Table of Contents
One in six adults in England is on antidepressants, which include selective serotonin reuptake inhibitors (SSRIs) like citalopram. In this article, we take a look at exactly what citalopram is and how it works. We take a look at what it is used for, along with who should and shouldn’t take it.
We also cover the side effects, including common ones like headaches and sweating, as well as serious side effects like seizures, suicidal thoughts, and mania. Later on, in the article, we explore the withdrawal symptoms some people face when getting off of citalopram and look at the best way to gradually reduce the dose to avoid the worst withdrawal symptoms.
The article finishes by looking at how citalopram compares with several other antidepressants, including sertraline, venlafaxine, and Lexapro (escitalopram).
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What Is Citalopram?
Citalopram is a tablet prescription medicine used to treat depression. It is part of a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). These SSRIs all work in a similar way and are often used to treat similar conditions.
For a long time, it was believed that they essentially worked by increasing the levels of serotonin in the brain, which was thought to have played a role in improving symptoms of depression. Interestingly, a recent review of available literature has found that depression likely isn’t caused by a chemical imbalance in the brain. We will explore this review in detail in the section below titled: What does Citalopram do to the body?
What Is Citalopram Used For?
Citalopram is used to treat depression and it is sometimes used to treat panic attacks.
What Does Citalopram Do to the Body?
Citalopram works in the brain by increasing the levels of serotonin. This is achieved by stopping the recycling of released serotonin back into the nerve endings.
Historically it was believed that citalopram was effective because of its ability to rebalance chemicals in the brain. Because SSRIs do temporarily boost serotonin in the brain, it is easy to understand why this theory took hold. However, it is not necessarily true that depression happens because of low serotonin. A recent research review found that the idea that depression is caused by a “chemical imbalance” is hypothetical and lacks good evidence.
The review looked at lots of different studies on the link between SSRIs and serotonin. One area of research compared levels of serotonin and its waste products in the body. It did not find a difference between people with depression and those without.
Another area of research looked at serotonin receptors. Research looking at the most frequently studied serotonin receptor found no difference between people with depression and those without.
The review also included some research that explored whether you could induce depression in a person by lowering their levels of serotonin. Two systematic reviews found that lowering serotonin didn’t cause depression in hundreds of healthy volunteers.
But why then, is there research that has found citalopram is an effective drug for treating mood disorders like depression? It isn’t fully understood, but there are other explanations for why SSRIs can help.
There are trials, studies, and reviews suggesting that at least some of the benefits of taking antidepressants can be attributed to the placebo effect. There is also evidence that SSRIs have the ability to numb emotions, which could affect people’s moods. Further research has found that citalopram may be helpful in reducing depression through its ability to suppress rapid eye movement (REM) sleep and increase deep slow-wave sleep, which is associated with improving depression.
Professor Joanna Moncrieff and Dr Mark Horowitz, who conducted the research review, concluded:
“It is important that people know that the idea that depression results from a “chemical imbalance” is hypothetical. And we do not understand what temporarily elevating serotonin or other biochemical changes produced by antidepressants do to the brain. We conclude that it is impossible to say that taking SSRI antidepressants is worthwhile, or even completely safe. People need all this information to make informed decisions about whether or not to take antidepressants.”
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What Are Normal Doses of Citalopram?
Citalopram is available in three doses: 10mg, 20mg, and 40mg. Typically, an adult would take 20mg a day, though in some cases people will start at a lower dose or may require the maximum dose.
If, for example, you were prescribed citalopram for panic attacks you may be prescribed a 10mg dose. Likewise, if your liver function is impeded or you’re over the age of 65, you likely wouldn’t be prescribed more than 20mg a day.
In any case, follow your doctor’s advice.
Is Citalopram Safe?
One in six people in England are on antidepressants, including selective serotonin reuptake inhibitors like citalopram – but are they safe? Like all medicine, citalopram comes with the risk of side effects. We will discuss these in-depth further in the article.
There are a couple of rare but very dangerous risks associated with taking citalopram. In the US, citalopram carries a black box warning, as it may increase suicidal thinking and behaviour in people under the age of 24.
Taking citalopram can also cause changes to your heart rhythm, known as QT prolongation or Torsade de Pointes, which can be fatal. It’s worth speaking with your GP or healthcare provider about any concerns.
How Long Does It Take To Work?
This varies from person to person, but generally speaking within a week or two of taking citalopram you should notice a reduction in symptoms.
