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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Serotonin Reuptake Inhibitor [EPC]
Citalopram is a selective serotonin reuptake inhibitor (SSRI) used primarily to treat major depressive disorder. It works by restoring the balance of serotonin in the brain to improve mood and energy levels.
Name
Citalopram
Raw Name
CITALOPRAM HYDROBROMIDE
Category
Serotonin Reuptake Inhibitor [EPC]
Salt Form
Hydrobromide
Drug Count
5
Variant Count
118
Last Verified
February 17, 2026
RxCUI
200371, 283672, 309314, 309313, 2591786, 213344, 213345, 284591
UNII
I1E9D14F36, 0DHU5B8D6V
About Citalopram
Citalopram is a selective serotonin reuptake inhibitor (SSRI) used primarily to treat major depressive disorder. It works by restoring the balance of serotonin in the brain to improve mood and energy levels.
Detailed information about Citalopram
This page is for informational purposes only and does not replace medical advice. Consult a qualified healthcare professional before using any medication containing Citalopram.
Historically, citalopram was developed by Lundbeck and marketed under the brand name Celexa. It exists as a racemic mixture, containing both the R-enantiomer and the S-enantiomer. Interestingly, the antidepressant activity is primarily attributed to the S-enantiomer (which led to the development of escitalopram), while the R-enantiomer was later found to potentially interfere with some of the therapeutic effects. Despite the arrival of newer agents, citalopram remains a first-line treatment option for depression due to its established efficacy profile and the availability of cost-effective generic formulations. Your healthcare provider will determine if this medication is appropriate based on your clinical history and symptom profile.
At the molecular level, citalopram functions by binding to the serotonin transporter (SERT) protein located on the presynaptic terminal of neurons. Under normal physiological conditions, serotonin is released into the synaptic cleft (the space between neurons) to transmit signals and is then 'recycled' back into the releasing neuron via the SERT protein. Citalopram effectively blocks this reuptake process. By inhibiting the transporter, the concentration of serotonin in the synaptic cleft remains elevated for a longer duration, allowing for enhanced stimulation of postsynaptic serotonin receptors.
Beyond simple reuptake inhibition, modern neuropharmacology suggests that citalopram's long-term benefits are linked to complex neuroplasticity changes. Chronic administration leads to the downregulation (reduction in sensitivity) of inhibitory autoreceptors (like the 5-HT1A receptor). This process eventually results in an overall increase in serotonergic neurotransmission. Furthermore, research indicates that SSRIs like citalopram may stimulate the expression of brain-derived neurotrophic factor (BDNF), a protein that supports the survival of existing neurons and encourages the growth of new neurons and synapses. This 'neurogenic' effect is thought to be why patients typically do not experience full symptomatic relief for several weeks, despite the immediate chemical effect on serotonin levels.
Understanding how the body processes citalopram is essential for optimizing therapy and minimizing adverse effects.
Citalopram is FDA-approved for the treatment of Major Depressive Disorder (MDD) in adults. In clinical trials, it has demonstrated significant superiority over placebo in improving symptoms such as persistent sadness, loss of interest in activities (anhedonia), sleep disturbances, and feelings of worthlessness.
In addition to its approved use, healthcare providers frequently prescribe citalopram 'off-label' (using the drug for a condition not specifically approved by the FDA but supported by clinical evidence) for several conditions, including:
Citalopram is primarily available in the following oral dosage forms:
> Important: Only your healthcare provider can determine if Citalopram is right for your specific condition. The choice of dosage form and strength depends on your individual medical history, the severity of your symptoms, and your response to treatment.
For the treatment of Major Depressive Disorder in adults, the standard starting dose is typically 20 mg once daily. Healthcare providers usually recommend taking the dose in either the morning or the evening, though consistency is key for maintaining steady blood levels. If clinical improvement is not observed after several weeks of treatment, the dose may be increased.
Historically, doses up to 60 mg were used; however, current FDA guidelines (updated in 2011/2012) state that the maximum recommended dose is 40 mg per day. This restriction was implemented because doses above 40 mg have not been shown to provide additional benefit for depression but significantly increase the risk of QT interval prolongation, a serious heart rhythm abnormality. For most patients, the effective therapeutic range is between 20 mg and 40 mg daily.
Citalopram is not FDA-approved for use in pediatric patients (children and adolescents) for the treatment of depression. While it may be prescribed off-label by specialists for specific conditions like OCD or anxiety in minors, this requires extreme caution. Clinical trials in pediatric populations have shown an increased risk of suicidal thinking and behavior in children and adolescents taking antidepressants. If a healthcare provider decides to prescribe citalopram to a minor, the patient must be monitored very closely for any changes in behavior or mood, especially during the first few months of therapy.
