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Jun 25, 2021
6 min read

Citalopram (Celexa) and alcohol: risks and side effects

Citalopram (brand name Celexa) is a drug approved by the U.S. Food and Drug Administration (FDA) to treat major depressive disorder. But you should avoid drinking alcohol while taking Celexa as this can lead to heart problems or a dangerous condition called serotonin syndrome. Citalopram carries a boxed warning from the FDA because, in rare cases, it may increase suicidal thoughts and behaviors in children, teens, and young adults under 25.

chimene richa

Reviewed by Chimene Richa, MD

Written by Seth Gordon

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Depression is more than just feeling sad—it can make it hard to get through the day. Antidepressants like Celexa can help. However, some people turn to alcohol to improve their mood. But combining Celexa and alcohol is a bad idea and can lead to dangerous consequences. 

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What is citalopram (Celexa)?

Citalopram (brand name Celexa) is a type of antidepressant medication called a selective serotonin reuptake inhibitor (SSRI). SSRIs stop nerve cells (neurons) from reabsorbing serotonin, a brain chemical (neurotransmitter) that plays an essential role in your mood, leaving more serotonin active in the brain. Scientists hypothesize that serotonin levels are low in people with major depressive disorder (MDD). 

SSRIs, like citalopram, are a common treatment option for depression and can help improve your symptoms. Other SSRIs include fluoxetine (brand name Prozac; see Important Safety Information), sertraline (brand name Zoloft; see Important Safety Information), and escitalopram (brand name Lexapro; see Important Safety Information) (Chu, 2021).

Depression is more than just feeling down after a break-up or losing a loved one—depression is a mental health condition. Being sad after a particular event is how we deal with life’s stresses. Still, most people feel better over time without the need for therapy or medication. When those feelings don’t go away or come about with no known cause, you may be experiencing depression. According to a 2019 study by the Centers for Disease Control and Prevention (CDC), depression affects over 18% of adults in the U.S (Villarroel, 2019).

Healthcare providers may also prescribe citalopram off-label to treat other mental health conditions. These include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), among others (UptoDate, n.d.).

Depression and alcohol

For many people, depression and alcohol often go hand-in-hand. That’s because it’s not unheard of for some people to turn to alcohol to cope with depression or other mental health problems. An analysis of 30 years’ worth of data in 2011 showed that alcohol abuse or dependence more than doubled the likelihood of a major depressive episode—proving alcohol and depression are linked (Boden, 2011). But in addition to potentially increasing your risk of depression, the effects of alcohol include impaired judgment and motor skills. 

While it may temporarily feel good to drown your sorrows with alcohol, it’s not recommended to self-medicate with alcohol when you’re feeling depressed. It could make things worse. 

Risks of mixing alcohol and Celexa

Even if you’re a light drinker, mixing alcohol with citalopram or other SSRIs may lead to an increased risk of side effects. Alcohol affects serotonin levels and serotonin receptors. Even short-term use can potentially affect the functioning of the same chemical you’re trying to regulate by taking an SSRI (Miczek, 2015). Potential serious risks of mixing alcohol and Celexa include: 

  • Serotonin syndrome is a dangerous condition caused by too much serotonin in the nervous system. Typically it’s due to taking too many medications that raise serotonin levels. It may be due to a Celexa overdose or combining medicines that affect serotonin levels. Serotonin syndrome is rare but can lead to organ failure and death. (Simon, 2021). A recent case report suggests that serotonin syndrome is a potential side effect of alcohol and SSRIs (Suzuki, 2019). 
  • Long QT syndrome is a rare condition affecting the heart that can be a severe side effect of citalopram, especially at higher doses. In straightforward terms, it means the heart is taking longer to recharge after each beat. People with long QT syndrome or at increased risk for this condition should not use Celexa—this may include those who drink alcohol. One study found that heavy drinkers had a higher likelihood of developing a prolonged QT interval (Li, 2016). 

Using SSRIs to treat depression in people with alcohol use disorders has yielded mixed results. A large literature review found that antidepressants may help people abstain from alcohol or drink less (Agabio, 2018). 

However, the data is not always so positive. Another study found that people with alcohol use disorders who were not already abstinent may have more heavy drinking days while taking citalopram than those taking a placebo (Charney, 2015).

If you feel the urge to drink while taking Celexa, please reach out to your healthcare provider or to the Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline

Side effects of Celexa

The use of alcohol can potentially worsen some of the possible side effects of citalopram. The most common adverse effects reported by patients taking citalopram include (DailyMed, 2019):

  • Nausea
  • Dry Mouth
  • Drowsiness
  • Insomnia
  • Increased sweating

Less common side effects can include (DailyMed, 2019):

  • Agitation
  • Anxiety
  • Diarrhea
  • Indigestion
  • Sexual side effects, such as lower sex drive, erectile dysfunction, and difficulty ejaculating
  • Menstrual cramps
  • Stuffy or runny nose

Never abruptly stop taking any antidepressant medication. Withdrawal symptoms from SSRIs can include dizziness, nausea, anxiety, headache, body aches, and trouble sleeping (Jha, 2018)

Always consult with your healthcare provider first, and they will gradually decrease your dose safely. 