However, it often takes around a month to six weeks to get the full benefits of taking citalopram, this is because it needs time to build up the levels in your body and then for your body to get used to this.
For this reason, most healthcare practitioners suggest giving the citalopram at least six weeks to assess whether or not it is helping you.
Is Citalopram Addictive?
Citalopram is a non-addictive antidepressant. However, an addiction could be possible for people recovering from depression seeking to boost the benefits of citalopram by taking more than the prescribed amount.
It’s also worth noting that after using citalopram for a prolonged period of time, your body is likely to develop a physical dependency on the medication. Coming off of citalopram when you have developed a dependency is unpleasant and can cause a range of withdrawal symptoms. This alone can make some people hesitant to stop taking citalopram.
Where to get Citalopram?
While studies have found citalopram helpful in alleviating depression symptoms, this drug also has side effects and some potentially dangerous drug interactions. Because of this, citalopram is only available on prescription.
Is Citalopram Good for Anxiety?
Citalopram is approved for use as an antidepressant, though it can be prescribed off-label to treat anxiety disorders, including panic attacks.
Does Citalopram Make Anxiety Worse Before Better?
People are advised to give citalopram six weeks before deciding whether or not it is an effective drug for them. This is because it takes a while to build up sufficient levels in the body and for the body to adapt.
However, in some cases, people report feeling worse during the first few weeks before they start to feel better. This could include a worsening of anxiety symptoms, which can be difficult to deal with. Speak with your doctor or healthcare provider if you have any concerns about the worsening of your symptoms.
When to Take Citalopram – Day or Night?
In most cases, you will be advised to take citalopram once a day. It doesn’t matter when you take it – whether that’s during the day or night – but it’s best to choose the same time every day.
If you have trouble sleeping, a common side effect of citalopram, you might prefer to take it in the morning. You do not need to take citalopram with food, however, if you are taking a liquid form, mix it with water and drink it straight away.
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Who Should and Shouldn’t Take Citalopram
There are certain health conditions that don’t mix well with citalopram. If you fall into any of the groups below, you may want to avoid this form of antidepressant. As always, discuss this with your GP or healthcare provider.
Heart Problems: If you have a pre-existing heart problem, you should avoid citalopram. This is because this drug could put you at a higher risk of heart rhythm change known as QT prolongation, which can result in death. If you have a slow heart rate or have recently experienced a heart attack or heart failure, avoid citalopram.
Low potassium or magnesium: Potassium and magnesium are vital minerals we need for multiple functions in the body. If you have low levels of potassium, you should avoid citalopram. It can also put you at a higher risk of QT prolongation and sudden death.
Kidney disease: You should discuss this with your doctor before taking citalopram. This is because it can build up and cause more side effects in people who have severe kidney disease.
Liver disease: Because citalopram is processed by the liver, you’ll need a functioning liver in order to use it. If you have liver disease, the levels of citalopram might be higher than they ought to be, giving you more side effects. One option is to take a limited dose of no more than 20mg per day.
Seizures: If you have a history of seizures, you may want to avoid citalopram. This is because this drug can increase your risk of seizures.
Pregnancy: The NHS advises that citalopram can be used in pregnancy, though highlights there are studies that have found a link between citalopram and the correct development of a baby’s heart. It’s also worth noting that taking citalopram in the lead-up to the birth can cause short-term withdrawal symptoms and breathing problems in the baby. It can also increase your risk of bleeding after delivery. Mental health problems can also affect your and the baby’s well-being, so it is worth weighing up your options with a doctor.
Breastfeeding: Citalopram passes into breast milk and has been linked with side effects including poor feeding, colic and babies who are unusually sleepy, irritable, or restlessly.
Fertility: There is no evidence that citalopram reduces fertility in women, although it is linked to several sexual side effects including reduced sexual desire, reduced satisfaction, and impotence. Citalopram may also reduce sperm quality.
Children: Citalopram is not recommended for people under the age of 18. This is due to concerns surrounding suicidal behaviours, such as suicidal thoughts and suicide attempts, along with hostility including aggression, anger, and oppositional behaviour. Both of these side effects were frequently observed in clinical trials on children and teenagers treated with antidepressants. If there is a clinical need, it’s vital that the patient is closely monitored for suicidal symptoms. It’s also worth noting that there is a lack of long-term safety data on children taking antidepressants, including growth, maturation, and cognitive and behavioural development.
Citalopram Side Effects
Like all medications, citalopram comes with the risk of side effects. These can range in severity from mild symptoms like feeling tired or having trouble sleeping, to more severe symptoms including mania, seizures, and suicidal ideation.
