side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
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Brand & Generic Names; Drug Classes; Availability & Forms
|US brand name: Celexa|
|Generic name: citalopram|
|Primary drug class: Antidepressants|
|Additional drug class(es): Serotonin-Selective Reuptake Inhibitors|
Generic and Overseas Availability
|Available as a generic? Yes|
Other Trade Names and Overseas Availability
- Celapram: Australia
- Celica1: Australia
- Ciazil: Australia
- Cilift: South Africa
- Cipramil: Australia,Ireland, New Zealand, South Africa, UK
- Citalohexal: South Africa
- Oropram: Iceland,Malta
- Talam: Australia
Shapes & Sizes (How Supplied)Tablets, oral solution
Approved & Off-Label Uses (Indications)
Celexa’s US FDA Approved Treatment(s)Major depressive disorder (MDD)
Uses Approved Overseas but not in the US
- In Ireland and the UK Cipramil is approved to treat both the initial phases of depression and to prevent its relapse; and Panic Disorder (PD).
- In South Africa Citalohexal is approved to treat depression and PD as above, as well as OCD.
Off-Label Uses of Celexa
Panic/Anxiety Spectrum Disorders
If an SSRI is approved to treat only depression, expect it to be used off-label to treat all sorts of conditions in the panic/anxiety spectrum.
- Panic disorders with phobias
- Combat PTSD
- Social anxiety disorder (SAnD)
- Social anxiety with depression
- Like most SSRIs (and crazy meds in general) it fails at doing a damn thing for hoarding. Not only that, it can sometimes exacerbate the symmetry and hoarding forms/dimensions of OCD.
- But Celexa is just fabulous for compulsive shopping
- Augmenting (using with) other meds to treat OCD. such as clomipramine .
- The data do get a bit mixed with straight-up anxiety, which is probably why it’s not approved to treat anxiety spectrum disorders.
Other Forms of Depression
- Severe & frequent hot flashes. Particularly in post-menopausal women and women being treated for breast cancer.
- Premenstrual Dysphoric Disorder (PMDD)
- Chronic fatigue, where it’s so-so.
- Fibromyalgia. Two studies. It didn’t work in the first one, it pooped out after two months in the second one.
- Various forms of unpleasant behavior, including:
- A variety of eating disorders:
- Irritable Bowel Syndrome
- Although this guy calls bullshit on the above study.
- And the title of this one says it all. Citalopram is not Effective Therapy for Non-Depressed Patients with Irritable Bowel Syndrome
- When it comes to IBS, it’s either Paxil or a TCA.
- Premature ejaculation
- I especially like the specificity of this study: Salvage Use of Citalopram for Treatment of Fluoxetine-Resistant Premature Ejaculation in Recently Married Men
- As well as this one: Panic attacks with spontaneous ejaculation successfully treated with citalopram and clonazepam
When & If Celexa Will Work
Celexa’s Usual Onset of Action (when it starts working)
Like all SSRIs anywhere from a couple days to over a month. If you don’t feel any positive benefit after six weeks, then you should talk to your doctor about either another SSRI or trying a med that hits another neurotransmitter.
Likelihood of Working
- There are just massive amounts of data with hard, real-world numbers from STAR*D giving actual odds of working:
- It’s a literal 50% coin-toss that you’ll a positive response within four weeks.
- And it’s a two-in-three chance that your depression will stay away.
- Based on what I can find in other clinical trials & studies, books, and anecdotal evidence, you’ve got a good 60–70% chance that Celexa will work, keep working, and suck less than MDD and any other antidepressant, except Lexapro.
- The data from the clinical trials for hot flashes are pretty encouraging, but anything in stage III tends to be encouraging.
- Its main problem with anxiety seems to be the short-term exacerbation of the problem.
Taking and Discontinuing
How to Take Celexa
Initial dosage of 20mg a day that can be increased to 40mg a day after at least one week. You can go up to 60mg a day, although there is little evidence from the clinical trials to support effectiveness at that dosage. Like any SSRI I recommend starting out with 10mg and then increasing to 20mg after a week. If you don’t feel anything go up to 30mg, but stay there until you’ve given it a try for a month, otherwise it’ll just be a pain in the ass to stop it. Even at 30mg you’ll know after a month if it’s going to do something for you.
How to Stop Taking Celexa (discontinuation / withdrawal)
Based on the 35 hour half-life your doctor should be recommending that you reduce your dosage by 10–20mg a day every 6–8 days if you need to stop taking it if you need to stop taking it, if not more slowly than that. Make that 10–20mg a day every week just to make things easier on everyone.
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Celexa’s Pros and Cons
- Works well on the combination of depression with OCD and/or SAnD-types of anxiety.
- Your insurance company may actually be right if they insist on your trying generic citalopram for your first med. Unless your doctor has a better idea, and/or you’ve used antidepressants in the past, especially SSRIs, just by playing the numbers Celexa is more likely to work (and suck less) than any other AD on the market.
- Generic citalopram is as good as Lexapro for most people.
- Basically, it’s the current King of all Antidepressants.
Interesting Stuff your Doctor Probably didn’t Tell YouFor whatever reason, it’s a good med to switch to if the SSRI you’re already taking stops working or sucks too much. A study with Prozac and another with Paxil correspond to the anecdotal evidence I’ve come across. So in addition to being the best first med to try - unless you have specific symptoms that indicate an SSRI isn’t a way to go in the first place - it’s also the best second med to try.
Best Known for
Being the first drug most doctors prescribe for depression.
