Citalopram (A 7 point guide)

In this blog, we will discuss Citalopram, its benefits, risks, withdrawal symptoms, intake guidance, recommended dosage and frequently asked questions about Citalopram.

What is Citalopram?

Citalopram is also known as Celexa (in the USA) or Cipramil (In the UK) is an antidepressant drug commonly used to treat anxiety, depression and panic disorders in adults.

It is a mixture of two stereoisomers: R-citalopram and S-citalopram (unlike Escitalopram which is only one enantiomer, s-citalopram).

It is most commonly used to treat depression and has fewer side effects than older antidepressants.

It may improve your energy levels and your feeling of being well. 

It has been available in the UK since 1995.

Citalopram is available in tablet form but more commonly found as oil liquid drops and medicine in the USA.

You can put the oil drops into water when you want to consume it.

Citalopram is licensed for use in the UK and EU for panic disorder with or without agoraphobia.

In the UK, a typical dose costs less than 20 GBP per month.

Citalopram has been shown to be 85% effective in treating those with generalized anxiety disorder even when other antidepressants and SSRI’s have been unsuccessful.

In the United States, citalopram carries a boxed warning stating it may increase suicidal thinking and behaviour in those under age 24 but these warnings are not present on the UK packaging.

Citalopram can also and has also been used to treat:

• Anxiety
• Body dysmorphic disorder
• Obsessive-compulsive disorder.
• Dysthymia
• Premenstrual dysphoric disorder
  

You can read a brief guide the NHS has for CItalopram here.

Anxiety, depression and panic disorders are mental wellness problems that can affect anyone of us.

In fact, 1 in 4 of us experiences mental wellness problems at some point or the other in our life.

Anxiety, depression or panic disorders could be caused by life events which occur such as bereavement, loss of a friend, an illness, loss of a job or other life events such as war, active combat experience etc

When we experience these traumatic events the brain cells in our brain called neurons release a number of chemicals which in turn go on to stimulate other neurons in our brain.

This neurons then lead to electrical impulses which result in many other parts of the brains being affected.

As you can see mental wellness issues such as anxiety, depression and panic disorders to have some scientific background and they aren’t simply emotional issues which can often be treated by “getting over things”.

One of the chemicals released in our brain is called Serotonin. Serotonin plays a major role here as you will see.

Once Serotonin is released it stimulates other neurons in the brain, it is then taken back up into the neuron cells and repeats the process again.

This will essentially leave you going through a trauma of emotions which result in anxiety, depression and panic disorders.

How does Citalopram work?

Citalopram works by increasing the levels of a mood-enhancing chemical called serotonin in your brain.

Citalopram is one of a number of selective serotonin reuptake inhibitor.

This means it increases the amount of circulating serotonin in your brain rather than allowing them to be taken up back into the neurons and release more chemicals which then repeat the process.

It helps reduce the symptoms of depression, anxiety and panic disorders in some people but not everyone.

Should you take Citalopram?

Citalopram isn’t for everyone. It won’t work for everyone and hence certain people with certain medical conditions.

In either case, the use of Citalopram should be carefully managed.

It should be prescribed to you by your doctor and you should always declare it as one of the medications you take to ensure any other future medication you are prescribed takes it into account.

You should not take Citalopram if:

• If you are pregnant, trying for a baby or breast-feeding.
• If you have recently taken any other antidepressants as some older antidepressants can still react with Citalopram even though you haven’t taken them for a few weeks. You should inform your doctor of any antidepressants you have used. Some antidepressants can interact with Citalopram and cause your blood pressure to rise very high.
• If you are under 12 except if prescribed by your doctor
• If you are going through any treatment involving electroconvulsive therapy (ECT).
• If you have ever been allergic to any medicine.
• If you have taken an antidepressant known as a monoamine-oxidase inhibitor (MAOI) within the last two weeks.
• If you have high blood sugar levels (diabetes mellitus).
• If you have increased pressure in your eye(s) (also known as glaucoma).
• If you have ever had a bleeding disorder.
• If you have ever had abnormally ‘high’ moods, called mania.
• If you are currently taking any other medicines which you have been prescribed for or medicines which you have bought over the counter including any supplements, complementary medicine or herbal treatments. 
• If you have any liver or kidney disorders.
• If you have a heart condition or have been told you have an irregular heartbeat. This is because Citalopram can speed up or change your heartbeat
• If you have epilepsy.

Guidance on taking Citalopram:

“Try to take citalopram at the same time each day.

It may take up to four weeks after starting this treatment before you feel the full benefit. Do not stop taking it, feeling it is not helping.