What are the most common side effects of Citalopram?
Some of the most common side effects associated with citalopram include:
- Headaches
- Lethargy
- Tiredness
- Yawning
- Nausea
- Constipation
- Diarrhoea
- Weakness
- Dizziness
- Anxiety
- Sleep issues and insomnia
- Sexual function problems
- Sweating
- Hunger
- Shaking
- Dry mouth
- Respiratory infections
These changes should resolve within a few weeks. If they worsen or do not go away, it’s time to speak to your GP or healthcare provider.
Children can experience all of the above, along with side effects including:
- Thirst
- Peeing frequently
- Nosebleeds
- Heavy periods
- Slow growth
- Weight changes
- Aggression
- Suicidal thoughts
- Suicide attempts
What Are the Most Serious Side Effects of Citalopram?
If you experience any of the serious symptoms listed below, you should get in touch with your GP or healthcare provider as soon as possible. If you are worried for your life, or you think you’re having a medical emergency, call 999 or get to A&E.
- Unexplained weight loss or weight gain
- Feeling suicidal
- Worsening of depression or anxiety
- Acting aggressive
- Heart rhythm changes
- Low blood pressure
- Chest pain
- Changes to heart rate
- Unable to catch your breath
- Fainting
- Hallucinations
- Coma
- Confusion
- Coordination problems
- Fever
- Muscle rigidity
- Mania
- Reckless behaviour
- Extreme emotions
- Seizures
- Convulsions
- Loss of urine or bowel control
- Eye pain
- Blurred or double vision
- Swelling around the eye
How Does Citalopram Make You Feel?
During the first few weeks, many people describe feeling exhausted, spaced out, and experiencing ‘brain zaps’. However, in the cases where citalopram is a good fit, that lifts after a couple of weeks and they are left feeling brighter and better able to cope. Some people describe it as taking the edge off of their emotions, both good and bad.
How Long Does Citalopram Stay In Your System?
Citalopram has a half-life of around 35 hours, meaning it takes most people about 35 hours for around 50% of the drug to be cleared from the body (assuming no more doses are taken).
If you stop taking citalopram, all traces may be removed from your bloodstream within a couple of days and it’s believed that it takes up to two weeks for the drug to fully leave the body.
It’s important to note that doesn’t mean all traces of the drug have gone completely, as is the case with other drugs, it can still be detected in your hair follicles and urine after it has been removed from the bloodstream.
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Can You Get Withdrawal Symptoms From Citalopram?
The rate of withdrawal depends on which SSRI the person is coming off of. You’ll often hear 25%, though it is higher for SSRIs with shorter half-lives. Research has found that ‘discontinuation symptoms’ for citalopram are generally mild.
Nevertheless, coming off an SSRI can be challenging and you may face withdrawal symptoms. This could be more likely if you have been taking citalopram for a longer period of time or at a higher dose. Symptoms when withdrawing from citalopram include:
- Irritability
- Confusion
- Mood issues
- Vivid dreams
- Fatigue
- Drowsiness
- Headaches
- Sleep problems
- Muscle spasms
- Tingling sensation
- Sweating
- Tremors
- Electric shock sensations
Withdrawal symptoms usually start within five days of stopping citalopram and usually last up to a fortnight. You might experience more severe withdrawal symptoms for longer, up to a few months.
If you experience withdrawal symptoms after coming off of citalopram, you should speak with your doctor about it. They may be able to change the dose or reintroduce a different antidepressant from the same group to manage your symptoms.
How to Come Off Citalopram Safely
It is incredibly important you do not stop taking antidepressants suddenly. Doing so can cause intense withdrawal symptoms and leave you feeling worse. Instead, speak with your doctor or healthcare provider and talk it through.
In most cases, you should slowly wean yourself off of the antidepressants over a period of weeks or months. This means gradually reducing the dose until eventually, you can stop it altogether.
Citalopram vs Sertraline
Sertraline is an SSRI antidepressant, you might know it by its brand name: Lustral. It is often used to treat a wider range of issues than citalopram, including depression, panic attacks, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
Like citalopram, side effects are common and usually abate after a few weeks. Sertraline can affect your appetite and could result in weight gain or weight loss. Using sertraline for more than a year has been linked to an increased risk of diabetes. You may also experience sexual side effects, such as low sex drive and inability to achieve an erection. These problems may continue even after you stop taking sertraline.
