it as soon as you remember it, if it is not too close to when your next dose is due-discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.
What should I avoid while taking Celexa?
Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications because the beneficial effects of the medication may be decreased and adverse effects may be increased (e.g., sedation).
What happens if I overdose with Celexa?
If an overdose occurs, whether intentional or accidental, immediate medical attention may be necessary. Call your doctor or emergency medical service (911). You may also contact the poison control center (1-800-222-1222).
What are the possible side effects of Celexa?
Common
Side effects with citalopram are generally mild and are similar to those reported with other SSRI antidepressants. The most commonly reported side effects are headache, nausea, diarrhea, insomnia, sleepiness, dry mouth, increased sweating, fatigue, yawning, and flatulence. If you experience side effects after starting citalopram they will often improve over the first week or two as you continue to take the medication. Sexual side effects, such as problems with orgasm or ejaculatory delay, may also occur, and often do not diminish over time.
Rare
Other side effects which occur infrequently with citalopram include mania in those with bipolar disorder, suicidal thoughts or behavior (see boxed warning), seizure, increase or decreased heart rate, low blood pressure, irregular menstrual cycle, increased frequency of urination, changes in taste, increased bleeding (e.g., gums may bleed more easily), low sodium blood levels (signs of low sodium levels may include headache, weakness, difficulty concentrating and remembering), and teeth grinding.
Are there any risks for taking Celexa for long periods of time?
To date, there are no known problems associated with long term use of citalopram. It is a safe and effective medication when used as directed.
What other drugs may interact with Celexa?
Citalopram should not be taken with or within two weeks of taking monoamine oxidase inhibitors (MAOIs). These include phenelzine (Nardil®), tranycypromine (Parnate®), isocarboxazid (Marplan®), and selegeline (Emsam®).
Although rare, there is an increased risk of serotonin syndrome when citalopram is used with other medications that increase serotonin, such as other antidepressants, migraine medications called "triptans" (e.g., Imitrex®), some pain medications (e.g., tramadol (Ultram®), meperidine (Demerol®)), and the antibiotic linezolid (Zyvox®).
Citalopram is not recommended to be given with pimozide (Orap®) due to possible increase in QTc which can result in serious irregular heart rhythm.
Citalopram may increase the concentration of clozapine. Monitoring carefully for side effects is recommended.
Citalopram may increase the concentration of tricyclic antidepressants, such as desipramine, and beta blockers, such as metoprolol. Monitoring carefully for side effects is recommended.
Cimetidine (Tagamet®) may increase the concentration of citalopram. Monitoring carefully for side effects is recommended.
Non-steroidal anti-inflammatory agents, such as ibuprofen (Motrin®), aspirin, or the "blood thinner" warfarin (Coumadin®) may increase the risk of bleeding when used in combination with citalopram.
How long does it take for Celexa to work?
While depressed mood and lack of interest in activities may need up to 4-6 weeks to improve, disturbances in sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working.
Updated by
Lisa M. Mican, Pharm.D., BCPP
(March 2011)
FDA Alerts
Suicidal Thoughts or Actions in Children and Adults
Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications. This risk may persist until significant remission occurs.
In short-term studies, antidepressants increased the risk of suicidality in children, adolescents and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults ages 65 and older taking antidepressants have a decreased risk of suicidality. Patients, their families and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patients prescriber or healthcare professional. All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.
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