Tell your doctor if you feel that you are not getting any better, or if you experience any troublesome side-effects.”]

Before you take CItalopram you should make sure you have read the above statement but more also as important you should follow the guidelines below.

• Before taking Citalopram or any medicine you should always read the manufacturers label in full. This may contain warnings, guidelines on dosage or ingredients which you may be allergic to. It will also provide you with a list of possible side effects so you are aware of any potential side effects of Citalopram before they occur.
• You can take Citalopram before or after food. You can also take it with or without food.
• It can be taken by children or adults over the age of 12
• If you forget to take a dose then take it as soon as you remember but if you remember on the day after the dose was meant to have been taken then do not take the dose to avoid taking two doses at the same time. You should never take two doses of Citalopram at the same time for any reason including trying to make up for a missed dosage.
•  If you are taking citalopram in its oral form then your doctor will inform you of how many drops you should take per dosage. You should drop the dosage into a glass of clear water or orange juice so you can count the drops with ease. You should then stir before drinking.
• If you have trouble sleeping then it is best to take citalopram in the morning
• You should always take Citalopram exactly as the doctor has asked you to take it. It is usually prescribed once a day and you will usually have flexibility on what time of the day you take it but you must try and ensure you take your doses at the same time every day to avoid ever taking two doses within close proximity of each other. If you find that you have taken two dosages then you should go to the A&E immediately with the packet. You may begin to experience the following after you have taken more than 1 dosage within a short period of time: being sick (throwing up), shaking, feeling sleepy, fast heart rate and seizures.
• Citalopram comes in different strengths. Your doctor will prescribe you the recommended strength which is suitable for you. You will be able to see the strength which you are taking on the package of the drug.
• Your doctor may prescribe a low dosage for you if you are currently being treated for a panic disorder. This is because some people may develop anxiety during the first two weeks and your doctor will want to monitor how you are reacting before slowly increasing the dosage you are taking.
• You should ensure you don’t miss any appointments with your doctor as it is very key they check how you are doing after prescribing you Citalopram. This could be because they want to reduce or increase the strength of your dosage.
• You should ensure you continue taking your citalopram treatment even if you feel it isn’t working. It will usually start working after the first two weeks (or maybe the first week) of usage. The effect of citalopram will slowly build up and you will begin to see its full effects within weeks 4 to 6.
• If you are diabetic then you may need to keep a calendar and check your blood sugar level more frequently as citalopram may affect the level of sugar in your blood. If you notice any sharp rise or fall in your blood sugar you should seek immediate medical advice from your doctor.
• You should not buy any over the counter medicine or supplements to consume with citalopram without informing your doctor. You should also not get any new prescriptions from any other doctor without informing them that you are currently on a Citalopram treatment and informing the doctor who prescribed your citalopram. You should especially avoid any anti-inflammatory pain killers and avoid taking the herbal remedy known as st John worts. This is because over the counter medicine and some prescription medicine can affect your Citalopram treatment.
• If you consume alcohol your doctor will likely ask you not to consume any alcohol for the duration of your Citalopram treatment as it may increase the side effects of the drug.
• You should not stop taking Citalopram without seeking the advice of your doctor first. Stopping your treatment suddenly can cause you problems as your doctor will typically want to gradually reduce your Citalopram dosage when the time has come for you to stop taking Citalopram.
• A course of Citalopram treatment will usually last for several months to avoid your symptoms from returning.
• Citalopram may make your skin more sensitive to sunlight. You should use a high SPF suncream whenever you are out with substantial sunlight until you are sure on how your skin reacts to sunlight. You can seek further advice from your doctor about this.
• If you become suicidal or start thinking about self-harm then it is important that you don’t do these things to yourself but instead inform your doctor. It could be a side effect of the drug or simply associated with the condition which you are taking Citalopram for.
• Citalopram isn’t the only antidepressant on the market. There are various antidepressants on the market and each has its own effects and side effects. If after a few weeks, usually more than 3, you find that citalopram isn’t working for you, you should tell your doctor and discuss this with them rather than suddenly stopping your treatment.
• There have been a  few cases of people developing allergic reactions to Citalopram. These are very rare but if you find yourself with any allergic reactions you should report this to your doctor immediately. The reactions could include but are not limited to itching., difficulty with your breathing and swelling on the face.
• You should never take more than the prescribed dose of citalopram. If you suspect that you or anyone else has done this then go straight to the accident and emergency(A&E) of your nearest hospital with the container or package of the CItalopram and explain what has happened.
• If your medicine is out of date then you shouldn’t keep it. Take it to your local pharmacy for disposal or discard it yourself.
• You should never give anyone Citalopram regardless of if they have been prescribed it or not.  It has been prescribed for you and you alone. Even if the person displays the same symptoms as you you should not give them the medicine.
• If you become pregnant whilst taking Citalopram then you should inform your doctor. Do not stop taking the treatment on your own. Citalopram can lead to some risky with unborn babies but it may be worse if you stop taking the treatment and experience depression during or after your pregnancy. You may have to continue taking the treatment throughout your pregnancy and your doctor will be able to advise you on the pros and cons. It is usually advised not to use Citalopram during pregnancy unless the potential benefit outweighs the risk. There is a small increased risk of congenital heart defects when taken during early pregnancy.
• You can continue to use citalopram during breastfeeding if your doctor says your baby is healthy and everything is fine. Citalopram has been known to pass into the breast milk in small doses as you breastfeed your baby. This has been linked to some small side effects with babies. If you notice your baby sleeps unusually or becomes tired and weak often then you should tell your doctor. It is important that you finish your citalopram treatment so that get better.

