Citalopram

Citalopram is a prescription drug acquirable in the form of oral tablets or oral solutions. The tablets are supplied under the brand-name Celexa. Both the tablets and solutions are available as generic drugs. Generic drugs are usually cheaper but may be unavailable in every strength. Ask your doctor to tell you which works best for you. Other prescription medication may be used together with citalopram.

How does it work?

Citalopram belongs to the SSRIs (selective serotonin reuptake inhibitors) family of antidepressants.

A family of drugs implies that it is in a category of medications treating almost similar ailments, and drugs within the family work in an indistinguishable manner.

SSRIs help the brain to bring balance of serotonin levels. The more the balance of serotonin in your brain, the lesser the depression symptoms.

Citalopram is a drug used by people who suffer from depression to make them more energetic and bring about feelings of emotional well-being. It working by optimizing the balance of serotonin in a human’s brain. It is therefore referred to as part of the selective serotonin reuptake inhibitor (SSRI) family of drugs.

It’s also used to:

• Treat mental conditions such as obsessive-compulsive disorder and panic disorder.
• Treat hot flashes that are commonly associated with menopause.

Note that the treatment for mental conditions listed in the above section are not among the professional labelling for citalopram. However, the uses can be prescribed by your doctor or pharmacist if he or she recommends the medication can help your individual case.

Take note that you should only use the drug after is has been prescribed to you after careful examination by your doctor.

How to use citalopram

Be sure to carefully acquire and read (paying attention to detail) the medication guide. And, if possible, the patient information leaflet that is usually provided by your pharmacist while you are taking the citalopram drug. Be it the first time or if you are taking a refill. Also, ask any questions you may have. It is always best to be well-informed about the medication you are taking.

The medication is either taken in the morning or evening, accompanied by food or on an empty stomach, as advised by your doctor once a day.

You may be prescribed a dose depending on:

• How old you are
• Preliminary examination
• Medical condition
• Other drugs you take

Always divulge to your doctor any other over the counter or prescription drugs you take. The maximum dosage for citalopram is 40 mg per day.

Use a measuring device to accurately measure the drug you take, if you use the liquid form of citalopram. Avoid using household spoons because you may get the wrong dose.

Carefully follow your doctor’s instructions. Your doctor may advice you on a lower dose or a gradual increase in dose so as to alleviate the risk of side effects. Increase dose as advised and stop when told to do so to avoid side effects.

Continue taking citalopram even if you feel better:never stop taking it without first confirming with your doctor. This is because some conditions are worsened by sudden stoppage of medication. Sudden discontinuation of such medicine can cause; mood swings, tiredness, headaches, insomnia, and brief electric shock sensations. So while transitioning towards stopping medication, your doctor can advise gradual reduction of your dose to avert the above symptoms. You should report any symptoms you experience during this time to your doctor.

Usually, it takes some time for the full benefits of citalopram to sink in; it could take one to four weeks for benefits to be felt. Always update your doctor on the developments such as worsening or no change in your condition. 

There are many different variations of the combination of the form and dose of the drug that your doctor might prescribe you. However, the form of drug, the dose, and the frequency of taking the medication will depend on:

• Your reaction to the initial dose
• How old you are
• Severity of your problem
• The disorder to be treated
• Other medical afflictions one has

Depression treatment

For adults between 18 and 60 years old

• The initial dose should be 20 mg a day, with a maximum dose of 40 mg a day.
• Your doctor or physician may increase your dose, but only one time a week until it is at the appropriate level.
• High dosages, above 40 mg a day, predisposes you to Long QT Syndrome. This is a heart rhythm disorder causing an irregular and usually fast heartbeat. 

For children between 0 and 17 years old

• The safety and effectiveness for use in children who are 17 years and below is unconfirmed.

For adults aged 61 years and above

• Your kidneys are less effective as they used to be at a younger age. Hence, slower drug processing occurs in your body. This causes drugs to take longer time to be eliminated from the body, increasing the risk of side effects. Therefore, avoid taking more than 20 mg daily.
• To help prevent drugs from accumulating in your body, doctors may advise low initial doses and different schedules.