Celexa warnings

The FDA has issued a boxed warning, the most severe warning it can give, to antidepressants like citalopram. Celexa can increase the risks of suicidal thoughts and behavior in children, teens, and adults under the age of 25. Healthcare providers and family members should watch for any worsening depression or suicidal behaviors, especially when first starting Celexa or any antidepressant (DailyMed, 2019)

Since Celexa increases your serotonin levels, combining it with other medications that also raise serotonin may lead to serotonin syndrome. Drug interactions that increase the risk of serotonin syndrome include taking citalopram with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, tryptophan, amphetamines, MDMA (ecstasy), or cocaine.

Symptoms of serotonin syndrome can include diarrhea, tremor, sweating, agitation, muscle spasms, high blood pressure, and fever. In the most severe cases, it can be lethal. If you think you may be experiencing signs of serotonin syndrome, seek medical advice immediately (Simon, 2021).

Citalopram can change your heart rhythm by increasing your QT interval (the amount of time your heart needs to recover between beats). This rhythm abnormality can lead to a fatal, irregular heart rate and is more likely to occur at Celexa doses higher than 40 mg per day. Anyone at high risk for developing a prolonged QT should not use citalopram (DailyMed, 2019).

Celexa is a Pregnancy Category C drug. This means that if you are pregnant or breastfeeding, you should only use citalopram if the benefits outweigh the risks to the fetus—a decision you’ll make with your healthcare provider (DailyMed, 2019).

Combining alcohol or illicit drugs with prescription drugs can be quite risky. Be honest with your healthcare provider about your alcohol or substance use, and follow their medical advice.

References

  1. Agabio R, Trogu E, Pani PP. (2018). Antidepressants for the treatment of people with co-occurring depression and alcohol dependence. Cochrane Database of Systematic Reviews, Apr 24;4(4):CD008581. doi: 10.1002/14651858.CD008581.pub2. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29688573/

    Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction (Abingdon, England), 106(5), 906–914. doi: 10.1111/j.1360-0443.2010.03351.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21382111/

    Charney, D. A., Heath, L. M., Zikos, E., Palacios-Boix, J., & Gill, K. J. (2015). Poorer drinking outcomes with citalopram treatment for alcohol dependence: a randomized, double-blind, placebo-controlled trial. Alcoholism: Clinical and Experimental Research, 39(9), 1756-1765. doi: 10.1111/acer.12802. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26208048/

    Chu A, Wadhwa R. (2021) Selective serotonin reuptake inhibitors. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554406/

    DailyMed – Citalopram hydrobromide tablet, film coated. (2019). Retrieved on June 14, 2021 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2632b547-2e13-447f-ac85-c774e437d6a8

    Jha, M. K., Rush, A. J., & Trivedi, M. H. (2018). When discontinuing SSRI antidepressants is a challenge: management tips. The American Journal of Psychiatry, 175(12), 1176–1184. doi: 10.1176/appi.ajp.2018.18060692. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30501420/

    Li, Z., Guo, X., Liu, Y., Sun, G., Sun, Y., Guan, Y., et al. (2016). Relation of heavy alcohol consumption to QTc interval prolongation. The American Journal of Cardiology, 118(8), 1201-1206. doi: 10.1016/j.amjcard.2016.07.033. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27561189

    Miczek KA, DeBold JF, Hwa LS, Newman EL, de Almeida RM. (2015) Alcohol and violence: neuropeptidergic modulation of monoamine systems. Annals of NY Academy of Sciences;1349(1):96-118. doi: 10.1111/nyas.12862. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26285061/

    National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2020). Alcohol use disorder: A comparison between DSM–IV and DSM–5. Retrieved Nov 16, 2020, from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm

    Simon LV, Keenaghan M. (2021). Serotonin syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482377/

    Suzuki, A. & Otani, K. (2019). Serotonin syndrome after an alcohol intake in a patient treated with escitalopram and clomipramine. Clinical Neuropharmacology, 42(3), 103-104. doi: 10.1097/WNF.0000000000000331. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30844852/

    UptoDate. (n.d.) Citalopram: drug information. Retrieved on June 14, 2021 from https://www.uptodate.com/contents/citalopram-drug-information

    Villarroel MA, Terlizzi EP. (2019) Symptoms of depression among adults: United States. NCHS Data Brief, no 379. Hyattsville, MD: National Center for Health Statistics. 2020. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db379.htm