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Depression rates are on the rise, but fortunately, there are many treatment options available. In addition to therapy, there are many effective medications to treat depression. Citalopram hydrobromide, brand name Celexa, is one commonly prescribed SSRI antidepressant. If your healthcare provider has recommended citalopram for depression, read on to learn more about its uses, side effects, and more.
What is citalopram (Celexa)?
Citalopram hydrobromide, brand name Celexa, is an SSRI (selective serotonin reuptake inhibitor) antidepressant. While you might hear the term “depression” tossed around, a confirmed diagnosis of major depression by a healthcare professional doesn’t just describe a short-term lousy mood. Depression can be a debilitating illness that prevents you from functioning on a day-to-day basis, affecting how you sleep, eat, think, and feel. Major depression is both relatively common and seems to be on the rise (Czeisler, 2020).
As an SSRI, citalopram increases the amount of serotonin in the brain. Serotonin is a brain chemical (neurotransmitter) that our brain cells use to communicate with each other. While scientists don’t know exactly why it happens, they believe that depression results from a reduced amount of serotonin and other substances in the brain. Increasing the amount of serotonin seems to help treat symptoms of depression (Chand, 2020).
The U.S. Food and Drug Administration (FDA) has approved citalopram to treat major depressive disorder (MDD) in adults (FDA, 2012).
There are many complexities and variations to MDD or unipolar depression. In simple terms, it requires at least five symptoms to occur within two weeks to diagnose a major depressive episode (MDE). One or two of these symptoms must be a depressed mood or a loss of interest in things you typically enjoy. Symptoms of major depression include feeling sad, anxious, empty, hopeless, or feeling nothing. Depression is a mental health condition that can affect many aspects of everyday life (Bains, 2021).
Off-label uses of citalopram are not FDA-approved but often have a basis in research and clinical data. Citalopram has been used off-label to treat a range of other conditions, including (UpToDate, n.d.):
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Premature ejaculation
- Social anxiety disorder
- Binge eating disorder
- Panic disorder
- Premenstrual dysphoric disorder
- Aggressive/agitated behavior among people with dementia
- Night sweats and hot flashes associated with menopause
Generalized anxiety disorder (GAD): symptoms and diagnosis
Citalopram side effects
The FDA has issued a black box warning (their most serious warning) for treatment with citalopram: Antidepressants like citalopram increase the risk of suicidal thoughts and behavior, especially in people under the age of 24. Depression and certain other psychiatric disorders are themselves associated with an increased risk of suicide, so you must consider the pros and cons. Healthcare providers should monitor for worsening depression or any changes in behavior, especially when first starting Celexa or changing the dose.
The most common side effects of citalopram hydrobromide are (UptoDate, n.d.):
- Dry mouth
- Trouble sleeping
Typically, the risk of side effects increases with higher dosages of medication. For many people, these side effects are minimal and pass with continued use.
Don’t stop taking citalopram without consulting with your healthcare provider first. Sudden discontinuation may lead to Celexa withdrawal syndrome—withdrawal symptoms include nausea, headache, and dizziness, among others (Hirsch, 2020).
Many other SSRIs can cause sexual side effects, and Celexa is no exception. Sexual dysfunction from citalopram may include lowered sex drive, erectile dysfunction, abnormal orgasms, decreased genital sensation, and priapism (a painful and persistent erection) (UptoDate, n.d.).
If you have sexual side effects, talk to your healthcare provider about potential alternative treatments. Other medications like mirtazapine (see Important Safety Information), bupropion (see Important Safety Information), and serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (brand name Cymbalta; see Important Safety Information) may be possible options for you (Jing, 2016).
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Serious side effects may occur with citalopram, including suicidality, serotonin syndrome, manic episodes (in people with undiagnosed bipolar disorder), bone fractures, and SIADH (a condition that causes the body to retain too much water) (UptoDate, n.d.)
Another possible side effect is acute angle-closure glaucoma (a sudden spike in eye pressure), which can cause eye pain and lead to permanent vision loss if not treated immediately. This can occur in people with certain anatomic findings in their eyes while taking Celexa (UptoDate, n.d.).
Lastly, citalopram has been shown to affect your heart rhythm—a condition called long QT syndrome—especially at higher doses (UptoDate, n.d.).
If you experience any serious effects or develop an allergic reaction to citalopram, seek medical advice immediately. This list includes only some of the side effects that can result from treatment with citalopram. Other side effects may exist. Consult your healthcare provider for more information.
Citalopram hydrobromide or Celexa is available as an oral solution or in tablet form. The tablet formulations come in dosages of 10 mg, 20 mg, and 40 mg, typically taken once per day. The maximum dose for any indication is 40 mg per day in adults under the age of 60 and 20 mg per day in adults over 60, as high doses of this medication may cause arrhythmias (Sharbaf-Shoar, 2021).