Special considerations

People with the following conditions should take 20 mg or less per day:

• Poor cytochrome P450 2C19 metabolizers: Cytochrome P450 2C19 is a body protein that helps break down drugs. People with less or no 2C19 proteins are called “poor metabolizers".
• Liver problems: Patients with liver problems are at risk of citalopram accumulating in their bodies since it is not filtered out of blood by their liver. They are likely to experience more side effects, which could be severe and dangerous. 

Common side effects

Adults experience different side effects from those of children.

Side effects in adults include:

• Nausea
• Lethargy
• Dizziness
• Anxiety
• Insomnia
• Sexual problems
• Profuse sweating
• Shaking
• Hunger
• Dry mouth
• Constipation
• Diarrhea
• Respiratory infections
• Yawning

Children experience the above side effects, plus:

• Increased thirst
• Increased muscle twitching
• Nosebleeds
• Frequent urination
• Weight changes and stunted growth
• Menstrual changes

Mild effects can subside after a couple of days or weeks. However, for severe effects you should consult your doctor.

Serious side effects

They include the following:

1. Suicidal thoughts or actions such as:

• Attempted suicides
• Acting on dangerous impulses
• Suicidal thoughts
• Depression
• Insomnia
• Anxiousness
• Panic attacks
• Acting ferociously, agitation, anger, irritability

2. Changes in the rhythm of the heart

Symptoms include:

• Chest pain
• fast or slow heart rate
• shortness of breath
• dizziness or fainting

3. Serotonin syndrome

Symptoms include:

• Rigidity of muscles
• Coma, agitation, confusion, difficulty thinking and hallucinations
• Muscle twitching and coordination problems
• Racing heartbeat or high/low blood pressure
• Profuse sweating
• Fever
• Nausea, vomiting, or diarrhea

4. Mania

Symptoms include:

• Greatly increased energy
• Insomnia
• Racing thoughts
• Reckless behavior
• Unusually grand ideas
• Excessive happiness or irritability

5. Seizures

Symptoms include:

• Convulsions
• Falling down or abrupt loss of muscle tone
• Sudden loss of having knowledge of what’s happening around you
• Losing control of bowels or urine suddenly

6. Visual impairment

Symptoms include:

• Eye pain
• Double vision
• Blurred vision
• Swelling or redness around the eyes

7. Decrease in the amount of blood alt/sodium

Symptoms include:

• Headache
• Lethargy
• Confusion, problems concentrating, thinking or memory problems

In case of serious and life-threatening side effects:

• Call your health professional immediately
• Call 9-1-1

Citalopram is classified under SSRIs (selective serotonin reuptake inhibitors), a category of drugs that also contains sertraline, Zoloft, paroxetine (Paxil) and fluoxetine (Prozac).

The FDA approved citalopram in July 1998.

Despite citalopram being often used as an antidepressant, it is also used to treat Social Anxiety Disorder. It is in a family of drugs generally recommended as a first choice by psychiatrists as a prescribed treatment for social anxiety disorder. The family is referred to as SSRIs, these function by balancing serotonin levels in the brain, hence regulating mood fluctuations.

Many citalopram users have reported positive outcomes and alleviation of their social anxiety symptoms, while others find this medication to be of little help. Common side effects associated with SSRI medications include an affected sexual function and appetite in many patients. Headaches and nausea are also reported, though these normally subside after a short time.

Cymbalta (Duloxetine): Improves mood and relieves pain. It’s an antidepressant and antianxiety. It is more likely to cause problems if you drink or have high blood pressure as compared with other antidepressants.

Wellbutrin (Bupropion): Improves mood. It’s an antidepressant with fewer sexual side effects than others, but you need to totally avoid alcohol while taking it.

Zoloft (Sertraline): Helps you relax and improves mood. It’s an antidepressant and antianxiety. It's more likely to bring about diarrhea and insomnia as compared to the others.

Remeron (Mirtazapine): Improves mood. It’s good for sleep and is an antidepressant. It causes more weight gain effects than any other antidepressant.

Oleptro (Trazodone): Helps you sleep and improves mood. It’s used as a sleeping aid, but at higher doses for treating depression, which in turn causes more side effects.

Paxil (Paroxetine): Helps you relax and improves mood. It’s an antidepressant and antianxiety, but it causes more withdrawal symptoms such as sleepiness and weight gain than other similar medications.

