Obsessive-compulsive disorder is a mental health condition characterized by repeated unwanted sensations or thoughts (obsessions) or an urge to do something over and over again (compulsions).

Experts believe that imbalance in neurochemicals such as serotonin may cause OCD. So, medicines that improve the levels of these chemicals can help manage it. One such medicine is Citalopram.

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

Here is more about OCD and how Citalopram can help treat it.

What Is OCD

Obsessive-compulsive disorder features symptoms of unwanted fears and thoughts, which may result in repetitive behaviors. These repetitive obsessions and compulsions may cause significant distress and interfere with your ability to carry out daily activities.

You may try to stop or ignore your obsessions, but this may only make it worse and cause anxiety. This causes you to do compulsive acts to relieve stress. Despite your efforts to get rid of bothersome thoughts, they may keep coming, resulting in ritualistic behavior. It is thus a vicious cycle.

Usually, OCD revolves around a theme. For instance, a fear of getting contaminated, which causes you to wash your hands repeatedly. 

If you think OCD is something about behaviors like biting your nails, then it is wrong. It is an obsessive thought like specific numbers or colors are negative or positive. And compulsion like washing your hands till they are chapped as you feel that everything you touch may be dirty.

While everyone may have these thoughts, OCD patients have thoughts that are beyond your control and take up at least an hour of your day. It may also interfere with your social life or work.

The condition may be embarrassing, but the good news is that it is treatable.

OCD Types 

While OCD may come in many forms, the mentioned are four common categories:

  • Contamination: A fear that things are dirty and touching them will cause you to catch an infection. Mental contamination may make you feel that you have been treated like dirt.
  • Checking: It involves checking alarm systems, light switches, locks, or ovens. It may also make you think that you have a condition such as schizophrenia or pregnancy.
  • Intrusive thoughts and ruminations: It is an obsession with some line of thought, which could be disturbing or violent.
  • Ordering and symmetry: It involves the need to have things lined up in certain ways.

Causes and Symptoms 

Causes

The exact cause behind OCD is know known, but experts believethe following theories:

  • Genetic
  • Abnormal brain chemistry
  • Learned behavior from seeing a family member

Risk factors

Factors that may increase your risk of OCD are:

  • Stressful life events
  • Family history
  • History of other mental health disorders such as anxiety and depression

Symptoms

OCD usually involves both obsessions and compulsions. However, it may be possible just to have one symptom. In some instances, you may not even realize you may have OCD unless it becomes unbearable and interferes with your daily life.

Obsessions

They are upsetting impulses or thoughts that occur repeatedly.

Obsessions often have themes to them, including:

  • Having difficulty tolerating uncertainty
  • Fear of dirt or contamination
  • Horrific or aggressive thoughts of losing control and harming others or yourself
  • Needing things symmetrical and orderly
  • Unwanted thoughts, including religious or sexual thoughts

Some common symptoms around these obsessions are:

  • Doubts that you have turned off the stove or locked the door
  • Images of driving your car into a crowded place
  • Unpleasant sexual images
  • Fear of touching objects others have touched due to fear of being contaminated
  • Thoughts of misbehaving in public
  • Intense stress when things are not in an orderly fashion
  • Avoiding actions that may cause obsessions, such as shaking hands

Compulsions

These are actions that relieve the obsessions temporarily. People with compulsions believe that these actions will prevent any negative thing.

So, compulsions are repetitive actions that compel you to perform; however, they only offer temporary relief.

Some common themes include:

  • Counting
  • Following a strict routine
  • Cleaning and washing
  • Checking
  • Demanding reassurance

Some symptoms of compulsions around these themes include:

  • Washing hands unless the skin peels off 
  • Repeatedly checking the stove to see if it is off
  • Repeating a word, prayer, or phrase
  • Repeatedly checking doors to see if it is locked
  • Counting in patterns

Citalopram and Treating OCD

Research shows that OCD is due to problems in communication between certain brain parts and deeper brain structures.

These brain structures use the neurotransmitter serotonin. Low serotonin levels may thus be responsible for OCD. Studies using pictures of the brain have shown that medicines that improve serotonin levels also improve brain circuits associated with OCD.

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.

Medication – 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 40mg/day. However, your doctor may decide to increase the dose based on your response and symptoms

Other 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.

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, 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

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

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. 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. Read more about the Citalopram here.

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