Citalopram drug interactions
Many medications might interact with citalopram or alter the way your body handles this medication. Tell your healthcare provider about all the prescription drugs, over-the-counter medicines, and nutritional supplements you take before starting this medication.
In addition to SSRI drugs, many drugs act like serotonin or affect natural serotonin levels in the body. Combining these medications with Celexa can have severe effects on serotonin levels in the body, leading to a hazardous condition known as serotonin syndrome (FDA, 2012).
The symptoms of serotonin syndrome, which can result from drug interactions or accidental or intentional overdoses, can include anxiety, restlessness, or being disoriented. You may also be sweaty, have a fast heart rate, high blood pressure, vomiting, or diarrhea, in addition to tremors or shaking. Without treatment, this condition can be fatal (Simon, 2021).
Citalopram (Celexa) and alcohol: risks and side effects
Drugs you shouldn’t mix with Celexa include monoamine oxidase inhibitors (MAOIs), which are sometimes used to treat depression or Parkinson’s disease (such as selegiline, phenelzine, and isocarboxazid, methylene blue, and tranylcypromine) (Simon, 2021).
Other medications that affect serotonin levels (serotonergic drugs) include other SSRI antidepressants (like paroxetine) or SNRIs. Triptans, linezolid, lithium, tryptophan, and even over-the-counter supplements containing St. John’s wort also increase the risk of serotonin syndrome if taken with citalopram (Simon, 2021).
Other drug interactions
If you take Celexa and any medication with a blood-thinning effect, you may increase your risk of bleeding problems. This includes prescription blood thinners such as warfarin (brand name Coumadin) or over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen (FDA, 2017).
Citalopram should not be combined with medications that might potentially similarly alter the heart rhythm because of the increased risk of long QT syndrome. Examples of other drugs that affect heart rhythm include (FDA, 2012):
- Antiarrhythmic medications like quinidine, procainamide, amiodarone, sotalol
- Antipsychotic medications such as chlorpromazine, thioridazine, or pimozide
- Certain antibiotics called fluoroquinolones
- Other medications that can cause heart rhythm problems, like methadone
Many medications might interact with citalopram and may require dosing adjustments—this list does not contain them all. Tell your healthcare provider about any medications you are taking before starting treatment with citalopram.
Treatment with citalopram or other SSRIs is not recommended for everyone—certain medical conditions can increase the risk of serious side effects. For instance, people with bipolar depression are at an increased risk of manic episodes with citalopram.
If you have “narrow angles” in your eyes, you are at increased risk for both narrow-angle glaucoma and acute angle-closure glaucoma while taking Celexa.
People with underlying heart conditions should consult their healthcare provider before starting this medication. You should not use citalopram if you have recently had a heart attack or have low blood potassium or magnesium levels, as this can increase the risk of heart problems.
Citalopram crosses the placenta and gets into breast milk. It is considered Pregnancy Category C, meaning that there is not enough data to rule out risks to the fetus. If you are pregnant or breastfeeding, talk to your healthcare provider about the risks and benefits of taking Celexa.
- Bains, N. & Abdijadid, S. (2021). Major depressive disorder. [Updated Apr 20, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559078/
- Chand, S. P. & Arif, H. (2020). Depression. [Updated Jul 26, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430847/
- Czeisler, M. É., Lane, R. I., Petrosky, E., et al. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24–30, 2020. MMWR Morbidity and Mortality Weekly Report,69:1049–1057. doi: 10.15585/mmwr.mm6932a1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32790653/
- Hirsch, M. & Birnbaum, R. J. (2020). Discontinuing antidepressant medications in adults. In UptoDate. Roy-Byrne, P.P. & Solomon, D. (Eds.). Retrieved from https://www.uptodate.com/contents/discontinuing-antidepressant-medications-in-adults
- Jing, E., & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. Mental Health Clinician, 6(4), 191-196. doi: 10.9740/mhc.2016.07.191. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007725/
- Sharbaf-Shoar, N., Fariba, K., & Padhy, R. K. (2021). Citalopram. [Updated Jun 9, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482222/
- Simon, L. V. & Keenaghan, M. (2021). Serotonin syndrome. [Updated Jul 22, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482377/
- UpToDate. (n.d.). Citalopram: Drug information. Retrieved June 24, 2021 from https://www.uptodate.com/contents/citalopram-drug-information
- U.S. Food and Drug Administration (FDA). (2012). Celexa (citalopram hydrobromide) tablets/oral solution label. Retrieved June 24, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021365s030lbl.pdf
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.