Citalopram

Brand Name:

Celexa

Drug Class:

Selective Serotonin Reuptake Inhibitor

How it works:

Boosts the effects of a neurotransmitter found in the brain called Serotonin. Also, it has very mild antihistamine properties.

What makes it unique:

Has two compounds that are mirror images of each other. The “S” compound does most of the work, while the “R” compound may just get in the way.

Side effects: 

Headaches and stomach aches are common when starting, but then often goes away. Sexual dysfunction can also occur. Insomnia, but also sedation, agitation, tremors, and dizziness are side effects.

Rare side effects include hyponatremia, seizures, induction of mania, and activation of suicidal ideation in people age 24 and younger.

How effective is it:

(1) A study compared the effectiveness of different doses of Citalopram. Antidepressant and antianxiety effects can be seen after 6 weeks in even the lowest dosing group of 10mg daily. However, the 10mg and 20mg dosing had a smaller effect than 40mg and 60mg dosing. Many prescribers in clinical practice don’t dose past 40mg daily due to potential heart issues at higher dosing. Both the positive and negative effects are related to how high the dose is.

(2) A large analysis of 37 trials compared Citalopram with other antidepressants. Citalopram was less effective than Escitalopram but more effective than Paroxetine. Citalopram users had fewer side effects than Tricyclic antidepressant (TCA) users.

Clinical experience: 

Generally well tolerated by patients. This medication is pretty common. I tend towards recommending Escitalopram over Citalopram due to the issues with the “R” chemical. Pharmaceuticals should never be used as the sole treatment for mental illnesses. Therapy, exercise, meditation or other treatments should always accompany prescriptions.

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Sources:

1. Bech P, Tanghøj P, Andersen HF, et at. Citalopram dose-response revisited using an alternative psychometric approach to evaluate clinical effects of four fixed citalopram doses compared to placebo in patients with major depression. Psychopharmacology (Berl). 2002 Aug;163(1):20-5. Epub 2002 Jul 3.

2. Cipriani A, Purgato M, Furukawa TA, et al. Citalopram versus other anti-depressive agents for depression. Cochrane Database Syst Rev. 2012 Jul 11;(7).