For patients with mild to moderate kidney impairment, dosage adjustments are generally not required. However, citalopram should be used with caution in patients with severe renal impairment (creatinine clearance less than 20 mL/min), as there is limited clinical data regarding its safety and clearance in this specific population.
Because citalopram is extensively metabolized by the liver, patients with hepatic (liver) impairment clear the drug more slowly. For these individuals, the maximum recommended dose is typically capped at 20 mg per day. Regular monitoring of liver function tests may be advised by your doctor.
In patients over the age of 60, the metabolism of citalopram is reduced, leading to higher concentrations of the drug in the bloodstream. Furthermore, the elderly are at a higher risk for drug-induced QT prolongation. Consequently, the maximum recommended dose for patients older than 60 is 20 mg per day.
Citalopram should be taken exactly as prescribed by your healthcare professional. It can be taken with or without food; however, taking it with a meal may help reduce initial nausea. The tablets should be swallowed whole with a glass of water. If you are using the oral solution, use a calibrated measuring device (not a household spoon) to ensure the correct dose.
It is important to take the medication at the same time each day to maintain a stable level in your system. Most patients find that taking it in the morning helps if they experience insomnia, while taking it in the evening is better if the drug causes drowsiness. Store the medication at room temperature (68°F to 77°F or 20°C to 25°C), away from moisture, heat, and direct light.
If you miss a dose of citalopram, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and resume your regular schedule. Do not take two doses at once to make up for a missed one, as this increases the risk of side effects and toxicity.
Signs of a citalopram overdose may include dizziness, sweating, nausea, vomiting, tremors, somnolence (extreme sleepiness), and sinus tachycardia (rapid heartbeat). In more severe cases, an overdose can lead to QTc prolongation, seizures, or Serotonin Syndrome. If an overdose is suspected, contact emergency medical services or a poison control center immediately. Treatment is generally supportive, focusing on maintaining an open airway and monitoring cardiac function.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or stop taking the medication without medical guidance, as sudden discontinuation can lead to withdrawal symptoms.
Many patients starting citalopram experience mild to moderate side effects as their bodies adjust to the increased serotonin levels. These symptoms often peak within the first two weeks and gradually diminish over time. Common side effects include:
> Warning: Stop taking Citalopram and call your doctor immediately if you experience any of these serious symptoms.
With prolonged use, some patients may experience 'emotional blunting,' where they feel less capable of experiencing both intense sadness and intense joy. Weight gain is also a documented long-term effect for some users, likely due to changes in metabolism or increased appetite as depression improves. Bone fractures have also been linked to long-term SSRI use in some observational studies, suggesting a possible effect on bone density.
The FDA has issued a Black Box Warning for citalopram and all other antidepressant medications. This warning highlights the increased risk of suicidal thinking and behavior in children, adolescents, and young adults (ages 18-24) during the initial stages of treatment (the first 1-2 months) and during dose adjustments. Families and caregivers should monitor patients closely for agitation, irritability, unusual changes in behavior, or the emergence of suicidality. Citalopram is not approved for use in pediatric patients.
Report any unusual symptoms to your healthcare provider. Do not ignore changes in your physical or mental health while on this medication.
Citalopram is a powerful psychiatric medication that requires careful medical supervision. It is not a 'quick fix' and usually takes 4 to 6 weeks to reach its full therapeutic potential. Patients should be aware that they might feel worse before they feel better, particularly regarding anxiety or sleep disturbances in the first week of therapy. It is vital to maintain all follow-up appointments with your healthcare provider to monitor your progress and safety.
Suicidality and Antidepressant Drugs: Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 and older. In patients of all ages who are started on antidepressant therapy, monitor closely for worsening and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber.
Your doctor may require periodic tests while you are taking citalopram, including:
Citalopram may cause dizziness or somnolence (drowsiness). Until you know how this medication affects you, use caution when driving, operating heavy machinery, or performing tasks that require alertness. Alcohol can worsen these sedative effects.
While citalopram does not significantly increase the impairment caused by alcohol in clinical studies, it is generally recommended that patients avoid or strictly limit alcohol consumption. Alcohol can worsen depression symptoms and increase the sedative side effects of the medication.
Never stop taking citalopram abruptly. Doing so can lead to Discontinuation Syndrome. Symptoms include 'brain zaps' (sensations like electric shocks), dizziness, nausea, irritability, vivid dreams, and headache. Your doctor will provide a tapering schedule to slowly reduce the dose over several weeks.
> Important: Discuss all your medical conditions, especially heart rhythm problems or Bipolar Disorder, with your healthcare provider before starting Citalopram.
