December 9, 2022

In this video I review citalopram (Celexa). A prescription drug primarily used to treat depression. I cover dosing, warnings, withdrawal risk and side effects. At the end of the video I give you my overall take from a pharmacist’s point of view.

Hey guys this is curtis alexander curtis-alexander.com i’m a pharmacist in this video i’ll be covering citalopram reviewing it we’ll be going over what it’s used for warnings if you notice from the board a lot of warnings on this one and i want to cover all of them will they all happen no but it’s good for you to know about them we’ll go overdosing some of those

Things but i just want to hop right into it so like i talked about citalopram is an antidepressant it is a selective serotonin reuptake inhibitor so i made a video about comparing zoloft and prozac citaloprams in the same class and its end result is as the name implies it’s going to stop your body or inhibit your body from reuptaking serotonin the end result is

You get higher blood levels of serotonin okay so it’s used for that reason for depression what we don’t use it in is pediatric patients young patients it’s particularly less than 24 i’ll get into that in a second dosing um i prefer to dose way on the the lower end i’ve seen higher doses i don’t like it i encourage starting out with 10 milligrams increase into

20 if needed you have to give it some time antidepressants are notorious you have to give them four to six weeks before you really start noticing a difference so don’t increase them too soon but particularly be careful in higher doses with over 60 years of age hepatic impairment or drug interactions even uh so so-called you know safe medications like omeprazole

Or prilosec can cause bumps in citalopram levels so with that being said 10 to 20 milligrams is a sweet spot the max is 40 milligrams but i don’t like going that high i don’t like people seeing people go that high now some just general warnings we would look at liver and kidney disease if you have that you want to be careful it can cause increased levels again

Especially in that over 60 year old age range and we want to caution its use in seizure disorder disorders now i want to hop into side effects now these side effects are broken into two groups there are some that are much more rare but can be very serious and then there are some that are more common not as serious and so i’ll try to point those out as i come across

Them okay so first and foremost we can see a development of manic episodes hypomania so low-grade manic episodes we don’t know who this will happen to why it happens per se but some of the risk factors is if you had bipolar disease or even a family history of bipolar disease females are at higher risk for that depression with psychosis we’re also a younger age this

Is coming back to this pediatric group antidepressant resistance if if you haven’t responded well to antidepressants in the past be careful with it okay we can funny enough you wouldn’t think this but we can see increased bleeding risk we believe it’s related because serotonin interacts essentially with platelets platelets are involved in the blood clotting process

So we can see some of those issues risk factors include are you using other anticoagulants and eliquis or a wharf friends something like that do you have von willebrand factory do you have coagulation disorders those are something to be concerned about and then nsaid use celebrex ibuprofen some of these meloxicam some of these medications that are nsaids using it

Along with citalopram you can see an increased bleeding risk another little oddball you wouldn’t think is fracture risk we don’t know why per se but the as far as the actual percentage after one year of use we can see an increase in 2.9 percent two years to use 5.4 all the way up to 13.4 percent increase in fracture risk after five years of use again pretty much

Related to the long-term use okay you need to watch your sodium levels okay this is called inappropriate adh secretion so adh is an antidiuretic hormone and it’s involved in that whole process so if you are of an older age female if you’re taking diuretics hydrochlorothiazide furosemide those sorts of things if you have a low body weight if you already have low

Sodium levels or if you’re volume depleted the bottom line is you want to make sure that you’re getting your sodium levels measured while you’re on citalopram ocular uh we see this in some of the other selective serotonin reuptake inhibitors we have ocular or eye side effects that we worry about the main one being acute uh closed angle glaucoma we can see that

Again in females again the age is even lower this time over 50 can be a risk factor inuit population asian population can be at higher risk and if you have a family history of glaucoma something you want to be careful of now serotonin syndrome this isn’t as surprising um it can be a little more common because we’re increasing serotonin levels in the body you can

Get serotonin syndrome it is dose related it usually starts pretty quick usually starts within the day and that includes if you’re starting citalopram or even if there’s a dose change you want to monitor people when they do this and then other serotonergic drugs which are mainly what are called maoi inhibitors not used a lot anymore but serotonin is something that

You you see on occasion qt prolongation this is one you want to be careful with okay so qt if you’re not familiar when you get an ekg there’s an interval in that ekg it’s called the qt interval well when we see uh changes in that it’s it’s heart issues so we want to be careful and the groups that we really want to be careful in again older age 65 or older is their

Structural heart disease do you have electrolyte disturbances how about your sodium your potassium your calcium those sorts of things okay liver or kidney disease because again a lot of these electrolytes are clearing through your kidneys substance abuse and other drugs that prolong the qt interval i i harp on this a lot in videos when you get a medication have your

Pharmacist run run a drug interaction check because there’s so many interactions that can occur and there’s other drugs that can do this qt prolongation sexual dysfunction people don’t like to talk about this but it happens a lot in a number of medications citalopram is known for it it’s known for it in men and women a big part of the reason why this can include

Erectile dysfunction a low libido those sorts of things and it happens because serotonin can actually affect some of your other hormones including testosterone and dopamine so again this is one of these little more common ones okay suicidal behavior or thinking this is a big one and we’re looping back to what we started with in the video which is in short-term

Studies what they found is that from kids to 24 years of age there is definitely an increase in risk once you get to adulthood 24 and beyond it tends to even out and then in the older group they saw a decrease in suicidal ideation so the moral of the story is extremely careful of using this can it be used in kids in rare circumstances it can obviously with the

Doctor psychiatrist evaluation not something you like to see done because it does increase the suicide risk in that age group okay also a history of depression in that age group is a risk factor for this worsening all right withdrawal this can happen um it happens in all the ssris happens in pretty much all the antidepressants okay so when you are on citalopram

And you’ve been on it for three weeks or more you want to if you and your doctor decide to stop it do it slowly okay um otherwise you can get dizziness fatigue headache chills uh did this in this twice i guess i wanted to emphasize that um the moral of the stories you’re going to feel like crap you’re going to feel like you got hit by a truck uh you know fever

Chills it’s it’s not pretty when somebody’s withdrawing um so just be aware that if you guys you and your doctor decide to stop go slow all right um and the reason again people fail to realize serotonin affects other neurotransmitters other systems in your body so when you stop re-uptaking serotonin when you stop that process and serotonin increases and then all

Of a sudden you pull that process in serotonin plummets it’s also affecting things like glutamine dopamine in your hpa axis hpas involved in a lot of things so i’ll stay away from explaining that one but we want to go slow if somebody’s on a high dose long term really go slow and if you’ve ever had issues withdrawing from an antidepressant before be very careful

Okay and now some of the just more run-of-the-mill very common maybe not as serious we’re looking at nausea 2 out of 10 people roughly same thing with dry mouth and again drowsiness almost we’re at 18 with drowsiness so citalopram very common antidepressant you see it used a lot i would encourage if you’re going to start on it talk to your doctor about starting at

The lowest dose possible increase slowly and only if you absolutely have to it just comes with a lot of warnings a lot of potential side effects some of them more common not as serious some of them less common but can be very serious so i i feel like it’s just kind of thrown out there willy-nilly too often and not given enough consideration into the downsides of

It so if you’ve taken citalopram let me know in the comments what was your experience if you’ve known anybody else who took it what was their experience it helps me it helps other people watching the video so i hope this video was helpful and valuable and until the next one miss curtis thanks

Transcribed from video
Citalopram Review – Side Effects, Withdrawal and Warnings By Curtis Alexander Pharm.D.