A panic attack is when you have a sudden episode of intense fear without an apparent cause or real danger. These episodes are frightening, and you may feel like you are having a heart attack or losing control.

Many patients have just one or two attacks, and usually, the problem goes away once the stressful events subside. But, if you get frequent panic attacks and stay in constant fear of another panic attack, you may have a panic disorder.

While these attacks are not harmful, they affect the quality of your life. But the best part is that you can manage the condition effectively.

If you are diagnosed with a panic disorder, your doctor may prescribe an antidepressant, such as citalopram (Celexa), to help you manage the condition.

Let’s understand more about this medicine and how it can help you manage the panic disorder.

Panic Disorder- Definition

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists the mentioned points to confirm the diagnosis of a panic disorder:

  • Having unexpected, frequented panic attacks
  • At least one of the attacks is followed by ongoing worry about having another episode for a month or more
  • Significant changes in your behavior, for instance, avoiding situations that may trigger your panic attack
  • Continued fear of consequences of an attack, such as losing control, or having a heart attack, or going crazy
  •  The panic attacks are not caused by a medical condition, drugs or other substance use, another mental health condition

Fortunately, although the symptoms of the conditions are overwhelming and affect the quality of your life, they can be effectively managed with treatment. So, the most important thing is to consult a doctor who will help reduce symptoms and improve your life quality.

Cause and Symptoms

Cause

The exact cause behind a panic disorder is not known, but experts believe it to be genetic in nature. It may also result from specific transitions in your life, such as getting married, having a child, or leaving for college. All these life transitions may cause stress and result in a panic disorder.

Some common causes include:

  • Major stress
  • Genetics
  • Changes in the functioning of certain parts of the brain
  • A temperament that is prone to negative emotions or more sensitive to stress

Risk Factors

  • Major life stress such as serious illness or death of a loved one, divorce, marriage, or having a baby
  • Family history of panic disorder or panic attacks
  • History of childhood sexual or physical abuse
  • Excessive caffeine intake or smoking

Symptoms

 A panic attack typically lasts for 10 to 20 minutes, but in some cases, it may also last longer than an hour.

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The experience is different for everyone, and symptoms can vary.

Some common symptoms include:

  • Shortness of breath
  • Dizziness
  • Palpitations or racing heartbeat
  • Chills or sweating
  • Lightheadedness
  • Tingling or numbness in your feet or hands
  • Trembling or shaking
  • Fear that you may die
  • Chest tightness or pain
  • Changes in your mental state, including a feeling of being detached from yourself or a feeling of unreality

It is also good to understand that symptoms of a panic attack may occur for no apparent reason. The symptoms are out of proportion to the level of danger. It is not possible to predict the occurrence of these attacks and thus may affect your functioning.

Panic Attack VS. Anxiety Attack

While the terms panic attack and anxiety attacks are used interchangeably, they are different. A panic attack occurs suddenly, along with intense, overwhelming fear and physical symptoms such as shortness of breath, racing heartbeat, and nausea.

An unexpected panic attack occurs without a cause, and an expected attack can happen due to known stressors and phobia.

On the other hand, an anxiety attack is not recognized by DSM-5. It may involve various symptoms, including distress, worry, and fear. Anxiety attack is usually due to an anticipation of a stressful experience, situation, or event.

As there is a lack of diagnostic recognition, the symptoms of an anxiety attack are open to interpretation. 

Here are some basic differences that may help you differentiate both: 

  • Anxiety is a response to a perceived stressor, but panic attacks usually occur without a trigger.
  • Anxiety symptoms may be mild or severe, but panic attack symptoms are disruptive and intense.
  • Anxiety symptoms become intense gradually, but panic attack symptoms appear suddenly.
  • Anxiety attack symptoms can stay for a long time, but panic attack symptoms usually subside after a few minutes.

How Does Citalopram Help Treat A Panic Disorder?

Although the exact cause of a panic disorder is not known, experts believe that low levels of neurotransmitters such as serotonin may change the functioning of certain brain areas, resulting in a panic attack.

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 depression.

As Citalopram has limited side-effects, long-term effectiveness, and validated research outcomes, it is commonly prescribed for a panic disorder.

Here are some ways how Citalopram can help:

  • Symptom reduction: Mainly, SSRIs are used to manage the symptoms of a panic attack, improving the quality of your life. This also reduces the chance of future episodes, reliving the fear of a future attack, which is the most debilitating feature of a panic disorder. So, Citalopram can have a significant effect if you are having difficulties engaging in activities or have become afraid of leaving the house.
  • Skill-building: Cognitive behavioral therapy plays a vital role in helping you cope with a panic disorder. Research has shown that CBT is more beneficial when accompanied by SSRIs.
  • Managing co-occurring conditions: SSRIs such as Citalopram help manage symptoms of a panic disorder and other morbidities such as anxiety and depression. 
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Use and Dosage 

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.

Dose

The usual starting dose is 20mg/day. However, your doctor may decide to increase the dose based on your response and symptoms.

Care and Precautions

Precautions

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.

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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

Interactions

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 such as Fentanyl and Lithium
  • Drugs that influence the heart rhythm such as Methadone and Pentamidine
  • Medicines that increase bleeding risk such as Enoxaparin and Heparin
  • Tricyclic antidepressants such as Imipramine and Amitriptyline
  • Drugs that cause drowsiness such as Alprazolam and Midazolam
  • Cytochrome P450 2C19 inhibitors such as Clopidogrel and Chloramphenicol

Side effects

Like all other medications, Citalopram may cause side effects. Although it is unlikely to happen to everyone, you must know 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

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
  • Nettle rash

Rare side effects:

  • Feeling unwell
  • Bleeding
  • Hepatitis 
  • Coughing

Read more about the Citalopram here.

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