Citalopram

Common Brand Names: Celexa, Cipramil

Citalopram is classified under the SSRI (selective serotonin reuptake inhibitors) category of drugs. The mechanism of action of SSRIs such as citalopram involves slowing the rate of serotonin reabsorption by the brain, thereby increasing serotonin availability and prolonging its action in the neurons.1 SSRIs are widely prescribed by mental health professionals and are typically considered first-line depression medications as they tend to carry fewer adverse effects than other types of antidepressants.

Citalopram is a prescription-only drug in the United States. It is administered orally either as a solution or in tablet form.

Therapeutic Uses of Citalopram

When using citalopram to treat depression, doctors generally start patients on a low dose (about 20 mg) once daily. After one week, patients under 60 years of age may have their dosage increased to 40 mg daily if needed. For patients over 60 or patients that exhibit poor metabolization of the CYP2C19 enzyme, however, 20 mg daily is the maximum recommended dose.

Common off-label uses of citalopram include the treatment of the following psychiatric and medical conditions:

• Alcohol use disorder
• Eating disorders
• Panic disorder
• Obsessive-compulsive disorder (OCD)
• Generalized anxiety disorder (GAD)
• Social anxiety disorder (SAD)
• Premenstrual dysphoric disorder (PMDD)

Understanding Citalopram’s Abuse and Misuse Potential

Animal studies that have been conducted using the drug suggest a low level of risk for abusing citalopram. Premarketing clinical experiences with citalopram likewise did not reveal any drug-seeking behaviors. It should be noted, however, that these limited observations do not form sufficient basis for predicting the extent to which citalopram and other similar drugs may be misused or abused once marketed. Furthermore, citalopram’s potential for abuse, tolerance, and physical dependance has yet to be studied systematically in human subjects.

Current research does, however, suggest a growing rate of prescription medication abuse, including antidepressants. Patient populations that are considered especially vulnerable to abusing prescription drugs include individuals with a history of substance abuse, patients in controlled environments, and patients diagnosed with comorbid mood disorders. In light of this, even clinicians prescribing citalopram and other similar drugs for therapeutic uses are advised to evaluate patients for prior experiences of substance abuse and to monitor their intake of the medication closely to prevent incidents of misuse or abuse.

There are many complex reasons an individual might resort to abusing antidepressants and other prescription drugs. The extant literature on the subject identifies the following as possible contributing factors:

Greater availability and accessibility of prescription drugs

• The proliferation of illegal “no-prescription” websites
• Perceptions of the nonmedical or recreational use of prescription medication as safer and more socially acceptable than using illegal substances, particularly among adolescents and young adults
• The imperviousness of certain prescription medications to detection during standard drug screening tests

It should also be noted that vulnerable individuals may abuse and misuse citalopram and other similar substances in a variety of ways, such as the following:

• Developing tolerance (needing to take higher doses of the drug to achieve the desired effects)
• Taking the drug more frequently or at higher doses than prescribed
• Acquiring the drug without a prescription (e.g. from an illegal source, or from friends or relatives who have been prescribed the drug)
• Coingestion of the drug with alcohol or other types of drugs
• Deliberate overdosing as a part of self-harm or attempted suicide

Drug Interactions, Contraindications, and Other Warnings for Citalopram Use

Individuals currently taking citalopram or those who may contemplate misusing the drug should be informed that it has clinically significant interactions with the following substances:

