thoughtscape NP Psychiatry · Patient education
Citalopram
Celexa • tablets: 10, 20, and 40 mg
A daily antidepressant. Improvement builds gradually; the right dose balances benefit, side effects, and heart-rhythm risk.
Draft for review · Clinical content has not been revalidated for this website.
This is general education, not a dose plan. Citalopram and escitalopram are different medicines.
What it is used for
FDA-approved for depression in adults; not approved for children.
Off-label uses include anxiety disorders and OCD. Evidence varies; ask about your treatment goal.
How it works
An SSRI: it slows serotonin reuptake, changing serotonin signaling over time.
Depression is not simply a serotonin shortage. This is not an immediate calming medicine.
What to expect over time
EARLY DAYS
Nausea, sleep changes, or jitteriness may appear before benefit. Report severe agitation or worsening mood promptly.
OVER WEEKS
Mood and anxiety may improve gradually. Full benefit can take several weeks; do not wait to report concerning symptoms.
AFTER IMPROVEMENT
Keep follow-up visits. Treatment often continues after you feel better, with duration based on your history and relapse risk.
Taking your medication
Take once daily, morning, or evening, with or without food. Follow your prescription; do not raise the dose yourself.
The adult maximum is 40 mg/day, but 20 mg/day if over 60, with liver impairment, certain slow metabolism, or interacting medicines. Heart risk still exists within these limits.
For liquid, check the concentration and use an oral syringe or pharmacy device, not a kitchen spoon. Do not stop suddenly.
When to get help
Emergency help: seizure, collapse, breathing trouble, severe allergy, or immediate self-harm danger. Seek urgent care for fainting, palpitations, or major bleeding.
Urgent care: fever with agitation, sweating, diarrhea, tremor, or stiffness; confusion, severe weakness, unsteadiness; eye pain/vision changes or blistering rash.
Call promptly: suicidal thoughts, marked mood changes, or little need for sleep with unusual energy. Risk of suicidal thoughts/actions rises through age 24; watch all ages.
Early side effects
Nausea, diarrhea, headache, sweating, dry mouth, dizziness, sleepiness, or insomnia can occur. Food may ease nausea. Ask about dose timing for sleep problems; report persistent effects.
Other effects to discuss
Sexual difficulties, appetite/weight changes, or feeling emotionally flat deserve discussion. There are treatment options; do not skip doses to manage them or assume they always mean the dose is too high.
What to keep track of
Review mood, sleep, sexual function, and side effects early and after dose changes. Heart/interaction risks guide ECG and potassium/magnesium tests. Older adults and water-pill users may need sodium checks.
Before you start
Discuss heart-rhythm problems, fainting, slow pulse, heart attack/failure, low potassium or magnesium, seizures, bipolar disorder, bleeding, glaucoma, liver/kidney disease, pregnancy or breastfeeding. Mention family bipolar history and every medicine or supplement. Citalopram is not usually used alone for bipolar depression. Do not take it with pimozide or an MAOI.
Medicines & interactions
MAOIs and related medicines
Antidepressant MAOIs need at least 14 days' separation in either direction. Linezolid and IV methylene blue need a managed alternative plan; tell the treating team.
Acid reducers and heart-rhythm medicines
Omeprazole, cimetidine, and other CYP2C19 inhibitors lower the dose maximum to 20 mg/day. Other rhythm-affecting medicines may be unsafe together. Ask before adding OTC products.
Other antidepressants and serotonin products
Check tramadol, lithium, buspirone, stimulants, triptans, and St. John's wort for serotonin-syndrome risk. Do not duplicate with escitalopram.
Pain relievers, blood thinners, and alcohol
Ibuprofen, naproxen, aspirin, and blood thinners increase bleeding risk. Ask which pain medicine fits your history. Avoid alcohol; do not drive until you know your response.
Everyday tips
Use a daily reminder and track mood, anxiety, sleep, and daily function. Bring questions to follow-up.
Tell your team about new medicines, including acid reducers and supplements. More medicine is not automatically better.
Keep regular sleep, meals, and activity. Therapy and social support can complement medication.
With your permission, ask someone you trust to notice sudden behavior changes and help you seek care.
Your questions, answered
What if I miss a dose?
Take it when remembered unless the next dose is nearly due; then skip it. Never double. Ask your pharmacist if unsure.
How do I stop?
Agree on a gradual taper; some people need slow reductions. Sudden stopping can cause dizziness, nausea, anxiety, poor sleep, or electric-shock sensations. Report withdrawal rather than changing the plan alone.
What about pregnancy or breastfeeding?
Discuss treatment and relapse risks before changing anything. Late-pregnancy use can affect newborn adaptation and rarely lung circulation; maternal bleeding risk also matters. It enters milk: watch infant sleepiness, restlessness, feeding, and weight.
What if I take too much?
Call Poison Help at 1-800-222-1222 or seek emergency care immediately, even if you feel well. Seizures or rhythm problems may be delayed. Call 911 for seizure, collapse, or breathing trouble.
Storage & safety
Store securely in the labeled container, away from children, pets, heat and moisture. Never share. Ask a pharmacy about disposal.
About this information
For general information only; not a substitute for individualized medical advice. This sheet does not cover every risk or interaction. Ask your prescriber or pharmacist before changing how you take this medication.
Sources
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.