Can you take celexa and amitriptyline together?

In this blog post, we are going to talk about the concomitant use of celexa and amitriptyline. Both of these medicines are antidepressants, but they belong to two different classes and have different mechanisms of action to counteract the symptoms of depression and other mental health conditions.

Can you take celexa and amitriptyline together? 

No, it is not safe to take celexa and amityiptyline together. Both of these drugs are antidepressants in nature. Your doctor will prescribe you either celexa, or amitriptyline, but not both. The concomitant use can significantly increase the risk of serotonin syndrome. 

These drugs treat depression by increasing the amounts of excitatory neurotransmitters in your body, usually serotonin and norepinephrine. The excessive amount of serotonin can result in serotonin syndrome, which is associated with symptoms like:

• Fever with chills
• Excessive sweating 
• Restlessness and fatigue
• Headache, which often feels like your head is pounding
• Changes in blood pressure and/or temperature
• Nausea
• Vomiting
• Diarrhoea
• Bradycardia
• Tremors
• Muscle twitching and muscle pain
• Shivering and goosebumps

Celexa can also increase the toxic side effects of amitriptyline by increasing its concentration in the body. This combination is not ideal and is not commonly used, but if it is extremely important to use these two agents, your doctor will adjust the dose. However, this condition is pretty rare. 

What are the safety concerns associated with the use of celexa and amitriptyline?

Celexa, brand name for citalopram, belongs to the class of selective serotonin reuptake inhibitors (SSRIs). As the name indicates, these meds inhibit the reuptake of serotonin and make more active serotonin available to bind to its receptors throughout the body. 

This is how it enhances mood, cognition, reward, learning, memory, and various other psychological processes. 

Amitriptyline (Brand name: Elavil), on the other hand, belongs to the class of Tricyclic antidepressants (TCAs). These agents work by inhibiting serotonin and norepinephrine transports, SERT and NET respectively. 

This way they can help increase the amounts of excitatory neurotransmitters in your system and cure your depression. As discussed earlier, it is not safe to use these two meds together. 

One is enough to tone down depression symptoms. When you talk about safety profiles, celexa is much safer than amitriptyline. 

Celexa and other SSRIs are used as a first line of treatment for depression and other psychological illnesses. Amitriptyline, on the other hand, was removed from the list of first line agents because of its adverse side effects. 

TCAs are much more likely to bind to several other receptors in our body. One study suggests that amitriptyline has much more affinity for other receptors including cholinergic receptors. The more if binds to different kinds of active sites, the more side effects occur. 

Adverse effects of amitriptyline includes:

• Painful urination 
• Dry mouth or xerostomia
• Gastrointestinal side effects, including nausea and vomiting 
• Weight gain
• Vertigo 
• Drowsiness or extreme fatigue 
• Constipation 
• Abdominal pain
• Enlarged breasts
• Heartburn
• Excessive sweating 

In severe conditions it can cause an allergic reaction, associated with painful rash, redness, pus filled blisters, itching, eczema, and burning sensation etc. It can also cause suicidal behavior in people older than 24 years of age. 

The effects of amitriptyline are unpredictable, because of its affinity to bind with multiple receptors. This is one of those drugs which are not that easily tolerated by a majority of the population. 

Amitriptyline can significantly cause QT elongation which can result in deadly arrhythmia. This class of antidepressants is well known for its cardiac toxicity. It can cause sudden cardiac arrest and death upon overdose. 

If, for some reason, you can not tolerate the first line of antidepressants and you have to take amitriptyline or any other TCA, make sure you follow proper adherence. 

A 2004 study gathered all the data from different research studies and revealed 1000+ deaths caused by amitriptyline overdose. The study revealed that cardiac toxicity associated with amitriptyline is dose dependent. People at higher doses are also most likely to suffer from toxic effects. 

Other than depression, amitriptyline is also used to treat other disorders like eating disorder or bulimia nervosa, neuralgia and migraines. Make sure you read the following instructions before taking amitriptyline:

• Always inform your doctor if you’re allergic to it or any other tricyclic antidepressant. 
• Carefully read the leaflet or medication guide
• Don’t take this medication concomitantly with monoaminoxidase inhibitors (MAOIs). 
• Inform your doctor if you’re pregnant. Breastfeeding is contraindicated with the use of amitriptyline. Make sure you avoid doing that. 
• Discuss the use of amitriptyline with your doctor if you belong to the geriatric population. It might not be safe for people above 60 years of age. Such people already have multiple underlying health conditions and their immunity and other physiological functions are not that competent. 
• Avoid drinking too much alcohol with this, as amitriptyline can make you drowsy and so can alcohol. It is advised to limit the use of these two together.
• If it makes you drowsy, do not take it in the morning. If you have, avoid driving, operating heavy machinery or any task that requires you to have full mental alertness. 

Celexa, although it is safer than amitriptyline in comparison, also has side effects. These include:

• Nausea 
• Vomiting 
• Diarrhoea or Constipation 
• Acid reflux or heartburn 
• Abdominal pain 
• Loss of appetite 
• Weight gain or loss 
• Excessive sweating or night sweating (nocturnal/night hyperhidrosis) 
• Frequent urination 
• Polydipsia or excessive thirst
• Tremors 
• Muscle twitching and pain
• Drowsiness 
• Dizziness 
• Excessive tiredness or fatigue 
• Insomnia or inability to fall asleep 
• Xerostomia or dry mouth 
• Dysmenorrhea or heavy periods
• Flu like symptoms including irritation in eyes and runny nose
• Loss of libido in both male and females. Males may suffer from inability to ejaculate, while females may suffer from inability to have an orgasm. 