Citalopram hydrobromide is an approved antidepressant. It may be used to treat mild dementia-associated agitation in nonpsychotic patients, smoking cessation, ethanol abuse, obsessive-compulsive disorder (OCD) in children and diabetic neuropathy.

You cannot fully predict how a patient will behave after treatment, and the outcome of treatment today is not a guarantee of future success, especially since some side effects increase gradually over time and withdrawal only comes up due to dosage changes, medication change, or discontinuation of antidepressants entirely.

Treatment for depression instead of other non-psychotic or psychotic conditions doesn’t change the potential side effects of the antidepressants experienced.

It could be deadly to take an MAOI (monoamine oxidase inhibitor) with citalopram. An MAOI shouldn’t be consumed less than 14 days before taking the drug or within 14 days after completing a citalopram dose.

Examples of MOAIs are; linezolid (Zyvox), isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate) or selegiline (Emsam, Eldepryl, Zelapar).

Drugs that cause or increase the likelihood of bleeding including: non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen; blood thinners such as warfarin (Coumadin); Aspirin and antiplatelet drugs like clopidogrel (Plavix); may react with citalopram.

Citalopram is not a controlled substance. It is an antidepressant falling in the SSRI (selective serotonin reuptake inhibitor) drug class.

Citalopram high

You cannot get high on citalopram. Never take more than the prescribed dose, as this might increase side effects.

Withdrawal from psychiatric medication is influenced by several factors, including things like: physiology conditions, time span of how long you were on the medication, dosage, and mode of quitting the medication whether it be quitting cold turkey or gradually tapering off.

1. Time Span

This is the length of time you have been under the medication. Generally, the longer you are on the antidepressant, the harder the withdrawal will be. This is because your brain gets used to the high serotonin levels caused by medication. Stopping medication means less serotonin is available in your brain. The brain has difficulty adapting to functioning without citalopram.

2. Dosage (40 mg, 20 mg, 10 mg)

20 mg a day is considered the standard dose of medication, but citalopram can be given at doses less than 20 mg and sometimes doses of up to 40 mg once a day. Often, the greater the dose taken, the tougher the withdrawal.

3. Individual Physiology

Most of the time, withdrawal from the drug is due to individual reaction of the body to the drug. The reactions vary with people. One may experience extreme withdrawal symptoms while another individual feels 100% normal several weeks after stopping the medication.

Therefore, there are several individual factors including; environment, withdrawal sensitivity, social support and physiology that can have an influence. Individuals who experience extreme withdrawal could largely be due to physiological differences.

4. Cold Turkey vs. Tapering

Did you quit suddenlyor gradually? The slow and cautious weaning off of medication is usually the most recommended, as this way, the body can readjust to normal functioning without citalopram.

Sudden quitting (cold turkey) can lead a person to a state of confusion and chaos. And also the severity of these symptoms may depend on the dosage one received - the higher the dose the more severe.

For overdoses of up to 2000 mg, no fatalities from citalopram overdose were reported during clinical trials. However, post marketing studies of citalopram overdoses indicated 12 fatalities. 10 overdoses occurred when used with alcohol and/or other drugs, and two were due to sole usage of citalopram (2800 mg and 3920 mg). There were overdoses of up to 6000 mg which were non-fatal.

Symptoms often accompanying citalopram overdose include; nausea, vomiting, dizziness, sweating, muscle tremors, somnolence and sinus tachycardia. In rarer cases, observed symptoms included; amnesia, convulsions, hyperventilation, confusion, coma, rhabdomyolysis cyanosis and ECG changes (including QT prolongation, ventricular arrhythmia, nodal rhythm, and possibly Torsades de pointes).

Management of overdose

First, an airway is established and maintained to ensure enough ventilation. Use of activated charcoal should be considered and evacuation of the gastrointestinal tract by lavage. Careful vital and cardiac sign monitoring is advised, along with generic sympathetic care.

Due to a large amount of citalopram in the body, the following are recommended: dialysis hemoperfusion, forced diuresis and exchange transfusion. There is no specialized antidote for citalopram overdose.

To manage an overdose, consider the probability of involvement of several drugs. The psychiatrist can consider contacting the center for poison control for specialized information on overdose treatment if any.

It has been noted by the FDA that side effects of citalopram are increased by alcohol ingested by a person on the medication. The combination of citalopram and alcohol can lead to overdose and associated problems.

