Citalopram is a selective serotonin reuptake inhibitor (SSRI) widely prescribed for depression and certain anxiety-related conditions. It works by increasing serotonin levels in the brain by blocking its reuptake at the presynaptic neuron. By enhancing serotonergic transmission, citalopram can improve mood, relieve symptoms of major depressive disorder (MDD), and reduce the physiological symptoms of anxiety. Unlike older antidepressants such as tricyclics or monoamine oxidase inhibitors, citalopram is generally well tolerated and has fewer anticholinergic or cardiovascular side effects, which explains its popularity as a first-line therapy in Europe and worldwide.
Citalopram is usually initiated at a low dose and titrated upward depending on therapeutic response and tolerability. Symptom relief is not immediate: it often takes 2–4 weeks for patients to notice improvement, and full benefit may take up to 8 weeks. The medicine is not habit-forming in the traditional sense but must be discontinued gradually to avoid withdrawal-like effects known as antidepressant discontinuation syndrome. As with all SSRIs, the therapeutic effect arises from consistent, long-term use under clinical supervision.
Though effective and generally safe, citalopram has notable risks at higher doses, particularly QT interval prolongation, which can predispose susceptible individuals to arrhythmias. Regulators recommend dose limits (generally 40 mg/day in adults and 20 mg/day in older adults) to minimize this cardiac risk. This highlights the balance between maximizing therapeutic efficacy and safeguarding patient safety that clinicians must maintain when prescribing citalopram.
Citalopram is mainly prescribed for mood and anxiety disorders, with specific clinical indications:
Patients must continue therapy even after they feel better, as stopping prematurely increases relapse risk. Treatment duration is usually 6–12 months for a first episode, and longer for recurrent depression.
Most side effects improve after the first few weeks. Patients are encouraged to report persistent or severe problems promptly so clinicians can adjust therapy if needed.
Patients should undergo regular review, especially in the first 4–8 weeks, to monitor therapeutic response and safety.
Citalopram has important interactions with many medications:
Patients should always share their full medication list, including supplements and herbal remedies, to avoid dangerous interactions. Pharmacist review is recommended.
Overdose: Symptoms may include nausea, dizziness, tremor, drowsiness, rapid heart rate, low blood pressure, seizures, and cardiac arrhythmias (especially due to QT prolongation). Severe cases may require hospital monitoring with ECG, IV fluids, and supportive treatment. There is no specific antidote.
Accidental double dose: Usually results in mild increased side effects (nausea, sleep disturbance). Skip the next extra dose and resume the regular schedule. Contact a clinician if severe symptoms appear.
Missed dose: Take as soon as remembered unless it is almost time for the next dose. Do not double up. Consistency is essential for effectiveness.
Patients and carers should always read the package leaflet, and any concerns about dosing errors should be discussed with a doctor or pharmacist promptly.
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