Citalopram is a prescription antidepressant that belongs to the class of drugs known as selective serotonin reuptake inhibitors (SSRI).

It is mainly used to treat depression but can also help manage other conditions such as panic attacks and social phobia.

This medicine has helped many to recover from depression with fewer side-effects than other older antidepressants.

How Does Citalopram Treat Depression?

Brain chemicals (neurotransmitters) are responsible for sending signals from one brain area to another. Their action depends on the type of brain cells they influence. For instance, the neurotransmitter serotonin supplies cells related to mood, social behavior, appetite, sexual desire and function, learning and memory, and temperature regulation. Low levels of serotonin are associated with depression, sexual problems, and other disorders.

SSRIs inhibit the reuptake or reabsorption of serotonin into nerve cells. This increases its level in the brain and improves the transmission of messages between nerve cells. As these drugs affect mainly serotonin and no other neurotransmitters, they are called selective.

So, Citalopram works by improving the serotonin level in your brain. It can also help manage other conditions, such as anxiety disorders.

Prescription and Use

Citalopram can be prescribed in the following conditions;

  • Depression
  • Panic disorder (a condition that causes sudden attacks of extreme fear with no cause)
  • Alcoholism
  • Eating disorders
  • Social Phobia (a condition that causes excessive anxiety while talking to others)
  • Premenstrual dysphoric disorder (a group of physical and emotional symptoms that occur before the menstrual period each month)

The medication may be prescribed for other uses; ask your physician or pharmacist for detailed information

How To Use

  • Take this medicine orally once a day in the morning or evening. It can be taken with or without food or as prescribed by your physician.
  • Take this tablet daily at the same time every day.
  • Follow all the instructions on the prescription label. 
  • Do not stop taking this medication abruptly without consulting your doctor.
  • Do not take it more or less or take it more often than prescribed by your doctor.
  • Do not stop using it even if you feel well.
  • Your physician may start you with a low dose and gradually increase your dose. It may take 1-4 weeks before you begin to notice the full benefits of the medication.
  • If you happen to miss a dose of Citalopram, take the missed dose as soon as you remember. 
  • However, if it is almost time for the next dose, do not take the missed dose and continue with your next scheduled dose. 
  • Do not take a double dose to compensate for the missed dose.

Progress of Treatment

Usually, the starting dose is once daily, which can be increased to twice daily after a week. 

You should know that, like other antidepressants, it may take several weeks before effects are seen. Your doctor will adjust your dose to find the most effective one.

While taking Citalopram 20, your doctor may advise you to monitor certain health conditions, including:

  • Heart rhythm
  • Depression and other mental health problems
  • Electrolytes levels such as magnesium and potassium

Common Side Effects of Antidepressants

Like all other medications, Citalopram may cause side effects. Although it is unlikely to happen to everyone, it is essential that you are aware of what could be the possible side effects.

Serious side effects:

  • Severe itching of the skin
  • Irregular heartbeat, fainting which could be symptoms of a life-threatening condition
  • Difficulty in breathing 
  • Swelling of lips, face, tongue, or throat that causes difficulty in swallowing or breathing

If you experience any of the above symptoms, stop taking medication, and seek medical advice immediately. 

If you notice the below-mentioned symptoms, you should contact your physician immediately as your dose might need to be reduced or stopped;

  • If you start having fits (convulsions) for the first time or the frequency of the fits have increased
  • If you start experiencing tiredness, confusion, and twitching of muscles. This could be because of low sodium levels (hyponatremia)
  • If you experience behavior changes like elated or overexcited
  • If you experience high fever, agitation, confusion, trembling, or abrupt contractions of the muscles. This may be signs of a rare condition known as “Serotonin Syndrome.”

Very Common side effects:

  • Headache
  • Difficulty in sleeping 
  • Sleepiness 
  • Loss of body strength, weakness 
  • Changes in sleeping pattern 
  • Nausea 
  • Increased in sweating 
  • Dry mouth 

Common side effects:

  • Decreased sex drive
  • Agitation
  • Lack of appetite
  • Confusion
  • Abnormal dreams
  • Nervousness 
  • Anxiety 
  • Reduced emotions
  • Dizziness
  • Tremors 
  • Migraine
  • Numbness in hands or feet
  • Problems in concentration 
  • Loss of memory 
  • Ringing in ears
  • Loss of weight 
  • Prickling of skin
  • For women, failing to reach orgasm 
  • For men, problems with ejaculation and excretion
  • Stomach pain 
  • Flatulence
  • Constipation
  • Increased in saliva
  • Yawning 
  • Palpitations
  • Pain in muscle and joints
  • Blocked nose or runny nose

