Citalopram is a selective serotonin reuptake inhibitor (SSRI) primarily approved to treat depression in adults. However, healthcare providers also prescribe it to manage symptoms of various anxiety disorders. This practice is known as “off-label” use, where a drug is prescribed for a condition for which it has not received formal approval to treat.
Mechanism of Action for Anxiety
Citalopram’s therapeutic effects on anxiety are linked to its influence on serotonin, a neurotransmitter that helps regulate mood, sleep, and anxiety. The medication works by blocking the reabsorption, or reuptake, of serotonin into nerve cells. This process leaves more serotonin available to transmit signals between neurons, enhancing communication.
By increasing available serotonin, citalopram helps stabilize communication within brain circuits associated with anxiety disorders. This mechanism makes it a common choice for conditions like panic disorder and generalized anxiety. The underlying theory is that the medication helps to correct a chemical imbalance that may contribute to heightened anxiety.
The Initial Treatment Period
The effects of citalopram are not immediate and require consistent daily use for therapeutic benefits to become apparent. It can take four to six weeks of administration to experience the full effects on anxiety symptoms. This gradual onset is a standard characteristic of SSRI medications.
During the first one to two weeks of treatment, some individuals may experience a temporary increase in their anxiety. This is a known phenomenon that usually subsides as the body adjusts to the medication. This initial phase is not indicative of how the medication will work in the long term.
Patience is required during this initial period due to the delay in positive effects and potential side effects. Communicating with a healthcare provider about any initial worsening of symptoms is recommended. They may suggest strategies, such as starting with a lower dose, to make the adjustment period more tolerable.
Potential Side Effects
As your body adjusts to citalopram, you may experience ongoing side effects that are often mild and diminish over several weeks. Taking the medication with food can sometimes help alleviate stomach-related discomfort.
Common side effects can include:
- Nausea, dry mouth, or changes in bowel habits like diarrhea or constipation
- Drowsiness, which may interfere with daily activities, or insomnia
- Headaches
- Decreased interest in sex or difficulty with arousal or orgasm
If drowsiness is an issue, a doctor might suggest taking the dose in the evening. Sexual side effects can be persistent for some individuals, so discussing them with a provider is important. You should avoid operating heavy machinery until you know how the medication affects you.
Important Safety Considerations
A rare but serious risk of taking citalopram is Serotonin Syndrome, a condition caused by excessive serotonin levels in the brain. It is more likely to occur when citalopram is taken with other medications that also increase serotonin, such as other antidepressants, certain pain or migraine medications, and the herbal supplement St. John’s Wort.
Symptoms can include:
- Agitation or confusion
- Rapid heart rate and high blood pressure
- Dilated pupils and fever
- Loss of muscle coordination or twitching muscles
You should avoid or limit alcohol consumption while taking citalopram, as it can increase drowsiness. Inform your doctor about all other medications and supplements you are taking to prevent harmful drug interactions. Combining citalopram with monoamine oxidase inhibitors (MAOIs) is particularly dangerous and must be avoided.
The U.S. Food and Drug Administration (FDA) has issued a “black box warning” for citalopram regarding an increased risk of suicidal thoughts and behaviors. This risk is highest among individuals up to age 24, particularly during the initial months of treatment or after a dose change. Patients, families, and caregivers should monitor for any worsening of depression, unusual changes in behavior, or the emergence of suicidal thoughts.
Dosage and Discontinuation
Treatment with citalopram starts with a low dose that is then gradually increased. This process allows a healthcare provider to find the lowest effective dose that manages anxiety symptoms while minimizing side effects. The starting dose for adults is often 20 mg per day, with adjustments made based on individual response. A lower starting and maximum dose is recommended for the elderly or those with liver impairment.
Stopping citalopram treatment requires careful management. Abruptly discontinuing the medication can lead to antidepressant discontinuation syndrome. Symptoms are usually mild but can be severe for some.
Common symptoms of discontinuation include:
- Dizziness and headache
- Sensory disturbances like “electric shock” sensations
- Agitation, anxiety, and sleep disturbances
- Nausea
To prevent these reactions, the dose should be tapered down gradually under a doctor’s guidance. The exact tapering schedule will depend on the dose, duration of treatment, and the individual’s response to the reduction.