• Monoamine oxidase inhibitors (MAOIs): Evidence suggests that concomitant use of citalopram with MAOIs can result in severe, at times fatal, cases of serotonin syndrome. Symptoms of serotonin syndrome may include hyperthermia, rigidity, changes in mental status including extreme agitation and delirium, and rapidly fluctuating vital signs. Similar reactions have been observed in patients that shift abruptly from using an SSRI such as citalopram to using an MAOI. In light of this, using citalopram in combination with an MAOI is not recommended. Even physicians are also advised to wait at least 14 days after discontinuing use of citalopram or other SSRIs before starting their patients on an MAOI, or vice versa.
• Pimozide: Use of citalopram is contraindicated in patients taking the antipsychotic medicine pimozide, as using these drugs concurrently can cause severe heart problems.
• Other serotonergic drugs: Concomitant use of citalopram and other serotonergic drugs such as triptans, tramadol, and lithium likewise carries a risk of serotonin syndrome and should thus be approached with caution.
• Drugs that inhibit hemostasis: Using citalopram in combination with drugs that affect blood coagulation, such as non-steroidal anti-inflammatory drugs (NSAIDs), warfarin, aspirin, and other anticoagulants, may increase the risk of gastrointestinal bleeding events.
• CYP3A4 and CYP2C19 inhibitors: CYP3A4 and CYP2C19 are the principal enzymes involved in the metabolism of citalopram. It is thus expected that potent inhibitors of CYP3A4 (e.g. macrolide antibiotics, ketoconazole, itraconazole) and of CYP2C19 (e.g. omeprazole) may impede citalopram clearance.

While use of citalopram is not absolutely contraindicated with pregnancy, the drug is not generally recommended for pregnant women, particularly in the first trimester.

Antidepressant use is also associated with higher risk of suicidal ideation and behavior (suicidality) in children, adolescents, and young adults.

Possible Adverse Effects of Taking Citalopram

You may experience a variety of side effects while taking citalopram. Inform your doctor immediately if any of the following symptoms are severe or persist for a long time:

• Drowsiness
• Dizziness
• Insomnia
• Headache
• Nausea
• Vomiting
• Constipation
• Diarrhea
• Stomach pain
• Heartburn
• Weight loss
• Loss of appetite
• Frequent urination
• Dry mouth
• Weakness
• Uncontrollable tremors or shaking in particular body parts
• Muscle or joint pain
• Heavy menstruation
• Ejaculation disorders (e.g. premature, retarded, or failed ejaculation)

Some serious side effects may indicate a dangerous adverse reaction to citalopram. Call your doctor or emergency medical services immediately should you or someone you know exhibit any of the following symptoms while taking the drug:

• Chest pain
• Shortness of breath
• Fainting
• Unusually fast, slow, or irregularly paced heart rate
• Hallucinations
• Fever
• Excessive sweating
• Confusion or disorientation
• Coma
• Loss of coordination
• Physical unsteadiness
• Stiff or twitching muscles
• Blisters, hives, or rashes
• Itching
• Difficulty breathing or swallowing
• Swollen face, lips, tongue, throat, hands, lower legs, ankles, or feet
• Hoarseness
• Unusual bruising or bleeding events
• Impaired memory, thinking, or concentration
• Seizures or convulsions

Recognizing a Citalopram Overdose

Taking citalopram in greater amounts than those recommended medically, whether accidentally or intentionally, can result in overdosing. The most common symptoms that accompany citalopram overdose, whether alone or combined with alcohol and/or with other drugs, include the following:

• Tremors
• Sweating
• Dizziness
• Nausea
• Elevated heart rate (sinus tachycardia)
• Drowsiness

Rarer symptoms of citalopram overdose may include:

• Hyperventilation
• Amnesia
• Confusion
• Coma
• Seizures
• ECG changes (e.g. QTc prolongation, ventricular arrhythmia)
• Bluish skin discoloration (cyanosis)
• Rhabdomyolysis, or the large-scale disintegration of skeletal muscles leading to the leakage of potentially toxic amounts of myoglobin into the blood

Call emergency medical services immediately if you suspect that someone is experiencing a citalopram overdose. Be prepared to provide EMS personnel with the following information:

• The patient’s age, weight, and preexisting health conditions, if any
• The amount of citalopram ingested, if known
• The time of citalopram intake, if known
• Whether the patient is on a prescription for citalopram, as well as their specific dosage details and schedule, if known
• Whether the patient is abusing citalopram and other substances, if known

Citalopram: Dependence, Withdrawal, and Addiction

Addiction or substance use disorder is defined as a compulsive, pathological need to continue using a drug in spite of the perceptible harm doing so causes to the self or others. Most health authorities do not consider citalopram and other antidepressants to be addictive substances.

