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Citalopram (brand names: Celexa, Cipramil and others) is an antidepressant drug of the selective serotonin reuptake inhibitor (SSRI) class. It has U.S. Food and Drug Administration approval to treat major depression, and is prescribed off-label for other conditions. In Australia, the UK, Germany, Portugal, Poland, and most European countries, it is licensed for depressive episodes and panic disorder with or without agoraphobia. In Spain and Denmark it is also used for obsessive–compulsive disorder.
Contents
1 Medical uses
1.1 Depression
1.2 Panic disorder
1.3 Off-label
1.4 Administration
2 Adverse effects
2.1 Post-SSRI sexual dysfunction
2.2 Abnormal heart rhythm
2.3 Endocrine effects
2.4 Exposure in pregnancy
2.5 Interactions
2.6 Overdosage
2.7 Suicidality
3 Stereochemistry
4 Metabolism
5 Pharmacology
6 History
7 Brand names
8 European Commission fine
9 See also
10 References
11 External links
Medical uses
Citalopram HBr tablets in 20-mg (coral, marked 508) and 40-mg (white, marked 509), and a United States one-cent coin (size 19.05 mm/0.75 in)
Depression
In the National Institute for Health and Clinical Excellence ranking of 10 antidepressants for efficacy and cost-effectiveness
Evidence for effectiveness of citalopram for treating depression in children is uncertain.
Panic disorder
Citalopram is licensed in the UK and other European countries
Off-label
Citalopram is frequently used off-label to treat anxiety, panic disorder, dysthymia,
It has been shown to be effective in 85% of patients with generalized anxiety disorder, including some who had failed with other SSRIs.
Citalopram is well tolerated and as effective as moclobemide in social anxiety disorder.
A meta-analysis, including studies with fluoxetine, paroxetine, sertraline, escitalopram, and citalopram versus placebo, showed SSRIs to be effective in reducing symptoms of premenstrual syndrome, whether taken continuously or just in the luteal phase.
Citalopram has produced a modest reduction in alcoholic drink intake and increase in drink-free days in studies of alcoholics, possibly by decreasing desire or reducing the reward.
Citalopram has been found to reduce the symptoms of diabetic neuropathy.
While on its own citalopram is less effective than amitriptyline in the prevention of migraines, in refractory cases, combination therapy may be more effective.
Citalopram and other SSRIs can be used to treat hot flashes. : 107
A 2009 multisite randomized controlled study found no benefit and some adverse effects in autistic children from citalopram, raising doubts whether SSRIs are effective for treating repetitive behavior in children with autism.
Some research suggests citalopram interacts with cannabinoid protein-couplings in the rat brain, and this is put forward as a potential cause of some of the drug’s antidepressant effect.
Administration
Citalopram is typically taken in one dose, either in the morning or evening. It can be taken with or without food. Its absorption does not increase when taken with food, The 5HT3 receptors stimulate vomiting. This side effect, if present, should subside as the body adjusts to the medication.
Citalopram is considered safe and well tolerated in the therapeutic dose range. Distinct from some other agents in its class, it exhibits linear pharmacokinetics and minimal drug interaction potential, making it a better choice for the elderly or comorbid patients.
Adverse effects
Sexual dysfunction is often a side effect with SSRIs. Specifically, common side effects include difficulty becoming aroused, lack of interest in sex, and anorgasmia (trouble achieving orgasm). One study showed, however, when remission of major depressive disorder is achieved, quality of life and sexual satisfaction is reported to be higher in spite of sexual side effects.
Citalopram theoretically causes side effects by increasing the concentration of serotonin in other parts of the body (e.g., the intestines). Other side effects, such as increased apathy and emotional flattening, may be caused by the decrease in dopamine release associated with increased serotonin. Citalopram is also a mild antihistamine, which may be responsible for some of its sedating properties. : 104
Common side effects of citalopram include drowsiness, insomnia, nausea, weight changes (usually weight gain), increase in appetite, vivid dreaming, frequent urination, decreased sex drive, anorgasmia, dry mouth,
Withdrawal symptoms can occur when this medicine is suddenly stopped, such as paraesthesiae, sleeping problems (difficulty sleeping and intense dreams), feeling dizzy, agitated or anxious, nausea, vomiting, tremors, confusion, sweating, headache, diarrhea, palpitations, changes in emotions, irritability, and eye or eyesight problems. Treatment with citalopram should be reduced gradually when treatment is finished.
Citalopram and other SSRIs can induce a mixed state, especially in those with undiagnosed bipolar disorder. : 105
Post-SSRI sexual dysfunction
Some people experience persistent sexual side effects after they stop taking SSRIs.
Abnormal heart rhythm
In August 2011, the FDA announced, “Citalopram causes dose-dependent QT interval prolongation. Citalopram should no longer be prescribed at doses greater than 40 mg per day”.
Endocrine effects
As with other SSRIs, citalopram can cause an increase in serum prolactin level.
Citalopram has no significant effect on insulin sensitivity in women of reproductive age
Exposure in pregnancy
Antidepressant exposure (including citalopram) during pregnancy is associated with shorter duration of gestation (by three days), increased risk of preterm delivery (by 55%), lower birth weight (by 75 g), and lower Apgar scores (by

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