Citalopram is an antidepressant drug classified in the group named as selective serotonin reuptake inhibitors (SSRIs). It is marketed all over the world with different trade names like Celepra, Celexa, Cipam, Citalop etc. Other drugs included in this group are fluoxetine, sertraline, dapoxitine, esCitalopram, fluvoxamine, indalpine, paroxetine and zimelidine. It is a known fact that decreased levels of serotonin and norepinephrine in the synapses of central nervous system are the main cause of depression. . Like tricyclic antidepressants, which inhibit the reuptake of norepinephrine in the synaptic terminals, Citalopram inhibits the reuptake of serotonin in the synaptic terminals. So, increased serotonin in the synaptic cleft helps in the management of depression.
What is Citalopram used for?
Citalopram is used for the following conditions:
- Depression – Citalopram has shown very promising results in the treatment of severe depression as compared to tricyclic antidepressants like Imipramine. Moreover, when compared with cognitive behavioral therapy for the management of severe depression, Citalopram alone has far better results in its management. 50 mg once daily is the initial dose, which can be increased to 200 mg once daily depending on the situation.
- Dysthymia – it is a milder but chronic type of depression and Citalopram is very effective in this condition
- Depression with obsessive compulsive disorder (OCD) – Citalopram shows far better results in patients with OCD as compared to tricyclic antidepressants
- Panic disorder – in depressed patients having panic attacks Citalopram decreases the frequency of panic attacks markedly
- Depression in elderly – Citalopram is a hallmark in the management of depression in the patients more than 60 years of age. Moreover, it is well tolerated in this age group
- Other common uses of Citalopram are obsessive compulsive disorder in both children and adults, social anxiety disorders, post traumatic stress disorder, panic disorders and premenstrual dysphoric disorder
Common side effects of Citalopram
Unlike Tricyclic Antidepressants (TCAs), SSRIs have fewer side effects and poses less dangerous adverse reactions compared to Monoamine Oxidase Inhibitors (MAOIs). Citalopram has fewer cardiovascular, anticholinergic, and sedating effects. Some of the common side effects of Sertralne per body system are:
1. Autonomic Nervous System
- Frequent Impotence- Impotence is a male disorder wherein there is a consistent incapability of sustaining an erection during sexual intercourse or incapability of achieving ejaculation. A person who has this disorder may manifest one or both of the condition. The risk of having impotence may also increase with age.
- Priapism- A reproductive disorder characterized by painful and prolong erection. This is considered as a medical emergency.
- Glaucoma- It is an eye condition wherein there is an increase in the intraocular pressure (pressure in the eye). This can damage the optic nerve if not treated immediately.
- Mydriasis- It is the dilation of the pupil.
- Cold, clammy skin
- Increased salivation
2. Cardiovascular System
- Frequent palpitations
- Angina or chest pain
- Hypertension- An increase in the blood pressure (140/90 or more)
- Tachycardia or increase in hear rate (more than 100 beats per minute)
- Peripheral edema or swelling on extremities
- Syncope or fainting
- Postural hypotension
3. Peripheral Nervous and Central System
- Hypertonia or increased muscle tone. If left untreated, it can cause functional abnormalities and deformities.
- Vertigo or feeling of lightheadedness or unsteadiness
- Ataxia or poor body coordination
- Abnormal gait
- Dysphonia or difficulty in speaking
- Nystagmus- It is an eye condition wherein there are involuntary, rhythmic and rapid eye movements.
4. Endocrine System (rare)
- Exophthalmos or protrusion of the eyeballs
- Gynecomastia or breast enlargement in males
5. Gastrointestinal System
- Increased appetite
- Aggravation of tooth caries
- Dyphagia or difficulty in swallowing
- Gastroenteritis or inflammation of the stomach and intestines
- Esophagitis or inflammation of the esophagus
- Abnormal liver function
- Hypoglycemia or low blood sugar
6. Musculoskeletal System
- Myalgia or pain in the muscles
- Arthralgia or pain in the joints
7. Integumentary System
- Pruritus or skin itching
- Alopecia or abnormal loss of hair
- Urticaria or also known as hives
- Dry skin
8. Circulatory System
- Anemia or low hemoglobin in the blood
9. Reproductive System
- Dysmenorrhea or painful menstruation
- Amenorrhea or absence of menstruation
- Vaginal hemorrhage
10. Respiratory System
- Dyspnea or difficulty breathing
11. Renal System
- Polyuria or excessive urination
- Frequent urination
- Urinary incontinence or inability to control urination
- Tinnitus or ringing in the ear
- Eye pain
13. General Body System
- Weight gain
- Malaise or body weakness
- Asthenia or absence of energy
- Back pain
Citalopram side effects on children
In children the most common adverse effect of Citalopram is manic episodes. Another common side effect of Citalopram in children is the increased risk of suicidal ideation. In children and people younger than 25 years of age Citalopram increases the risk of suicide manifold. It is necessary to monitor the child for altered thoughts, irritability, and thoughts of self harm or suicide while on this drug.
Citalopram side effects on men
In men the most prominent side effect of Citalopram is decreased libido. During the use of this drug there is decreased sensation in the genitals, which results in decreases sexual arousal. Moreover, it becomes difficult to achieve orgasm while on this drug. Ejaculation failure is another adverse effect of Citalopram in men and it is closely related to decreased libido in men. Few cases of priapism have also been reported with the use of Citalopram.
Citalopram side effects on women
The hormonal levels of women can be affected by Citalopram intake. This can be manifested by breast milk discharges (even if you are not pregnant), breast tenderness, mood swings, low energy, weight gain or weight loss, insomnia, and cramping. These symptoms will subside slowly after discontinuation of the antidepressant drug. Some women also report PMS symptoms when using Citalopram.
Citalopram side effects on pregnant women
Citalopram is metabolized into desmethylsertraline in which form it circulates in the blood. If a pregnant woman is exposed to this drug in the first trimester then almost one third of this metabolite is transported to the fetal blood where it can result in certain birth defects like:
- Omphalocele – abdominal wall defect characterized by extrusion of abdominal contents like stomach, liver and intestines
- Defects of septal formation
- Anal atresia – inability of anal canal to open or canalize
- Limb deformities
The drug is safe to be used in the breast-feeding mothers because this drug is not secreted in the milk.
Citalopram side effects on elderly
Clinical study shows that elderly patients who take Citalopram also experience the same side effects that younger adults have. However, hyponatremia (low sodium in the blood) appears to be more common in elderly than in young adults.