Celexa (Citalopram) is also associated with some serious side effects, which may include:

• Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 
• Auditory or visual hallucinations 
• Nose bleeds
• Severe headache
• Arrhythmia or abnormal heartbeats
• Impaired memory and concentration 
• Convulsions 
• Swelling or tenderness in different parts of the body.

If your doctor has prescribed celexa, give the following points a quick read:

• Make sure you take celexa once daily, as recommended by your healthcare provider.
• Consult your doctor if your mood worsens or you experience a serious side effect. 
• Celexa tends to induce suicidal behavior in users younger than 24 years of age. If you have someone who shows suicidal behavior or you see hopelessness in them, make sure you keep an eye on them and get medical attention as soon as you can. 
• Do not stop celexa abruptly. If it’s time for you to stop celexa, your doctor will simply make a taper schedule for you, which should be followed vigilantly if you wish to keep withdrawal symptoms at bay. 
• Report any problems with bleeding or bruising to your doctor. If you see any unexplained blisters or rashes on your body, or experience any problems with urination, or if you feel changes in your vision, immediately report to your healthcare provider. 

As discussed earlier, celexa is much safer than amitriptyline because of lesser attraction to other receptors. This is why it is preferred over amitriptyline. 

For people who can not tolerate celexa and other SSRIs, the doctor starts going through other classes of antidepressants and that’s where you might end up with amitriptyline. 

Conclusion 

In this blog, we discussed the concomitant use of celexa and amitriptyline. They both are antidepressants, but belong to two different classes. Celexa belongs to selective serotonin reuptake inhibitors (SSRIs) and amitriptyline belongs to tricyclic antidepressants (TCAs). 

Celexa inhibits the reuptake of serotonin, whereas amitriptyline inhibits the reuptake of both serotonin and norepinephrine. It is not recommended to use these two agents together. 

The concomitant use can increase the risk of serotonin syndrome, which occurs with dangerously high amounts of serotonin in your body. This is why your doctor will either recommend celexa or amitriptyline, but never both. In terms of safety, celexa is considered much safer than amitriptyline. 

Amitriptyline and other TCAs have higher affinity to bind with several other types of receptors in the body which is the root cause of more side effects. Make sure you never start taking medications without your doctor’s approval.

Self-medication for the treatment of psychological illnesses can wreak havoc on your body. It is not even recommended to change your timing or dose without discussing with your healthcare provider first. 

FAQs: celexa and amitriptyline

Is Celexa and amitriptyline the same thing?

No, celexa and amitriptyline are not the same thing. Celexa, brand name for citalopram, belongs to the class of selective serotonin reuptake inhibitors (SSRIs). As the name indicates, these meds inhibit the reuptake of serotonin and make more active serotonin available to bind to its receptors throughout the body. 

This is how it enhances mood, cognition, reward, learning, memory, and various other psychological processes. Amitriptyline (Brand name: Elavil), on the other hand, belongs to the class of Tricyclic antidepressants (TCAs). 

These agents work by inhibiting serotonin and norepinephrine transports, SERT and NET respectively. This way they can help increase the amounts of excitatory neurotransmitters in your system and cure your depression. 

Can you use SSRI and amitriptyline together?

It is not advised to take SSRIs and amitriptyline together. Usually one antidepressant with appropriate dose is enough to provide relief from depression. SSRIs are used as the first line of agents for the treatment of depression because of their better safety profile. 

Amitriptyline on the other hand can bind to several other receptors in your body and produces more side effects. If it is extremely necessary to combine these two drugs together, your doctor will carefully adjust the dose. However, this condition is pretty rare.

What drugs should not be taken with amitriptyline?

• Monoaminoxidase inhibitors. The concomitant use increases the risk of serotonin syndrome.
• Non-steroidal anti-inflammatory drugs (NSAIDS). The combination can increase the risk of bleeding 
• Pimozide 
• Alcohol 

Which is stronger amitriptyline or citalopram?

Both  amitriptyline and celexa are believed to be equally strong. However, celexa has a better safety profile. It can tone down the symptoms of anxiety and stabilise mood. 

Amitriptyline, on the other hand, has more side effects because of its ability to bind with other receptors. It’s best to consult your healthcare provider to determine which medicine is best to treat your anxiety. 

What can I replace citalopram with?

You can replace citalopram with other SSRIs including sertraline, escitalopram, fluoxetine, and paroxetine. Serotonin-norepinephrine reuptake inhibitors (SNRIs) can also be used.

References 

• C J Kyle, H E Petersen, K F Over (1998) – Comparison of the tolerability and efficacy of citalopram and amitriptyline in elderly depressed patients treated in general practice https://pubmed.ncbi.nlm.nih.gov/9871816/
• D M Shaw, D R Thomas, M H Briscoe, S E Watkins, R Crimmins, B Harris, J Lovett, M Raj, A T Lloyd, C Osborne (1986) – A comparison of the antidepressant action of citalopram and amitriptyline https://pubmed.ncbi.nlm.nih.gov/3545354/
• Kenneth Wilson et al. Int J Geriatr Psychiatry. (2004) – A comparison of side effects of selective serotonin reuptake inhibitors and tricyclic antidepressants in older depressed patients: a meta-analysis https://pubmed.ncbi.nlm.nih.gov/15290699/
• Trindade E, Menon D, Topfer LA, et al. (1998) – Adverse effects associated with selective serotonin reuptake inhibitors and tricyclic antidepressants: a meta-analysis https://www.ncbi.nlm.nih.gov/books/NBK67237/#_NBK67237_pubdet_
• Wayne A Ray et al. Clin Pharmacol Ther. (2004) – Cyclic antidepressants and the risk of sudden cardiac death https://pubmed.ncbi.nlm.nih.gov/15001975/