Citalopram (Celexa): uses, side effects and precautions

Citalopram is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class. Celexa is its brand name; it is also sold as generic citalopram. The brand tablet comes in 10, 20 and 40 mg, and MedlinePlus notes it also comes as a capsule and an oral solution. It is taken once a day, with or without food, at about the same time each day.

It is a prescription medicine. Per the FDA label, citalopram is not a controlled substance.

Per its FDA-approved label, citalopram has one approved use: major depressive disorder in adults. It is not approved for children or teenagers. Read more about depression.

MedlinePlus notes it is sometimes also used off-label (for uses the FDA has not approved for this medicine), such as panic disorder, obsessive-compulsive disorder, social anxiety disorder, PTSD and premenstrual dysphoric disorder. If anxiety is what you feel, read about anxiety: the doctor first works out which kind it is and then explains your options.

Serotonin is a natural brain chemical that helps regulate mood. According to MedlinePlus, citalopram works by increasing the amount of serotonin available, because it slows its reuptake by nerve cells. That is why its effect is gradual: the body needs time to adjust, and the benefit is not felt on day one.

Dose. Per the FDA label, adults start at 20 mg once a day, which can be raised to a maximum of 40 mg a day. Doses above 40 mg a day are not recommended because of the risk to heart rhythm. For some people the maximum is 20 mg a day (see the heart section). The doctor decides the dose for your case; do not change it on your own.

How long it takes. MedlinePlus says it may take several weeks to feel the full benefit. In the label's main studies, the effect was measured after 4 to 6 weeks. Keep taking it even when you feel better, and talk with the doctor if you notice no change after several weeks.

Per the FDA label, the most common side effect is delayed ejaculation. Other frequent side effects in the studies were:

Like every antidepressant, citalopram carries an FDA boxed warning: in short-term studies, antidepressants increased the risk of suicidal thoughts and behaviors in children, teenagers and young adults. Per the label, the increase was seen in people under 18 and in adults aged 18 to 24. The risk may be higher in the first months and when the dose changes.

At any age, speak up right away if you or your family notice new or worse depression, anxiety, agitation, panic attacks, insomnia, irritability or thoughts of harming yourself. If that happens, call Línea PAS at 1-800-981-0023 or 988.

This is what sets citalopram apart. Per its label, it can cause QT prolongation (a change on the electrocardiogram) and a dangerous arrhythmia called torsade de pointes, and the risk rises with the dose. So the label sets these limits:

• Above 40 mg a day: not recommended for anyone.
• 20 mg a day maximum for people over 60, people with liver problems, people who process the drug slowly (CYP2C19 poor metabolizers) and people taking cimetidine or another medicine that blocks the CYP2C19 enzyme.

The label says to avoid it in people with congenital long QT syndrome, a slow heart rate (bradycardia), low potassium or magnesium, a recent heart attack or uncompensated heart failure. For people at risk of abnormal levels of those salts, the label calls for checking potassium and magnesium. That is why the doctor asks about your heart and your medicines and, if needed, gives you a lab order.

If you faint, feel like you are about to faint, or have palpitations or an irregular heartbeat, get urgent care.

Before you start, tell the doctor everything you take, including supplements. Per the FDA label:

The FDA label for citalopram also warns about:

If you are pregnant, planning a pregnancy or breastfeeding, the decision is made with the doctor. Per the FDA label, babies exposed to SSRIs such as citalopram late in the third trimester have had complications at birth, such as trouble breathing or feeding, and use late in pregnancy may raise the risk of persistent pulmonary hypertension of the newborn. Untreated depression carries risks too, so do not stop it on your own if you become pregnant: talk with the doctor first.

Breastfeeding. Citalopram passes into breast milk. The label advises watching the baby for irritability, restlessness or excessive sleepiness.

Per the FDA label, stopping citalopram abruptly can cause a discontinuation syndrome: nausea, sweating, low mood, irritability, agitation, dizziness and “electric shock” sensations. The label recommends lowering the dose gradually whenever possible. If you want to stop or switch, do it with the doctor. If your prescription is running out, do not wait until you have no pills left: see prescription refills.

They are closely related. Per the Lexapro label, escitalopram is one of the two mirror-image halves (the S-enantiomer) of the citalopram molecule, which is a mix of both forms. So both are SSRIs and work in a similar way, but their labels differ:

• Citalopram (Celexa): approved for major depressive disorder in adults. Maximum 40 mg a day, and 20 mg a day for people over 60 and other groups, because of the QT limit.
• Escitalopram (Lexapro): approved for major depressive disorder from age 12 and generalized anxiety disorder from age 7. Its milligrams are not equivalent to citalopram's. Read the escitalopram (Lexapro) guide.

Neither is “better” for everyone, and they are not taken together. The choice depends on your symptoms, age, heart, other medicines and how you did before on an antidepressant. Sertraline (Zoloft) is another SSRI.