Citalopram (Celexa, Cipramil, Emocal, Sepram, Seropram)

Citalopram is a SSRI antidepressant that was introduced in 1989 by Lundbeck, a niche pharmaceutical company that specializes in developing medications for disorders of the central nervous system. The patent expired in 2003, and citalopram has been available as a generic medication since then.

The Bottom Line: What You Really Need to Know

Uses of citalopram

Citalopram is primarily used to treat depression in adults. It is also prescribed for social anxiety disorder (SAD), panic disorder, obsessive-compulsive disorder (OCD), Huntington"s disease and premenstrual dysphoric disorder (PMDD). Citalopram may also be helpful in treating irritable bowel syndrome (IBS), diabetic peripheral neuropathy (DPN), premature ejaculation, eating disorders, alcoholism and pathologic crying after a stroke.

Dosage and instructions

The usual dosage of citalopram is 20-40 mg daily. It is taken once a day, either in the morning or the evening and can be taken with our without food.

Most people begin taking 20 mg of citalopram daily. The dose can be increased to 40 mg after a week if necessary. The maximum recommended dose is 60 mg/day.

Elderly people and people with liver disease may need a lower dose of citalopram and may start with 10 mg/day.

If citalopram causes excessive drowsiness, it should be taken in the evening.

How citalopram works

It is thought that depression is at least partially due to imbalances in the chemicals at the junction of two nerve cells. These chemicals are called neurotransmitters and they are involved in the transmission of messages from one nerve cell to the next. Each neural junction is bathed in a sort of soup of neurotransmitters that includes serotonin, norephinephrine and dopamine-the neurotransmitters most likely involved in depression. Most people with depression have low levels of serotonin at the neural junctions.

Citalopram is a selective serotonin reuptake inhibitor (SSRI), a type of antidepressant that prevents serotonin from being reabsorbed by nerve cells from this neurotransmitter soup. This allows serotonin to accumulate and normalizes the biochemical balance at the neural junctions. Citalopram is highly selective, which means it has little effect on norepinephrine and dopamine.

Citalopram is distinctive among antidepressants because it has little direct interaction with other medications. Drug interactions with citalopram are usually due to common metabolic pathways instead of chemical interactions. In other words, citalopram and another drug may work the same way or be metabolized and excreted the same way. In those cases, a lower dose of citalopram may be necessary.

After you take citalopram, it is absorbed into your bloodstream and it attaches chemically to plasma molecules so that it is distributed throughout your body. Citalopram is mostly metabolized (broken down) in the liver and excreted in feces. A small amount is excreted in urine.

Side effects

Most people who take SSRI antidepressants experience some side effects. The most common ones with citalopram are fatigue, drowsiness and dry mouth. Some other fairly common side effects are:

Most of these side effects get better after you have taken the medication for a while.

Side effects that are rarely experienced include: allergic reactions, bleeding from the gastrointestinal tract, seizures, mood changes, anxiety and confusion, hallucinations, activation of mania (excessive agitation), hyponatremia or bruxism (grinding your teeth).

Sexual dysfunction due to SSRI medications usually resolves after you have taken the medication for several weeks. If it does not, it usually resolves when the dose is decreased or the medication is stopped. In rare instances people suffer from Post SSRI Sexual Dysfunction, and it takes months or years for sexual function to return to normal. Occasionally Post SSRI Sexual Dysfunction does not resolve.

Drug interactions

Most interactions with citalopram occur because the medications work the same way or are metabolized the same way. Still, the list of medications that interact with citaloprim is long and includes:

Herbs and natural remedies that interact with citalopram include St. John"s Wort, 5HT, grapefruit juice or extract, kava kava, valerian and tryptophan.

Ecstasy, PMA, cocaine and LSD also affect serotonin and can interact with citalopram in dangerous ways.

Serotonin Syndrome is a very dangerous toxicity syndrome caused by overdosage of SSRI medications or the combined action of more than one medication that affects serotonin. The symptoms of serotonin syndrome can range from mild to life-threatening. Shivering, sweating, rapid heart beat and anxiety are mild symptoms of serotonin syndrome. Moderate toxicity produces high blood pressure, fever to 104° F, muscle twitches and agitation. Severe toxicity causes shock, very high fevers, seizures, psychosis and death.

Withdrawal from citalopram:

It is extremely important not to abruptly stop taking citalopram. It must be tapered gradually. Even with gradual withdrawal, you may experience dizziness, tingling, fatigue, irritability, weird and vivid dreams and the sensation of electrical shocks in your hands and upper body. Abrupt discontinuation can cause severe symptoms.

Warnings, precautions and contraindications

Suicide Risk: Recent studies indicate that there may be an increased risk of suicide in the first few weeks after starting citalopram, especially in children and adolescents. The FDA has ordered a serious "black box" warning on all SSRI antidepressants regarding the increased risk of suicide. Anyone who takes citalopram should be closely observed for the first month or more of therapy. This includes weekly physician or therapist visits and daily contact with family or friends. Family and friends should be instructed to ask about any thoughts of suicide or self-harm. The physician should be notified of any suicidal thoughts, deepening depression, sudden mood change, agitation or other unusual symptoms.

Pregnancy and lactation: Citalopram has not been tested in pregnant or lactating women. Recent studies indicate that women who take SSRI antidepressants during pregnancy are at risk for fetal abnormalities, including heart defects and pulmonary hypertension. Babies born to mothers who are taking SSRIs can also experience withdrawal or serotonin syndrome symptoms.
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