Overdose

There is risk of overdose when you mix citalopram and alcohol. These effects can manifest even when taking citalopram at your prescribed dose.

The following are overdose symptoms:

• Sweating
• Vomiting
• Sleepiness
• Nausea
• Racing heart
• Tremors in one limb

You should call any medical emergency service or make a call to 911 if you experience the symptoms stated above.

Treatment and management of your overdose symptoms by your doctor is the recommended way to treat cases of overdoses that are associated with the combination of citalopram and alcohol.

To ensure proper supply of oxygen to your body, your doctor can decide to put you on a ventilator. Your doctor will also take note of your vital organs among them the heart.

Other reactions:

Other side effects of combining citalopram and alcohol include:

• Hyperventilation
• Amnesia
• Coma
• Irregular heart rate
• Convulsions
• Severe heart issues
• Death

Other medications you take may also induce more side effects which will be made severe by the drinking of alcohol.

For example, combining alcohol with medication could make the side effects of drugs for anxiety, pain medication and sleeping aids worse. Make known to your doctor any other medication you take.

The FDA has warned that doses of citalopram that are above 40 mg a day cause heart conditions, and to add alcohol to the combination increases the severity of the heart condition even more.

Combining citalopram with alcohol has been linked to irregular heart rate. To learn more about this, talk to your doctor. You should divulge any history of heart conditions you might be suffering from or have been diagnosed with.

Antidepressants can affect your appetite and body’s metabolism. Hence, they can cause slight weight loss or weight gain.

Citalopram is relatable to a slight increase in weight. This could be due to improved appetite induced by citalopram. Because of improved appetites, you tend to eat more, leading to a slight body weight increase. However, citalopram can also reduce a person’s appetite. This causes a minor weight loss.

It’s difficult to say which to anticipate since research reveals equal occurrence of weight gain and loss. The extended effects of citalopram on a person’s weight haven’t been examined clinically, hence, it is unknown for sure how long any weight gained or lost would last.

Note that there are few reports of weight gain and weight loss. Weight changes are typically small, usually a few pounds. So citalopram’s impact on weight will likely be minor or none at all.

If you suspect citalopram is causing you weight gain or loss, don’t stop taking it without consulting your doctor. Stopping citalopram abruptly causes problems such as insomnia, anxiety, moodiness and confusion. Your doctor can help you taper your dosage to alleviate side effects.

Talk with your doctor

Consult your doctor if you gain or lose a substantial amount of weight after starting citalopram. A gain equal or greater than 10 percent of your body weight is alarming, especially if it occurs over a short time period.

Should your doctor suggest you gained weight due to citalopram use, ask if an alternative antidepressant could help. Otherwise, discuss what the real cause might be. If you’re leading a healthy lifestyle but still gaining extra weight, inform your doctor.

Always share with your doctor any concerns you may be having regarding weight gain or loss. These might include questions such as:

• Do you think my weight change is related to the citalopram I use?
• If so, what do you recommend: lower dose or alternative antidepressant?
• What is your advice for me to maintain a healthy weight?
• Can you refer me to a nutritionist who can advise me on matter of diet and weight?
• How can I safely stay active in my day to day lifestyle?

It is very important to treat depression during pregnancy. If depression is left untreated during pregnancy, you might avoid prenatal care, lose the strength to keep yourself healthy, and/or not function to lead the healthy lifestyle your unborn child needs you to. This could result in low birth weight, premature birth, or other birth related problems.

Some mothers are at risk of postpartum depression, which could cause them to have a hard time creating a bond with the unborn baby.

Are antidepressants an option during pregnancy?

The decision to use depression medication should strike a balance between pros and cons.

Generally, consuming antidepressants when one is pregnant poses a low risk of birth related problems and other complications to the unborn child.

However, few medications have been proven to be safe during pregnancy: some antidepressants are associated with health complications for babies.

It is true to say that it gets dark just before dawn. But don’t let yourself be discouraged by this fact. It takes up to four weeks to get maximum benefit from the drug. During the initial time, you can go through initial side effects. However, as you get more acclimatized with the medication, people have reported an increased level of depression and/or anxiety. You should try to overcome these effects and take one day at a time. However, if this situation continues, speak with your doctor.