Citalopram is a prescribed medication used to manage the symptoms of various mood and anxiety disorders. This drug belongs to a class of compounds that affect chemical messengers in the brain. Understanding how Citalopram works and how to use it safely is important for individuals seeking relief from persistent anxiety symptoms. This article covers the administration, effects, and safety considerations for Citalopram use.
Understanding Citalopram’s Action
Citalopram is classified as a selective serotonin reuptake inhibitor (SSRI), meaning it specifically targets the neurotransmitter serotonin in the brain. Serotonin is a chemical messenger that regulates mood, emotion, and anxiety. Normally, after a nerve cell releases serotonin to transmit a signal, the releasing cell reabsorbs it (reuptake).
Citalopram works by blocking this reabsorption process via a specialized protein called the serotonin transporter. Inhibiting reuptake increases the amount of free serotonin available in the synaptic cleft, the space between nerve cells. This increased availability enhances serotonin signaling, which helps regulate brain circuits associated with anxiety and emotional distress. The full therapeutic effect is not immediate, as benefits arise from the brain’s gradual adaptation to these higher serotonin levels over several weeks.
Practical Guidelines for Starting Treatment
Starting Citalopram treatment requires a careful and gradual approach, always following a healthcare provider’s specific directions. Treatment typically begins with a low dose to allow the body to adjust and minimize initial side effects. Many adults may start at 10 milligrams (mg) once per day, though 20 mg is also a common starting point.
The medication must be taken exactly as prescribed and at a consistent time each day. Citalopram can be taken with or without food, but maintaining a routine ensures steady blood levels, contributing to its effectiveness. If a dose is forgotten, skip the missed dose entirely and take the next dose at the usual scheduled time. Never attempt to take two doses simultaneously to compensate for a missed one.
Gradually increasing the dosage, known as titration, must only be done under a doctor’s supervision. Dosage increases, if needed, are generally spaced out by no less than one week to assess tolerability and response. The maximum recommended dose for most adults is 40 mg per day. However, for individuals over the age of 65 or those with liver impairment, the maximum daily dose is restricted to 20 mg.
The therapeutic effects of Citalopram do not happen overnight. While minor improvements in sleep or appetite may be noticed within the first one to two weeks, a noticeable reduction in anxiety symptoms takes longer. The medication commonly requires six to eight weeks of consistent use before the full benefit is realized. Adhering to the prescribed schedule during this initial period is important for treatment success.
Managing Side Effects and Safety Monitoring
Citalopram can cause a range of side effects, many of which are mild and temporary as the body adjusts. Common side effects experienced during the first few weeks include nausea, dry mouth, drowsiness, insomnia, and dizziness. Sexual side effects, such as reduced libido or difficulty reaching orgasm, are also frequently reported and may persist throughout treatment. These effects should be discussed with a healthcare provider if they are bothersome or do not improve over time.
There are several serious risks that require immediate attention and safety monitoring. Citalopram can cause a dose-dependent prolongation of the QT interval, a measure of the heart’s electrical cycle. This condition can lead to Torsade de Pointes, a rare but life-threatening irregular heart rhythm, which is why the maximum dose is limited to 40 mg daily. Patients with pre-existing heart conditions or those taking other medications that affect heart rhythm may require an electrocardiogram (ECG) before and during treatment.
Another serious risk is the development of Serotonin Syndrome, a dangerous condition resulting from excessive serotonin activity in the central nervous system. Symptoms of Serotonin Syndrome include:
- Agitation
- Confusion
- Rapid heart rate
- High blood pressure
- Muscle rigidity
- Fever
If any of these symptoms appear, seek emergency medical care immediately.
There is a standard warning regarding an increased risk of suicidal thoughts or behavior, particularly in children, adolescents, and young adults under the age of 25. This risk is highest when first starting the medication or following a dose change. Families and caregivers should closely monitor the patient for unusual changes in behavior, worsening anxiety, or the emergence of suicidal ideation. Any sudden changes in mood or behavior must be reported to the prescribing healthcare provider immediately.
Important Considerations for Discontinuation
Citalopram should never be stopped abruptly without the explicit guidance of a healthcare professional. Suddenly stopping the medication can trigger Antidepressant Discontinuation Syndrome. This syndrome occurs because the brain has adapted to Citalopram, and its sudden removal disrupts the chemical balance.
To minimize this risk, the dose must be slowly reduced over weeks or months, a process known as tapering. The required duration of the taper is individualized based on the dose, treatment duration, and patient sensitivity. Common symptoms of Antidepressant Discontinuation Syndrome include:
- Dizziness
- Sensory disturbances (often described as “brain zaps”)
- Flu-like symptoms
- Nausea
- A return of anxiety or irritability
If discontinuation symptoms appear during tapering, the healthcare provider may recommend slowing the rate of reduction or temporarily returning to a slightly higher dose. Close medical supervision ensures the tapering is managed effectively to prevent distressing symptoms. Stopping Citalopram too quickly increases the likelihood of a relapse of original anxiety symptoms or the onset of severe discontinuation effects.