However, abrupt discontinuation of citalopram, as with many antidepressants, may give rise to withdrawal symptoms. This condition is also known clinically as discontinuation syndrome. Symptoms of discontinuation syndrome for citalopram include but are not limited to the following:

• Nausea
• Irritability
• Dizziness
• Headaches

These symptoms, as well as others typically associated with withdrawal, are frequently reported among patients who abruptly cease using antidepressants. However, these withdrawal symptoms do not tend to be accompanied by other features of addiction such as compulsive use or tolerance, except in very rare cases.

Experiencing citalopram withdrawal is, first and foremost, a sign that the body has developed dependence on the drug—that is, that it has become accustomed to the drug’s presence. While drug dependence and its attendant withdrawal symptoms do accompany addiction in many cases, they are not in themselves guaranteed signs of addiction and may arise independently of it.

To prevent withdrawal, doctors recommend a gradual tapering off of the antidepressant over a period of weeks or months, depending on the treatment duration.This process is done in a medical detox setting where the patient may also receive pharmacological support to relieve symptoms of toxicity and withdrawal.

Seeking Treatment for Citalopram Abuse

You may be struggling with a substance abuse problem if you find yourself using citalopram for nonmedical purposes, taking it at a dosage level or frequency other than that recommended by your doctor, or finding illicit ways to acquire the drug. At such time, it’s best to consider exploring professional treatment options to address your reliance on citalopram.

If you or someone you know feel ready to seek treatment for substance abuse issues, you’ll notice that you can choose between two common treatment setups depending on your condition and general situation:

• Inpatient treatment: Patients undergoing inpatient treatment live at the treatment center for the tenure of their rehabilitation program. There, they may be prescribed medication to help their minds and bodies heal from the adverse physical effects of substance abuse. They may also be concurrently given a variety of other therapeutic interventions to help them develop healthy coping mechanisms and prepare them for life in recovery. Examples of these therapies include individual or group counseling, behavioral therapy sessions, and drug education modules. As inpatient treatment is the more intensive and involved of the two treatment options, it’s primarily recommended for patients with more severe substance abuse problems who would benefit most from a controlled environment and round-the-clock professional support.
• Outpatient treatment: Patients that go through outpatient treatment, meanwhile, commit to visiting their treatment center regularly for therapy, counseling, and education sessions. They continue to live at home, and are free to attend to their daily obligations such as work and school as much as their condition allows. This less intensive treatment option is best for patients with milder conditions who can be expected to comply more easily with rehabilitation procedures and don’t necessarily require regular professional supervision.

Contact a Recovery Support Advisor Now

Recognizing the problem and seeking professional medical help are important and necessary first steps on the road to recovery. When it comes to funding your treatment, rest assured that most insurance providers offer at least some coverage for substance abuse rehabilitation. If you don’t have insurance at the moment, however, there’s no need to worry—a professional recovery support advisor will be able to walk you through numerous other available financing options.

Our recovery support advisors at Better Addiction Care can help you verify your insurance and choose a treatment center that’s well-aligned with your budget, condition, and treatment goals. Call us today at (800) 429-7690 and we’ll do our very best to get you the support you need no matter your situation.

A Short History of Citalopram

Citalopram was first synthesized and patented by the Danish pharmaceutical company Lundbeck in 1972. After years of development and extensive clinical trials, the drug was released in Denmark in 1989 under the trade name Cipramil. Cipramil would go on to acquire a strong global reputation over the following years, and by 1998 it had been approved for prescription in the USA under the trade name Celexa. Citalopram was consistently distinguished as Lundbeck’s bestselling product until its patent expired in 2003, allowing other companies around the world to produce and market generic iterations of the drug.