How much Citalopram should you take?

The amount of Citalopram you should take will usually be determined by your doctor but a brief guide on dosage is below.

Citalopram tablets come in different strengths ranging from 10mg to 40mg.

The usual dose of citalopram is 20mg a day in adults but your doctor may start you at a much lower dosage to see how you react to it and then gradually increase the strength of the citalopram which you are taking up to a maximum of 40mg per day.

If you’re over 65 or have liver problems, then the maximum recommended dose is 20mg per day.

The usual dose of citalopram in children is 10mg a day, but this may be increased by your doctor to a maximum of  40mg a day.

With liquid drops of citalopram, 4 oral drops(8mg) are equivalent to a 10mg tablet.

If you are suffering from depressive illness:

The dosage you are prescribed by your doctor will differ based on what you are suffering from but these are the guidelines is you are suffering from a depressive illness. 

Tablets via the mouth

If you are taking Cilatopram in the tablet form then these are the usual guidelines.

For an adult it is 20 mg once daily, increased in steps of 20 mg daily if required, dose to be increased at intervals of 3–4 weeks; maximum 40 mg per day.

For the elderly it is 10–20 mg once daily; maximum 20 mg per day.

Oral drops via the mouth

For an adult it is 16 mg once daily, increased in steps of 16 mg daily if required, dose to be increased at intervals of 3–4 weeks; maximum 32 mg per day.

For the elderly it is 8–16 mg daily; maximum 16 mg per day.

If you are suffering from a panic disorder

If you are suffering from a panic disorder then your doctor will typically provide you with a prescription based on the severity of your panic disorder but these are the guidelines. 

Tablets via the mouth

For an adult it is initially 10 mg daily, increased in steps of 10 mg daily if required, dose to be increased gradually; usual dose 20–30 mg daily; maximum 40 mg per day.

For the elderly it is initially 10 mg daily, increased in steps of 10 mg daily if required, dose to be increased gradually; maximum 20 mg per day.

Oral drops via the mouth

For an adult it is initially 8 mg once daily, increased in steps of 8 mg if required, dose to be increased gradually; usual dose 16–24 mg daily; maximum 32 mg per day.

For the elderly it is initially 8 mg once daily, increased in steps of 8 mg if required, dose to be increased gradually; maximum 16 mg per day.

How to store Citalopram?

You should always store Citalopram out of the reach of children.

Store in a cool, dry place, away from direct heat and light.

You can use citalopram drops for 16 weeks after first opening the bottle. Do not use the drops after this time.

What are the most common side effects of Citalopram?

There are a few very common side effects of Citalopram. Common side effects of citalopram will happen in 1 in every 100 people.

You should have read about them on the manufacturer’s leaflet which would have been in your Citalopram package of the drug and if you find that you are experiencing any of them then you should inform your doctor immediately.

As with most medicines, Citalopram will have unwanted side effects.

These side effects are not going to be affected by everyone but if you feel you are experiencing a side effect of citalopram then you should inform your doctor immediately.

The side effects of Citalopram will usually get better as your body adjusts to the drug but if you feel they are worsening or you are concerned about them then you should inform your doctor.

Below are the most common side effects of Citalopram and what you can do about them:

Dry mouth

If you are experiencing a dry mouth and you think this may be a side effect of citalopram then try chewing some sugar free chewing gum or having sugar free sweets.

General unease

You may have several things which make you unease. If any of the below is part of that and continue then you should inform your doctor.

Lack of appetite, loss of weight, aches and pains, Increased sweating, difficulty sleeping,  tingling feelings, reduced sexual drive or ability, ringing in your ears, yawning, the sensation of having a ‘thumping’ heart (palpitations), runny nose, itching

Mood swings or changes

You may experience different mood changes or swings when using Citalopram, this is a common side effect of Citalopram.