Celexa’s Side Effects
Typical Side Effects
The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia (sleeping is more likely), constipation or diarrhea (I wish SSRIs would make up their minds about these contradictory side effects), weight gain (if it happens the weight gain can be pretty bad for an SSRI), and assorted sexual dysfunctions. Most everything but the weight gain and bedroom problems usually goes away within a couple of weeks.
Uncommon Side EffectsTremor, brand new anxiety or exacerbation of existing anxiety, acne, disruption of your menstrual cycle. Given that it works on PMDD and severe hot flashes, those last two shouldn’t be much of a surprise if they happen.
Somewhere between rare and uncommon are heart arrhythmia problems like torsades de pointes (TdP)/prolonged QT interval (QTc). This happens more often than I had originally thought. Here’s a list of drugs to totally avoid if you have a history of TdP/QTc/cardiac arrhythmia.
Freaky Rare Side EffectsRectal hemorrhage. Hiccups that won’t stop. Mouse had the unending hiccups. At the time it’s only funny when something like that happens to someone else. A year or two later, or even a couple months, it’s pretty funny no matter whom it happened to.
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What You Really Need to be Careful About
C-Use with caution
Celexa’s Half-Life & How Long Until It Clears Your System
Plasma half-life: 35 hours. It clears your system within 6–8 days.
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream2, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what3, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.
about a week.
Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.
How citalopram Works
the current best guess at any rateBased upon the chemical imbalance theory of mental illness (or brain cooties as we often call it), citalopram effectively raises the serotonin levels in your brain by letting your synapses soak in serotonin for longer than usual by slowing (inhibiting) the mechanism of serotonin transmission deeper into the neurons (reuptake). Depending on where, and to what extent that effect on serotonin occurs, the regulation of your dopamine can be affected, which is the likely cause of various side effects, especially those involving sexual dysfunction.
This study may explain why it, and probably other SSRIs, works in treating OCD. I wish there were more pretty neuroimaging pictures.
Here’s another one, looking at people with several anxiety-spectrum conditions (OCD, PTSD, & SAnD).
Your guess is as good as, if not better than, mine when it comes to how any crazy meds work in regards to things like PMDD.
The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.
Tablets: 5 years. Oral solution: 2 years.
Noted Drug-Drug & Drug-Food Interactions
Check for Other Drug-Drug & Drug-Food Interactions
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on te Faecesbooks.
Comments, PI Sheet, Ratings, Reviews and More
CommentsIts efficacy, lack of drug-drug interactions with anything involving CYP2D6 & CYP3A4/5 (i.e. half the meds on the planet) and, now that it’s available as a generic practically everywhere, cost, makes it one of, if not the most-prescribed antidepressant on the planet. It’s certainly the most-prescribed, and usually the first-prescribed for MDD wherever it’s available. Unless your symptoms scream something else (e.g. anhedonia and the inability to figure out how to go about getting out of bed, in which case Wellbutrin would probably work better), citalopram should be the first antidepressant you’re prescribed. Unless your insurance covers Lexapro and you’re not taking a drug that interacts with it, you may as well get the med that sometimes works a little faster and sucks a little less.
Currently the only SSRI-class antidepressant that is approved by the FDA for depression and nothing else.4 Although that may change as it is undergoing phase III tests to treat hot flashes in women who experience them frequently long after menopause or during breast cancer therapy. In the latter it manages to do so without messing with tamoxifen, which is critical.
Celexa was part of the cocktail Mouse was on when she went completely manic. The main culprit was Geodon. For an SSRI it wasn’t all that bad for her.
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Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest
Prescribing Information & Patient Information from Around the World
- Australian Cipramil PI
- Australian Cipramil Consumer Medicine Information
- Canadian Product Monograph
- Icelandic Oropram SPC í íslensku
- Icelandic Oropram PIL (FYLGISEÐILL: UPPLÝSINGAR FYRIR NOTANDA LYFSINS) í íslensku
- Irish Cipramil SPC
- Maltese Oropram SPC in English
- New Zealand Cipramil MDS
- South African Citalohexal Patient Information
- UK Cipramil SPC
- Everyday Health Reviews
- AskaPatient Drug Ratings
- PatientsLikeMe Treatment Report
- DailyStrength User Reviews
- WebMD User Reviews & Ratings
- Drugs.com User Reviews
Other Sites of Interest
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BibliographyStahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press. Primer of Drug Action 12th edition by Robert M. Julien Ph.D., Claire D. Advokat, Joseph Comaty © 2011 Published by Worth Publishers. The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition by Stephen Stahl © 2009 Published by Cambridge University Press. Clinical Handbook of Psychotropic Drugs 18th edition Adil S. Virani, K. Bezchlibnyk-Butler, J. Jeffries © 2009 Published by Hogrefe & Huber Publishers. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier. Also the 2004 edition, but only on pages that haven’t been fully updated yet. Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc. PDR: Physicians’ Desk Reference 2010 64th edition back through to 53rd edition of 1999. Old copies of the PDR come in handy for PI sheets that are no longer available and difficult to find, as well as to track the changes in both indications and adverse effects. Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.
2 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady state if they can't get, or won't provide a number for that.
3 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
4 Luvox is approved to treat OCD and nothing else, making it the redheaded stepchild of SSRIs.
5 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.
|Last modified on Tuesday, 11 March, 2014 at 01:46:59 by SomeMedCritic||Page Author: JerodPoore||Date created Monday, 28 January 2013 at 17:14:56|
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]