Citalopram (Celexa)

Basic Instructions

· Start at 10mg/day – To be taken all at once, at the same time every day. If it causes sleepiness, take it at night. If it is activating, take it in the morning

· Take this medication with or without food

· Increase by 10mg/day every two to four weeks (as tolerated) until 100% better to a maximum of 40mg/day (20 mg/day in elderly)

· Common side effects tend to go away within 1-2 weeks after starting or after each dose increase, as your body adjusts to the medicine

· Monitor your blood pressure before starting and once a month thereafter

· We recommend that you have baseline bloodwork done prior to starting the medication – Ask your family doctor to make the arrangements

· We recommend that you have a baseline ECG done prior to starting the medication – Ask your family doctor to make the arrangements – Repeat ECGs should be done every 2-3months

Mayoclinic.org

Side effects and cautions

All SSRIs work in a similar way and generally cause similar side effects. However, each SSRI has a different chemical makeup, so one may affect you a little differently than another. Most side effects may go away after the first few weeks of treatment, but talk to your doctor if any side effects are too troublesome for you.

Side effects of Citalopram/Celexa may include, among others:

· Nausea

· Loss of appetite

· Fatigue

· Blurred vision

· Yawning

· Cold symptoms (stuffy nose, cough, sore throat)

· Reduced sexual desire or difficulty reaching orgasm or inability to maintain an erection (erectile dysfunction)

· Drowsiness

· Insomnia

· Weight gain or loss

· Dry mouth/Cough

· Vomiting

· Diarrhea

· Frequent urination

· Sweating increased

· Trouble sleeping

Taking your medication with food may reduce the risk of nausea. Also, as long as your medication doesn't keep you from sleeping, you can reduce the impact of nausea by taking it at bedtime.

Read the package insert for additional side effects, and talk to your doctor or pharmacist if you have questions.

Safety concerns

SSRIs are relatively safe. However, here are some examples of safety issues to be considered with this medication:

· Drug interactions. When taking an antidepressant, be sure to tell your doctor about any other medications or dietary supplements you're taking. Some antidepressants can cause dangerous reactions when combined with certain medications or herbal remedies.

· Lack of sodium in blood. This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, headache, memory problems, trouble concentrating, weakness, or unsteadiness.

· Difficulty concentrating and increased drowsiness. Make sure you know how you react to Citalopram before you drive, use machines, or do anything else that could be dangerous if you are not alert or well-coordinated.

· Changes in Heart Rhythm. Contact your doctor right away if you note any changes in your heart rhythm. If you feel dizzy or faint, or might have a fast, pounding, or irregular heartbeat. Also, inform your doctor if you or anyone in your family has ever had a heart rhythm problem such as QT prolongation or slow heartbeat.

· Abnormal bleeding. Use of some pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), or anticoagulants, such as warfarin (Coumadin), may increase the risk of bleeding when combined with SSRIs. Talk to your doctor about the risks of using these medications in combination.

· Serotonin syndrome. Rarely, an SSRI can cause dangerously high levels of serotonin. This is known as serotonin syndrome. It occurs when two medications that raise serotonin are combined. These include other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort. Signs and symptoms of serotonin syndrome include anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination and rapid heart rate. Seek immediate medical attention if you have any of these signs or symptoms.

Suicide risk and antidepressants

Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Stopping treatment with SSRIs

SSRIs aren't considered addictive, but sometimes physical dependence, which is different from addiction, can occur. So stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms. This is sometimes called discontinuation syndrome. Work with your doctor to gradually and safely decrease your dose.

Withdrawal-like symptoms can include:

· Nausea

· Dizziness

· Lethargy

· Increased sweating

· Nightmares

· Prickling or tingling feelings

· Flu-like symptoms

Finding the right antidepressant

Each person may react differently to a particular antidepressant and may be more susceptible to certain side effects. Because of this, one antidepressant may work better for you than another, or your doctor may prescribe a combination.

When choosing an antidepressant, your doctor will take into account your particular symptoms, what health problems you have, what other medications you take, what has worked for you in the past and what has worked for a close relative with depression.

Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of special blood tests may offer clues about how your body may respond to a particular antidepressant. The study of how genes affect a person's response to drugs is called pharmacogenomics. However, other variables besides genetics can affect your response to medication.

Typically, it may take several weeks or longer before an antidepressant is fully effective and for initial side effects to ease up. You may need to try several dose adjustments or different antidepressants before you find the right one, but hang in there. With patience, you and your doctor can find a medication that works well for you.