CitalopramReturn to Citalopram overview
After a couple of weeks my sleeping patterns regulated to how they had been before I began the medication
Citalopram can be used to treat the following conditions
Headmeds fills the medicines information gaps for young people - things you might want to know about meds like will it affect my sex life? Can I still study? Can I drink?
Headmeds does not give medical advice so this is just general information.
Each medicine has a balance of good and bad effects, and each person gets their own individual effects.
You might want to know just one thing about your medicine, but on each page we have given you the ‘safety headlines’. Please read them as they are important.
We have included lots of information about each medicine - but if you want all the details, please look at the patient information leaflet - which is inside every pack. These leaflets are also at www.medicines.org.uk - where there will be the most up-to-date information.
- If you have taken more citalopram than it said on the label, you must see a doctor quickly – even if you do not feel any different.
- As part of depression some people think about hurting themselves or committing suicide. Taking an antidepressant may not stop this. You must get some urgent help if you are having these sorts of thoughts. Speak to someone who is looking after you or go straight to hospital with your tablets.
- Citalopram can sometimes also cause other serious side-effects: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), and other serious symptoms that you can find here. Go to a hospital if you get any of these symptoms, with your medicine.
- Do not take citalopram if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.
- Stopping citalopram suddenly can cause unpleasant withdrawal effects– go to your doctor if you are thinking of stopping or want to stop, talk to your doctor.
- If you take citalopram while you are pregnant, it may affect the developing baby’s heart. Use good contraception while you are taking citalopram. It can also cause symptoms in newborn babies if you take it at the end of pregnancy. Talk to your doctor or midwife about this and get their help.
Citalopram is a Selective Serotonin Re-uptake Inhibitor
A Selective Serotonin Re-uptake Inhibitor (SSRI) helps make more serotonin available in your brain.
Citalopram can be used to help with low mood or anxiety.
You can take citalopram in tablets or drops
- Tablets (10mg, 20mg and 40mg strengths)
- Oral drops (40mg per ml - each drop contains 2mg. 4 drops are like one 10mg tablet). At first glance the maths don’t add up here. The reason 4 drops = 10mg tablet is due to the liquid being in a lighter formulation when compared to the tablet mix. For those that like chemistry it’s a case of citalopram hydrochloride (liquid) v citalopram hydrobromide (tablet).
The dose of citalopram in mg given as drops is a bit lower than that of tablets. This is because the drops are made slightly differently to the tablets, so a conversion factor is applied.
The tablets contain lactose
- The tablets may not be suitable for you if you have problems eating some sugars or dairy (milk-based) foods, as they contain lactose.
- The drops contain a small amount of alcohol, but it would not affect your blood-alcohol level.
Use and Action
Citalopram can be used for a number of conditions
- Low mood (depression)
- Panic Disorder (with or without agrophobia)
Citalopram can help to adjust the chemicals your brain needs
For low mood (depression):
The brain is usually good at making sure we have enough of the chemicals we need to function properly.
- Research suggests that depression or low mood is more likely to happen when the brain doesn’t have enough of a chemical called serotonin (also called ‘5HT’). Serotonin is a natural chemical in the brain that helps messages get around.
- Medicines like citalopram are called selective serotonin reuptake inhibitors (SSRIs) because they focus on increasing brain serotonin involved in nerve activity. They work by blocking recycling of released serotonin back in to the nerve endings.
- This means that the amount of serotonin is increased and the depression and low mood get better.
You should take citalopram once a day
- To get the best effect from citalopram, take it every day.
- Make sure that you know your dose. If it is not written on the label, check it with your pharmacist or doctor.
- You should start by taking it in the morning, this will lower the chance of it affecting your sleep.
- Try to get into a routine, like taking it when you have breakfast or brush your teeth.
- If you find that it makes you sleepy, you can take it at night-time instead.
- You can take it before or after food, it doesn't matter.
- Swallow the tablet with a drink of water or liquid - if you chew it, it tastes bitter.
If you forget to take a dose then just take it as soon as possible
What to do if you miss a dose:
- If you remember later during the day, take it as soon as possible.
- If you forget to take it by bedtime, just start again on the next day.
- Do not take a double dose.
What might happen?
- If you forget to take it for a few days, you may start getting withdrawal symptoms, such as flu-like symptoms. If you do, see your doctor as soon as possible.