One particular caution you need to take with sertraline is to avoid grapefruit juice, as it can increase the amount of sertraline in the body which in turn can make it more likely you experience side effects.
People with heart problems, glaucoma, and epilepsy may need to avoid sertraline as it can worsen symptoms associated with those health issues.
Like citalopram, sertraline should be used with caution in pregnancy, and third-trimester use can result in withdrawal symptoms and breathing problems in the baby. It can also increase your risk of bleeding after birth. As with citalopram, sertraline passes through breast milk and can cause side effects in babies. Also as is the case with citalopram, sertraline may cause reduced sperm quality.
Citalopram vs Venlafaxine
Venlafaxine is from a group of antidepressants called serotonin and noradrenaline reuptake inhibitors, or SNRIs, used to treat depression, anxiety, and panic attacks. Whereas citalopram increases serotonin, venlafaxine increases both serotonin and noradrenaline in the brain.
Venlafaxine is not appropriate for all people. If you have diabetes, it can make maintaining a stable blood sugar level difficult. It’s also not recommended for people with heart problems, glaucoma, or epilepsy.
Like citalopram, taking venlafaxine can cause side effects including constipation, nausea, sweating, or hot flashes. It can also cause more serious side effects like weight gain or loss, changes to your period, confusion, and chronic headaches.
When you stop it, it can also cause withdrawal symptoms, such as feeling dizzy, difficulty sleeping, and headaches. Some people experience unwanted sexual side effects, such as a low sex drive or inability to achieve an erection, and these can continue even after you stop taking it.
Taking venlafaxine towards the end of pregnancy can cause withdrawal symptoms and breathing problems in the baby, as well as increase your risk of bleeding after delivery. It also passes into breast milk. While there is no clear evidence that it impacts fertility, it can affect women’s periods.
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Citalopram vs Lexapro
Lexapro is the US brand name for Escitalopram. In the UK, the brand name used is Cipralex. Like citalopram, escitalopram is a selective serotonin reuptake inhibitor (SSRI). It is used to treat depression, as well as anxiety, OCD, and panic attacks.
One of the big differences between the two drugs is that some people who take escitalopram report feeling unable to concentrate properly. For this reason, it’s advised that you avoid driving for the first part of treatment to ensure you don’t experience this side effect.
People with diabetes may struggle to keep their blood sugar stable while on escitalopram, so may have to undergo more monitoring than normal. You will also want to be cautious if you have epilepsy, a heart problem, low sodium levels or glaucoma.
Side effects of taking escitalopram are similar to citalopram and can include nausea, sweating, and problems sleeping. You could also gain or lose weight. Sexual side effects can include painful erections, inability to achieve erection or orgasm, vaginal bleeding, and a low sex drive. As with citalopram, stopping escitalopram can cause withdrawal symptoms like feeling anxious, shaky, or dizzy.
Taking escitalopram during pregnancy may develop the development of a baby’s heart. Taking it shortly before birth can cause the baby to experience withdrawal symptoms and breathing problems, as well as increase your risk of bleeding. As with citalopram, escitalopram passes through breast milk and has been linked to restlessness, irritability, and vomiting in babies. Escitalopram may reduce sperm quality.
Foods to Avoid When Taking Citalopram
You don’t need to avoid any specific drinks or food while you’re taking citalopram. Some people experience side effects, such as dizziness and drowsiness, when mixing citalopram with alcohol.
Most Common Questions About Citalopram
Is Citalopram More for Anxiety or Depression?
Citalopram is most commonly used to treat depression rather than anxiety. However, it can be used to help with panic attacks too.
Is Citalopram and Sertraline the Same?
Citalopram and sertraline are both forms of SSRI antidepressants. While they have similar properties and uses, they are different drugs.
Are Citalopram and Fluoxetine the Same?
Citalopram and fluoxetine (also known as Prozac) are both a type of antidepressants known as selective serotonin reuptake inhibitors (SSRI). While they are similar, they are not the same drug and have some different uses. For example, fluoxetine can be used to treat bulimia.
What Happens if You Mix Drugs With Citalopram?
Mixing an SSRI like citalopram with drugs like LSD, ecstasy and legal highs can cause dangerous side effects. Taking citalopram and using cannabis can result in increased lethargy and a faster heart rate.
Mixing an SSRI like citalopram with drugs like LSD, ecstasy and legal highs can cause dangerous side effects. Taking citalopram and using cannabis can result in increased lethargy and a faster heart rate.
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