Citalopram
Generic name: citalopram hydrobromide · Brand name: Celexa®
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How It Works
Citalopram is a selective serotonin reuptake inhibitor (SSRI) known for its high selectivity and relatively simple drug interaction profile. It works by blocking serotonin reabsorption in the brain. Citalopram is closely related to escitalopram (Lexapro) — escitalopram is actually the active component of citalopram. Both are well-tolerated, but citalopram has a dose-dependent effect on heart rhythm (QT prolongation) that limits its maximum dose.
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What It Treats
Major Depressive Disorder (MDD)Persistent low mood, fatigue, loss of interest, sleep and appetite changes
Generalized Anxiety Disorder (GAD)Excessive worry, muscle tension, restlessness — used off-label with good evidence
Panic DisorderUsed off-label; reduces frequency and severity of panic attacks
Social AnxietyCommonly used off-label for social anxiety disorder
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Dosing Overview
| Population | Start | Typical Range | Max |
|---|---|---|---|
| Adults Depression / Anxiety | 10–20 mg | 20–40 mg | 40 mg |
| Adults 60+ Or with liver disease | 10 mg | 20 mg | 20 mg |
Taken once daily, with or without food. Maximum dose is 40 mg due to cardiac risk at higher doses. Older adults and those with liver disease should not exceed 20 mg.
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What to Expect — Timeline
1–2
Weeks 1–2
Body adjusting. May notice sleep changes, mild nausea, or fatigue before mood lifts
3–4
Weeks 3–4
Many notice improved sleep, energy, or motivation. Anxiety may still feel elevated
6–8
Weeks 6–8
Mood and anxiety typically improve significantly at a therapeutic dose
3–6m
3–6 Months
Full therapeutic benefit. Duration discussed based on your history and goals
⏳ Be patient. Most people need at least 4–8 weeks at a therapeutic dose before evaluating effectiveness. Do not stop without talking to your provider.
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Side Effects
Common (often temporary)
- Nausea or upset stomach
- Dry mouth
- Drowsiness
- Increased sweating
- Tremor
- Sexual side effects
- Insomnia
- Decreased appetite
Call us if you notice
- Worsening depression or anxiety
- New or increased suicidal thoughts
- Agitation or restlessness
- Unusual bleeding
- Hypomania or mania-like symptoms
- Serotonin syndrome signs (fever, confusion, tremor)
Citalopram is generally well tolerated with a simpler drug interaction profile than many SSRIs. The key limitation is the cardiac risk at higher doses — do not exceed 40 mg. Your provider will monitor accordingly.
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Tips for Success
Same Time DailyTake at the same time each day for consistent levels in your system.
With FoodTaking with food can reduce nausea, especially in the first weeks.
Don't Stop AbruptlyStopping suddenly can cause dizziness and mood changes. Always taper with guidance.
Limit AlcoholAlcohol worsens depression and anxiety and may increase side effects.
Tell All ProvidersLet other prescribers know you take this medication — interactions matter.
Track Your MoodJournaling or a mood app helps you and your provider see what is changing.
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Important Safety Information
Black Box Warning (under 25): Antidepressants may increase risk of suicidal thinking in children, adolescents, and young adults, especially in the first few weeks. Monitor closely and contact us right away if new or worsening thoughts of self-harm appear.
Serotonin Syndrome: A rare but serious reaction when combined with MAOIs, triptans, tramadol, or St. John's Wort. Signs include fever, agitation, rapid heart rate, muscle twitching, or confusion — seek emergency care immediately.
Drug Interactions: Do not take with MAOIs (must wait 14 days between). Use caution with blood thinners and NSAIDs. Always share your full medication list with your provider.
Pregnancy & Breastfeeding: Discuss risks and benefits with your provider. Do not stop without consultation.
QT Prolongation: Citalopram can affect heart rhythm at higher doses. Do not exceed 40 mg (20 mg if over 60 or with liver disease). Tell your provider if you have any heart conditions or take other medications that affect heart rhythm.
Questions? I'm here.
Reach me between appointments if you have concerns about side effects, notice mood changes, or have questions about your medication. You don't have to wait until your next visit.
360-389-3712
info@rootedmindspsychiatry.com