- If you want to stop your tablets please speak to your doctor first as it is better if they are stopped slowly over a few weeks rather than stopping suddenly.
You must go to A&E if you take too much
What to do if you take too much:
- If you have taken more citalopram than it said on the label, you must get help quickly – even if you do not feel any different.
- Go to A&E. Take your medicine with you, to show to the doctors. Tell them how much you have taken.
- Get a friend or family member to go with you, if you can, just in case you feel ill on the way.
You might get any of the following signs:
- changes in your heartbeat, going fast or unevenly
- feeling sick (nausea) or being sick
- having a fit (seizure)
- feeling sleepy
- passing out
- feeling shaky (tremor) or dizzy
- changing blood pressure, where you feel dizzy if you stand up
- feeling agitated
- your eye pupils getting bigger (dilating)
- your skin going a bit blue
- your fingers and toes may feel very cold
- quick breathing
You are also at risk of getting ‘Serotonin syndrome’. This is when you can get a high fever, agitation, confusion, trembling, or weird movements of your muscles. This is rare, but you should watch out for it. Go straight to A&E if you experience these side effects.
It can take a few weeks to have its full affect but should start to help within the first 1-2 weeks for depression
For anxiety it can take up to 4 weeks for the benefits to be noticed
It takes up to 4 weeks for citalopram to show its full effect in depression and a bit longer for anxiety related conditions but you should notice some benefits within the first 1-2 weeks.
- Scientists believe that at first the higher level of serotonin have direct effects which do not help relieve the depression or anxiety. In fact you are likely to feel a bit more anxious or on edge for a couple of weeks.
- But after some days of regular treatment, adaptive changes take place in the brain which lead to improvements in mood and anxiety.
Your doctor will probably start you on a low dose (10-20mg) and then increase it slowly over 2-4 weeks to a dose that works for you (usually between 20mg-40mg a day). This is because at first citalopram may make you feel anxious or sick, but starting with a low dose makes this less likely to happen.
If you're taking citalopram for anxiety it can take longer to feel any benfit and may initially make you feel a bit more anxious - this will improve.
Most people take citalopram for about 6 months
You and your doctor should talk about how long you need to take citalopram.
- You will not get the full effect for a few weeks.
- You should probably take it for at least 6-9 months for depression - otherwise your symptoms can come back. If you're taking it for anxiety you may need to take it for longer.
- People who have had low mood or depression more than once may take these for a couple of years or more. This is to stop themselves experiencing depression or low mood again.
- Never stop the tablets suddenly because this may make you more at risk of experiencing low mood. Ask your doctor or your pharmacist for advice on how to stop medicines safely.
It can take a month before you will see good effects. Let your doctor know if you do not feel better after a month.
- For the first 2-3 weeks you may not feel any different. In fact, you may feel a bit more anxious at the start of treatment.
- But by the end of the first month on treatment you should feel your mood lifting, have more interest in things, and start to enjoy things you used to.
- If you do not feel any different after a month, you may need something different or need the dose increased. Carry on taking the medicine and go back to see your doctor as soon as possible.
Search www.medicines.org.uk to find patient information leaflets and prescribing information on citalopram. Tablets and drops are listed separately. The SmPC lists all the inactive ingredients in the product so you can check against any allergies. If you are still unsure about this then speak to your pharmacist.
- British National Formulary (BNF) and British National Formulary for children. Download the BNF/BNFC app (blue background) on to your mobile device. No longer available for public access via the web
- Taylor D, Barnes T, Young A. Maudsley Prescribing Guidelines in Psychiatry, 13th edition. Oxford: John Wiley & Sons, May 2018. ISBN: 978-1-119-44260-8Royal Pharmaceutical Society. Medicines Ethics and Practice (42nd edition). London: RPS, 2018. Standards for pharmacists to work to. It is not a free publication
- World Anti Doping Agency WADA Prohibited List https://www.wada-ama.org/en/resources/science-medicine/prohibited-list-documents
- Choiceandmedication; an independent source of information on many mental health conditions and their medicines with easy to read fact sheets www.choiceandmedication.org Personal subscriptions to download the app available for £1 per month (with proportionate discounts for longer periods) but your local mental health Trust may subscribe and provide information sheets for free.
- Best Use of Medicines in Pregnancy (BUMPS). Information sheets on drugs in pregnancy http://www.medicinesinpregnancy.org/ Drugs and Lactation Database (LactMed). Information on drugs in breastfeeding https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm