Citalopram 

Citalopram is an antidepressant belonging to the class of selective serotonin-reuptake inhibitors (SSRIs) widely used to treat the symptoms of depression. It is a racemic bicyclic phthalate derivate and is the only compound with a tertiary amine and 2 nitrogen-containing metabolites among all SSRIs. Citalopram enhances serotonergic transmission through the inhibition of serotonin reuptake, and among all the SSRIs, citalopram appears to be the most selective toward serotonin reuptake inhibition. Specifically, it has a very minimal effect on dopamine and norepinephrine transportation and virtually no affinity for muscarinic, histaminergic, or GABAergic receptors. Citalopram was approved by the FDA in 1998 for the treatment of depression in adults 18 years or older. 

Citalopram is approved by the FDA for treating adults with major depressive disorder. It has also been used off-label to treat various diseases, including but not limited to sexual dysfunction, ethanol abuse, psychiatric conditions such as obsessive-compulsive disorder (OCD), social anxiety disorder, panic disorder, and diabetic neuropathy. Citalopram metabolites exert little pharmacologic activity in comparison to the parent drug and are not likely to contribute to the clinical effect of citalopram. The mean terminal half-life of citalopram is about 35 hours. SSRIs, including citalopram, have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse reaction. 

 Mechanism of action of Citalopram 

The mechanism of action of citalopram is unclear but is presumed to be related to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT), potentially through the inhibition of the serotonin transporter. Citalopram binds with significantly less affinity to histamine, acetylcholine, and norepinephrine receptors than tricyclic antidepressant drugs. Particularly, citalopram has no or very low affinity for 5-HT1A, 5-HT2A, dopamine D1 and D2, α1-, α2-, and β-adrenergic, histamine H1, gamma aminobutyric acid (GABA), muscarinic cholinergic, and benzodiazepine receptors. 

Behavioral and neuropsychological effects of serotonin include the regulation of mood, perception, reward, anger, aggression, appetite, memory, sexuality, and attention, as examples. The onset of action for depression is approximately 1 to 4 weeks. The complete response may take 8-12 weeks after initiation of citalopram. 

 Recommended dose of Citalopram 

citalopram is often started at a dose of 20 mg once day, either in the morning or the evening, for depression. An initial dose of 10 mg once a day may be necessary for elderly individuals and those with chronic medical conditions. The dose may be raised in increments of 10 mg to a typical maximum dosage of 40 mg/day if no improvement is shown after 3–4 weeks, while it is not unusual for some people with severe depression to need as much as 80 mg/day. Doses for treating OCD and other mental illnesses may need to be greater than those for treating depression. There is a liquid version of citalopram available for those who are unable to swallow tablets. 

It might take up to 2-4 weeks for the majority of people to feel the full benefits of the medicine. The length of a person’s pharmaceutical therapy is determined by their family history and own psychiatric history. 

For instance, the length of medication treatment will be longer for those who have had two or more previous episodes of major depressive disorder. For most people, the medication may be tapered 6–9 months after their depression responds to treatment. However, a small percentage of patients will continue to have depressive symptoms after their antidepressant is reduced or stopped. These individuals may benefit from continuing to take citalopram for 1 year or longer. 

 Common side effects of Citalopram Administration 

The gastrointestinal disturbances associated with citalopram—mainly nausea, vomiting, indigestion, diarrhea, or loose stools—are the most commonly reported adverse effects. Other often mentioned adverse effects include jitters, anxiety, and difficulty falling asleep. On rare occasions, people may feel drowsy, sweat excessively, and have headaches. Unlike some other SSRIs like Paxil, citalopram has relatively little effect on changes in appetite and weight. 

Citalopram has the potential to cause sexual dysfunction in both genders. The claimed adverse consequences on sex are delayed. men’s delayed ejaculation and women’s orgasm. Some people could feel less interested in engaging in sexual activities or have less desire. However, citalopram’s side effects on libido are often less common than with fluoxetine.  
Patients should talk to their doctor about these side effects, particularly if they are still bothering them.  2-4 weeks following the initiation of the treatment. In the event that a rash or other serious symptoms appear, patients should call their doctor right once. 

What happens when you take an overdose of Citalopram 

citalopram, like other SSRIs, is far less likely to cause an overdose than some of the more recent antidepressants and the older tricyclic antidepressants. Most deaths from citalopram overdoses that have been documented have included the combination of alcohol and/or other medicines. However, when citalopram alone was used at extremely high dosages, fatalities were documented in many occasions. 

Treating any suspected overdose as an emergency is imperative. The individual has to be brought to the emergency space for care and observation. It is advisable to include both the prescription bottle of medication and any other medication suspected in the overdose, since the information on the label can be useful in helping the treating physician figure out how many tablets the patient has taken. 

 Effect of Citalopram on Pregnancy and Lactation 

• • Citalopram is pregnancy category C. 

There haven’t been any studies done on women to evaluate citalopram’s safety during pregnancy. It is uncertain how the drug will affect the growing fetus in expectant mothers. However, difficulties necessitating extended hospital stays were seen in newborns exposed to antidepressants such SSRIs late in the third trimester, including respiratory assistance as well as tube feeding. Women who are or may become pregnant should talk to their physician about this. When they stop taking their antidepressant, some women may have a relapse of depression. In these in certain situations, it can be essential to resume taking the medicine or look for a different kind of drug or treatment. Citalopram should not be used by nursing women since tiny quantities may enter breast milk and be consumed by the unborn child. Breastfeeding should not begin or should be stopped if quitting the medication is not an option. 

 Precautions taken while 

 using citalopram 

Some people may experience sleepiness with citalopram. patients should stay away from using machinery or driving till they are convinced that citalopram does not affect their attention. Citalopram shouldn’t be taken by anybody with a known allergy to the drug or who has had a serious response to it. 

Major depressive disorder may often be effectively treated with medication, psychotherapy, or both. When treating moderate to severe depression, the combination of psychotherapy and antidepressants is particularly successful. While treatment develops coping mechanisms, dealing with mood, sleep, energy, and hunger, the drugs also with potential underlying problems, and enhances behavior and mental habits. 

majority of patients taking antidepressants report feeling better overall. Most people don’t notice any major effects from their antidepressants until about 3–4 weeks, and it might occasionally take as long as that. A small number of people may notice some improvement by the end of the first week. It takes 8 weeks for the drug to give its maximum effect. so, it’s imperative that patients take their antidepressants for the whole recommended amount of time in order for them to be effective and that they don’t give up on them. Taking medicine too soon if they don’t feel better right away. 

Antidepressants have been shown in short-term trials to raise the likelihood of suicidal thoughts and actions in kids and teenagers suffering from severe depressive illness and other mental health issues. When beginning anti-drug therapy in children and adolescents, the U.S. Food and Drug Administration (FDA) mandates that the practitioner disclose this risk. depression-related treatment. The FDA’s studies indicate that the possibility of suicidal thoughts and actions linked to age is a factor in antidepressant use. This phenomenon is more likely to arise early in the course of therapy and is more common in younger populations. Antidepressant use did not seem to be associated with a higher incidence of suicidality in people over the age of 24, as compared to placebo use. 

The results indicated that antidepressants had a “protective effect” on suicide thoughts and behavior in people over the age of 65. According to other research, the suicide rate is lower in communities where a larger proportion of the population uses antidepressants. Suicide risk is a part of depression and may not fade away until the patient responds to therapy. When starting or stopping antidepressant medication, the patient especially a child or adolescent should be regularly monitored for increasing symptoms of depression, and the caregiver or family member should report any concerns to the doctor. 

Warning: If you’re having suicidal thoughts, don’t hesitate to tell your doctor or a family member. 

• •  Inform your Whenever your depressed symptoms increase or you feel like you can’t manage suicide thoughts or desires, see a psychiatrist or your general physician.  you should not stop citalopram abruptly.  

• • It is recommended to reduce your dose gradually to avoid having any withdrawal symptoms.   

• • If you forget to take a dosage, catch up by taking it two to three hours later than planned. If it’s near the Skip the missed dosage and resume your usual dosing regimen for the next scheduled dose.  

• • Avoid taking two doses at once. 

• • You can take citalopram with or without meals.  

• •  Keep the medication out of direct sunlight and dampness, in the light-resistant container that came with it.  

• • Your drug may break down more quickly in hot and humid environments, losing its therapeutic benefits.  

• •  Make sure kids can’t get to your medication. 

 Possible drug interactions of citalopram 

Because one medicine may change the other’s blood levels, using citalopram with some other drugs may have unfavorable drug interactions. Thankfully, citalopram has a decreased frequency of documented medication interactions compared to paroxetine or fluoxetine among other SSRIs. 

Citalopram may cause bleeding by raising the levels of warfarin and its anticoagulant effects. Compared to other SSRIs, this interaction is less likely to occur. However, when beginning any SSRI, thorough monitoring is necessary when on Coumadin medication. The erythromycin class of antibiotics may raise blood levels of Celexa and raise the risk of negative side effects.  

Cimetidine may raise blood levels of citalopram and raise the risk of negative side effects. Antifungals may raise citalopram blood levels and raise the risk of negative side effects. 

When citalopram is taken with other drugs, including herbal supplements like St. John’s wort, that increase serotonin may result in high amounts of that neurotransmitter and cause a hazardous state called serotonin syndrome. Serotonin syndrome’s initial symptoms include tremors, flushing, restlessness, and bewilderment. and uncontrollably jerking muscles. Should the medicine not be discontinued, the patient may experience further potentially fatal side effects such as muscular weakness, elevated body temperature, breathing difficulties, blood coagulation issues, and red blood cell decomposition, which might result in abrupt renal failure. Citalopram users should be aware of the potential symptoms of serotonin syndrome, which call for stopping the serotonin-boosting drugs and seeking emergency medical assistance. 

Monoamine oxidase inhibitors (MAOIs), an antidepressant class, should not be taken with citalopram as this combination may cause a dangerous reaction that includes elevated body temperature, high blood pressure, along with a great deal of excitement and anxiety. Patients should consult their doctor or pharmacist before starting any new medications, including OTC medications and herbal supplements, while taking citalopram.