Certain medications must never be taken with citalopram due to the risk of fatal interactions:
Citalopram does not typically interfere with common laboratory tests (like blood counts or basic metabolic panels). However, it can cause false-positive results in some urine drug screens for benzodiazepines or amphetamines, depending on the specific testing method used. Always inform the laboratory that you are taking citalopram.
For each major interaction, the primary mechanism is usually either pharmacodynamic (the drugs have additive effects on the same system, like the heart's electrical circuit or serotonin levels) or pharmacokinetic (one drug changes how the liver processes the other via CYP enzymes). Management usually involves dose reduction, switching to an alternative medication, or intensive monitoring.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, including over-the-counter pain relievers.
Citalopram must NEVER be used in the following circumstances:
In these cases, a healthcare provider must perform a careful risk-benefit analysis:
While citalopram is chemically unique, there is a theoretical risk of cross-sensitivity with escitalopram (Lexapro), which is the S-enantiomer of citalopram. Patients who have had a severe allergic reaction to escitalopram should generally avoid citalopram. There is no significant evidence of cross-allergy between citalopram and other SSRI classes like fluoxetine or paroxetine, though side effect profiles may overlap.
> Important: Your healthcare provider will evaluate your complete medical history, including your cardiac health and any history of mania, before prescribing Citalopram.
Citalopram is classified as Pregnancy Category C (under the older FDA system). Data regarding its use during pregnancy is complex.
However, untreated depression during pregnancy also carries significant risks for both the mother and the baby. Healthcare providers must weigh the risks of the medication against the risks of untreated mental illness.
Citalopram is excreted into breast milk in small amounts. While many infants show no adverse effects, there have been reports of increased sleepiness, decreased feeding, and weight loss in some nursing babies. If you are breastfeeding, your doctor will help you decide whether to continue the medication or switch to an antidepressant with lower milk penetration, such as sertraline.
Citalopram is not approved for use in children. The primary concern is the increased risk of suicidality. If used off-label for severe OCD or depression that hasn't responded to other treatments, it must be managed by a pediatric psychiatrist with frequent monitoring for behavioral changes.
Elderly patients (age 65+) are more sensitive to citalopram. They are at a significantly higher risk for:
No dosage adjustment is needed for mild to moderate renal impairment. For patients with a GFR below 20 mL/min, citalopram should be used with extreme caution as clearance may be reduced, and data is lacking for this population.
In patients with chronic liver disease (Child-Pugh Class A or B), the clearance of citalopram is reduced by about 37%. These patients should be limited to a maximum dose of 20 mg daily to prevent toxic accumulation of the drug.
> Important: Special populations require individualized medical assessment. Always inform your doctor if you are pregnant, planning to become pregnant, or are over the age of 65.
Citalopram is a highly selective serotonin reuptake inhibitor (SSRI). Its primary molecular target is the SLC6A4 protein, also known as the Serotonin Transporter (SERT). By binding to the primary binding site of the transporter, citalopram prevents the reabsorption of serotonin (5-HT) into the presynaptic neuron. This increases the synaptic concentration of serotonin, enhancing neurotransmission at 5-HT1A, 5-HT2, and 5-HT3 receptors. Unlike tricyclic antidepressants, citalopram has negligible affinity for muscarinic, histaminergic, or alpha-adrenergic receptors, which explains its cleaner side-effect profile regarding dry eyes, sedation, and blood pressure drops.
The antidepressant effect typically requires 2 to 4 weeks of continuous dosing to manifest, as the brain must undergo compensatory changes in receptor sensitivity. Citalopram is considered the most selective of all SSRIs, meaning it has the least effect on norepinephrine and dopamine reuptake. This selectivity minimizes 'jitteriness' but may also mean it is less effective for certain types of lethargic depression compared to dual-action drugs.
| Parameter | Value |
|---|---|
| Bioavailability | ~80% |
| Protein Binding | ~80% |
| Half-life | ~35 hours (Adults) / ~50 hours (Elderly) |
| Tmax | ~4 hours |
| Metabolism | Hepatic (CYP2C19, CYP3A4, CYP2D6) |
| Excretion | Renal 10% (unchanged), Fecal (remainder) |
Citalopram belongs to the Selective Serotonin Reuptake Inhibitor (SSRI) therapeutic class. Other medications in this class include Escitalopram, Sertraline, Fluoxetine, Paroxetine, and Fluvoxamine. Among these, Citalopram is noted for its intermediate half-life and moderate drug-interaction potential.
