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Citalopram: Effects, Dosage and Side Effects

Citalopram is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression and anxiety disorders.

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Things worth knowing about "Citalopram"

Citalopram is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression and anxiety disorders.

What is Citalopram?

Citalopram is a prescription medication belonging to the drug class of selective serotonin reuptake inhibitors (SSRIs). It is one of the most commonly prescribed antidepressants worldwide and has been used clinically since the 1980s. The active ingredient is available under various brand names, including Celexa and Cipramil.

Indications

Citalopram is primarily used to treat the following conditions:

Depressive disorders (unipolar depression, including severe episodes)
Panic disorder with or without agoraphobia
Generalized anxiety disorder
Social anxiety disorder
Obsessive-compulsive disorder (OCD) – in selected cases

Mechanism of Action

Citalopram selectively inhibits the serotonin transporter (SERT) in the brain. Under normal circumstances, this transporter is responsible for removing serotonin from the synaptic cleft and returning it to the nerve cell. By blocking this transporter, more serotonin remains available in the synaptic cleft, enhancing communication between nerve cells. Serotonin is a neurotransmitter that plays a key role in regulating mood, sleep, and overall well-being. Compared to other SSRIs, citalopram is considered particularly selective and has minimal interactions with other receptor types.

Dosage

The dosage of citalopram depends on the indication, the age of the patient, and individual tolerability. General guidelines based on current clinical recommendations:

Adults: Typically 20 mg once daily; may be increased to a maximum of 40 mg per day if needed
Elderly patients (over 65 years): Maximum dose of 20 mg per day due to an increased risk of side effects
Children and adolescents: Not recommended in this age group

Citalopram is taken once daily, usually in the morning, with or without food. The full therapeutic effect often does not occur until 2 to 4 weeks after starting treatment.

Side Effects

Like all medications, citalopram can cause side effects. Common side effects include:

Nausea, vomiting, or diarrhea
Sleep disturbances or increased fatigue
Dry mouth
Headache
Excessive sweating
Sexual dysfunction (e.g., decreased libido, delayed ejaculation)

Rare but serious side effects include:

QT prolongation: Citalopram can prolong the QT interval on an ECG, increasing the risk of serious heart rhythm disturbances. This is why a maximum daily dose of 40 mg is strictly enforced.
Serotonin syndrome: Particularly when combined with other serotonergic agents – symptoms include agitation, tremor, fever, and in severe cases, loss of consciousness.
Suicidal ideation: Especially in young adults at the start of treatment, there may be a temporary increase in suicidal thoughts.

Drug Interactions

Citalopram may interact with a number of medications and substances:

MAO inhibitors (e.g., tranylcypromine, phenelzine): Combination is strictly contraindicated – risk of life-threatening serotonin syndrome
Other serotonergic substances (e.g., tramadol, triptans, St. John's Wort): Increased risk of serotonin syndrome
QT-prolonging drugs (e.g., certain antiarrhythmics, antipsychotics): Increased risk of cardiac arrhythmia
Anticoagulants and antiplatelet agents (e.g., warfarin, aspirin): Increased bleeding risk

Treatment Guidance

Treatment with citalopram should always be started and discontinued under medical supervision. Discontinuation should be done gradually to avoid withdrawal symptoms such as dizziness, irritability, or flu-like sensations. Patients should inform their doctor if their mood worsens or if suicidal thoughts occur – especially during the first weeks of treatment.

References

European Medicines Agency (EMA): Assessment Report on Citalopram and QT-prolongation, 2011. Available at: www.ema.europa.eu
National Institute for Health and Care Excellence (NICE): Depression in adults – treatment and management. NICE guideline NG222, 2022. Available at: www.nice.org.uk
Stahl, S.M.: Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 5th edition. Cambridge University Press, 2021.

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