Your mood changes could include feeling nervous, becoming forgetful, feeling agitated, anxious, restless or shaky.

These feelings are usually common once you start a treatment of CItalopram but if they last longer than the first few days or more than the first week of you starting your Citalopram treatment then you should inform your doctor.

Nausea, indigestion or throwing up

Feeling sick and experiencing feelings of nausea, throwing up being constipated or diarrhoea can be solved by eating simple foods and drink.

If these symptoms continue then you should inform your doctor immediately.

Sleepy weakness or tiredness

If you experience a feeling of weakness, tiredness or just sleepiness then you should not drive and avoid using heavy machinery.

You should also cut down on your alcohol usage and try taking your citalopram in the morning.

Headache

If you are experiencing headaches then you should drink lots of water and ask your pharmacists to recommend a suitable painkiller.

Make sure you inform the pharmacist that you are taking Citalopram.

If you continue to experience a headache then you should inform your doctor. 

Heavy sweating

If you are experiencing heavy sweating due to your use of citalopram then you should use a fan, try wearing light and baggy clothes and use a strong antiperspirant deodorant.

If all of these don’t work then you may need to ask your doctor for a different antidepressant.

Severe side effects of Citalopram

There are some severe side effects of citalopram which you should go to the A& E immediately if you start experiencing.

You should go to an A&E immediately in the cases below.

They include:

• “Chest pain or pressure or shortness of breath
• Severe dizziness or passing out
• Painful erections that last longer than 4 hours – this may happen even when you’re not having sex
• any bleeding that’s very bad or you can’t stop, such as cuts or nosebleeds that won’t stop within 10 minutes”

You should call and speak to a doctor immediately in the cases below.

• If you start throwing up dark throw up or blood or maybe you start seeing blood in your tinkle, coughing up blood, produce red or black poo( which could indicate bleeding from your guts) then you should call and speak to a doctor immediately.
  
• If you start bleeding from your gums, notice bruising on your gums or your gums get bigger for no apparent reason.
  
• If you start experiencing self-harm or suicidal thoughts then you should call and speak to a doctor immediately.
• If you start experiencing constant headaches, find yourself being confused for long periods of time, find yourself being weak for a long period of time or begin experiencing frequent muscle cramps then these can all be signs of low sodium levels in your blood (in severe cases low sodium can lead to seizures)

Serious allergic reactions

Citalopram could also lead to serious allergic reactions. An allergic reaction is a medical emergency and you should call your doctor immediately.

You will see a full list of side effects on the manufacturer’s leaflet inside your Citalopram packet.

If you start experiencing any or all of the below then these are all warning signs of an allergic reaction.

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you’re wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You should book a medical appointment in the cases below.

• If you notice changes in your periods, such as heavy bleeding, spotting or bleeding between periods
• If you suddenly lose a lot of weight or gain a lot of weight without trying and for no apparent reason then you should book an appointment to see a doctor.

Withdrawal symptoms of Citalopram

If you stop your Citalopram treatment abruptly then you may suffer from sudden withdrawal symptoms.

It is important that you don’t stop taking citalopram unless directed by your doctor who will usually look to reduce your dosage over a period of at least one or two weeks in order to reduce any potential withdrawal symptoms.

If you experience discomfort or any withdrawal symptoms after discontinuing citalopram then speak to your doctor.

Below are some of the withdrawal symptoms people may experience from Citalopram.

• Dizziness
• Diarrhoea
• Palpitations
• Emotional 
• Instability 
• Irritability
• Sensory disturbances (including paraesthesia)
• Sleep disturbances (including insomnia and intense dreams)
• Agitation or anxiety
• Nausea
• throwing up
• Tremor
• Confusion
• Sweating
• Headache
• Visual disturbances 
  

These are the most common withdrawal symptoms of citalopram and will usually be mild in the first few days after finishing the treatment.

Thes symptoms may also occur if you miss a dose but will usually revert back to normal within 2 weeks.

In some cases, the withdrawal symptoms of citalopram may be severe. You should report all withdrawal symptoms to your doctor.

Some frequently asked questions about Citalopram

Disclaimer: Our goal is to provide you with the most relevant and current information.

However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects.

This information is not a substitute for medical advice.

Always discuss possible side effects with a healthcare provider who knows your medical history.

If you are under 18 then CAMHS, an NHS run programme may just be the answer for your mental health struggles.

You should look to see if you meet the CAMHS referral criteria and then fill in the CAMHS referral form.