Medications containing this ingredient
Common questions about Citalopram
Citalopram is primarily FDA-approved for the treatment of Major Depressive Disorder in adults. It works by increasing the levels of serotonin in the brain, which helps improve mood, sleep, and appetite. Beyond depression, healthcare providers often prescribe it 'off-label' for conditions like generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder. It is considered a first-line treatment due to its effectiveness and generally well-tolerated nature. However, it is not a cure for these conditions but rather a tool to manage symptoms as part of a broader treatment plan.
The most common side effects reported by patients include nausea, dry mouth, increased sweating, and changes in sleep patterns such as drowsiness or insomnia. Many people also experience sexual side effects, including a decrease in sex drive or difficulty reaching orgasm. Most of the physical side effects, like nausea, tend to fade within the first two weeks as the body adjusts to the medication. If side effects are severe or persistent, you should consult your healthcare provider about adjusting the dose. It is important to remember that everyone reacts differently to the medication.
It is generally recommended to avoid or strictly limit alcohol consumption while taking citalopram. Alcohol is a central nervous system depressant that can worsen the symptoms of depression and anxiety, potentially counteracting the benefits of the medication. Additionally, both alcohol and citalopram can cause drowsiness and dizziness; combining them can significantly increase these effects, making activities like driving dangerous. While a single drink may not cause a severe reaction for everyone, it is best to discuss your alcohol use with your doctor. Maintaining a stable internal environment helps the medication work most effectively.
Citalopram use during pregnancy involves a careful balance of risks and benefits that must be discussed with a doctor. While it is not considered a major teratogen, some studies suggest a small risk of heart defects or persistent pulmonary hypertension in the newborn if taken during the third trimester. There is also a risk of 'withdrawal' symptoms in the baby after birth, such as irritability or breathing difficulties. However, untreated depression during pregnancy poses its own serious risks to both mother and child, including preterm birth. Most doctors will only prescribe it if the benefits to the mother outweigh the potential risks to the fetus.
Citalopram does not work immediately; it typically takes 2 to 4 weeks for patients to notice a significant improvement in their mood. Some symptoms, such as sleep and energy levels, may improve slightly sooner, but the full therapeutic effect often takes 6 to 8 weeks of consistent use. This delay is because the brain needs time to adjust its receptor sensitivity in response to the increased serotonin. It is crucial to keep taking the medication even if you don't feel better right away. If you see no improvement after 6 weeks, your doctor may consider adjusting your dosage or switching medications.
No, you should never stop taking citalopram suddenly without consulting your healthcare provider. Abruptly stopping an SSRI can lead to 'discontinuation syndrome,' which includes symptoms like dizziness, 'brain zaps' (electric shock sensations), nausea, irritability, and vivid dreams. These symptoms are not dangerous but can be very uncomfortable and distressing. To avoid this, your doctor will provide a tapering schedule to gradually lower your dose over several weeks or months. This allows your brain chemistry to slowly readjust to the lower levels of serotonin.
If you miss a dose, take it as soon as you remember, unless it is almost time for your next scheduled dose. In that case, skip the missed dose entirely and continue with your regular routine. Never take a double dose to make up for a missed one, as this can increase the risk of side effects like nausea or heart rhythm changes. Consistency is vital for the medication to work effectively, so try to take it at the same time every day. Using a pillbox or a phone reminder can be helpful if you frequently forget your doses.
Weight changes are a possible side effect of citalopram, though they affect everyone differently. Some patients may lose weight initially due to nausea or a decreased appetite when starting the drug. However, long-term use of SSRIs is sometimes associated with modest weight gain, which may be due to a direct effect on metabolism or simply an increase in appetite as the depression improves. If you are concerned about weight changes, discuss a plan for healthy eating and regular exercise with your doctor. They can help monitor your weight and determine if the medication is the primary cause.
Citalopram can interact with many other medications, some of which can be dangerous. It should never be taken with MAOIs or pimozide, and caution is needed when combining it with blood thinners, NSAIDs like ibuprofen, or other drugs that affect serotonin. There is also a significant risk when combined with other drugs that affect the heart's rhythm (QT-prolonging drugs). Always provide your doctor and pharmacist with a complete list of all prescription drugs, over-the-counter medicines, and herbal supplements you use. This allows them to check for potential interactions and ensure your treatment is safe.
Yes, citalopram is widely available as a generic medication, which is typically much more affordable than the original brand-name version, Celexa. Generic citalopram contains the same active ingredient and meets the same FDA standards for quality, strength, and purity as the brand-name drug. It is available in various forms, including tablets and oral solutions, at most pharmacies. Because it is a common medication, most insurance plans cover the generic version with a low co-pay. Switching to the generic is usually a seamless process for most patients.