Uncommon side effects:

  • Bruised easily 
  • Increased weight
  • Swelling in arms or legs
  • Difficulty in urination 
  • Excessive menstrual bleeding
  • Sensitivity to sunlight
  • Rash
  • Loss of hair
  • Increased appetite
  • Aggression 
  • Mania
  • Hallucinations 
  • Large pupils
  • Fainting 
  • Fast heartbeat
  • Slow heartbeat
  • Nettle rash

Rare side effects:

  • Feeling unwell
  • Bleeding
  • Hepatitis 
  • Coughing
  • Increased sex drive 
  • Involuntary movements
  • Taste disturbances 
  • Convulsions

Citalopram can, very rarely, increase the risk of bleeding, including stomach or intestinal bleeding. Let your physician know if you vomit blood or develop black or blood-stained stools.  

Citalopram takes about two weeks or longer to work, so you may have thoughts of killing or harming yourself. If you have such thoughts at any time, contact your physician immediately or go to the hospital straight away. 

Interaction with Other Medicines

Citalopram can interact with other medicines, herbs, or supplements. An interaction means a substance changes the course of action of a drug. It can result in adverse effects or lower the impact of the medication.

Here are a few examples of medicines that interact with Citalopram.

Medicines that increase serotonin levels

  • Fentanyl
  • Lithium
  • Buspirone
  • Linezolid
  • Sumatriptan
  • Amphetamine
  • Dextroamphetamine
  • Imipramine
  • Isocarboxazid
  • Tranylcypromine
  • Amitriptyline
  • Zolmitriptan
  • Nortriptyline
  • Phenelzine
  • Selegiline
  • St. John’s wort
  • Tramadol

Drugs that influence the heart rhythm

  • methadone
  • Pentamidine
  • Procainamide
  • Sotalol
  • Amiodarone
  • Moxifloxacin
  • Pimozide
  • Quinidine
  • Thioridazine

Medicines that increase bleeding risk

  • Enoxaparin
  • Heparin
  • Naproxen
  • Aspirin
  • Warfarin
  • Dalteparin
  • Ibuprofen
  • Ketorolac

Tricyclic antidepressants

  • Imipramine
  • Amitriptyline
  • Nortriptyline

Drugs that cause drowsiness

  • Alprazolam
  • Midazolam
  • Lorazepam
  • Diazepam
  • Temazepam
  • Zolpidem

Cytochrome P450 2C19 inhibitors

  • Clopidogrel
  • Chloramphenicol
  • Omeprazole
  • Cimetidine
  • Clopidogrel
  • Fluvoxamine
  • Modafinil

Warnings

This drug comes with several warnings.

Inform your physician if you have the following conditions before starting Citalopram:

  • Liver disorders
  • Kidney disorder
  • Abnormal heart rhythm
  • Diabetes
  • Mania or panic disorder
  • Epilepsy 
  • Bleeding disorder
  • If you have a history of bleeding in the stomach or intestine
  • Low sodium levels
  • Problems with eyes such as Glaucoma 
  • Electroconvulsive therapy 
  • Low heart rate
  • If you experience a fast or irregular heartbeat, collapse, fainting, or dizziness on standing up.
  • History of heart attack 

Also, talk to your doctor if:

  • You are taking any other medication, are pregnant, breastfeeding, or planning a pregnancy. 
  • You are allergic to Citalopram or any of its ingredients or have any other allergies.
  • You are allergic to any other medication.
  • You are taking any other drugs, over-the-counter medicines, herbal products, or nutritional supplements.
  • You are lactose intolerant.
  • You are consuming herbal products that have St. John’s wort or tryptophan.

Ask your doctor about the safe use of alcoholic beverages during your treatment with Citalopram as it can make the side effects of Citalopram worse.

Besides, this medicine is seen to increase the risk of suicide in teens and adults. So, it is best to consult your doctor if you or any of your family members have a history of a maniac or bipolar depressive disorder, especially if there is a past history or family history of suicidal attempts.

Lastly, children are more sensitive to weight and appetite changes associated with this medicine. It is thus essential to monitor height and weight in children who are taking Citalopram.

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