Celexa (citalopram)

side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

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§1.  Brand & Generic Names; Drug Classes; Availability & Forms

US brand name: Celexa

Generic name: citalopram

§1.1  Celexa (citalopram) Drug Class(es)

What is Celexa (citalopram)

Celexa (citalopram) is in the Antidepressants class of drugs.

Celexa (citalopram) is also in the Serotonin-Selective Reuptake Inhibitors class(es) of drugs.

§1.2  Celexa (citalopram) Generic and Overseas Availability

Is Celexa available as a generic? Yes

What Other Brand, Trade, & Branded Generic Names¹ for Celexa (citalopram) are there? And Where is Celexa (citalopram) Available?

• Celapram: Australia
• Celica²: Australia
• Ciazil: Australia
• Cilift: South Africa
• Cipramil: Australia,Ireland, New Zealand, South Africa, UK
• Citalohexal: South Africa
• Oropram: Iceland,Malta
• Talam: Australia

§1.3  How is Celexa (citalopram) Supplied

Tablets, oral solution

§2.  What is Celexa (citalopram) Used For?

§2.1  US FDA Approved Treatment(s)

Depression

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.

§2.2  What are Some of Celexa (citalopram) Off-Label Uses?

Panic/Anxiety Spectrum Disorders

As you can expect for an SSRI, especially one that is approved to treat only depression, Celexa will be used 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
• OCD .
  • Like most SSRIs, Celexa doesn’t do anything for, and can sometimes exacerbate the symmetry and hoarding forms/dimensions of OCD.
  • But Celexa is just fabulous for compulsive shopping
  • Celexa is often used to augment other meds to treat OCD. such as clomipramine .
• The data do get a bit mixed with straight-up anxiety.
  • On one hand it works well with very specific things like Late-Life Anxiety Disorders .
  • On the other hand there are several studies, in humans and critters, like this one showing how Celexa exacerbates anxiety symptoms during the early phases of treatment.

Other Forms of Depression

• Augmenting antipsychotics to treat psychotic depression
• Bipolar Depression

Other Conditions

• 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:
  • Reducing hostility
  • Aggression in schizophrenia
  • “Anger attacks” in bipolar depression. AKA dysphoric mania .
• A variety of eating disorders:
  • Anorexia nervosa
  • Binge eating
  • Bulimia - compares well with Prozac, which is approved to treat bulimia.
• 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

§3.  How & When Celexa Will Work; How to Take Celexa

§3.1  When Will Celexa (citalopram) Start 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.

§3.2  Will Celexa Really Work for What You Have

• As far as depression is concerned, Celexa is one of the few meds where we have some hard, real-world numbers from STAR*D on its 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.

§3.3  How to Take Celexa (citalopram)

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.

§3.4  How to Stop Taking Celexa (citalopram)

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.

Because Celexa’s half-life is 35 hours - Prozac is the only SSRI/SNRI with a longer half-life - severe discontinuation syndrome is less likely than most other SSRIs and all the SNRIs.

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§4.  What are Celexa (citalopram) Pros and Cons

§4.1  Pros

• 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 HBr 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 HBr is as good as Lexapro for most people.
• Basically, Celexa is the current King of all Antidepressants.

§4.2  Cons

• If it does happen, the weight gain can be bad for an SSRI.
• Your insurance company might still insist you try citalopram even if you’ve failed two other SSRIs previously.
• Not all generics are created equal.

§4.3  Interesting Stuff your Doctor Probably didn’t Tell You about Celexa (citalopram)

For whatever reason, Celexa is 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 - citalopram is also a good second med to try.

Like Zoloft, women tend to respond to Celexa better than men. Celexa has a slightly better chance of working for you than Zoloft regardless of your gender.

§4.4  What Celexa (citalopram) Is Best Known for

§5.  What are Celexa (citalopram) Side Effects

§5.1  Typical Celexa Side Effects

The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido. Most everything but the weight gain and loss of libido usually goes away within a couple of weeks.

§5.2  Uncommon Side Effects of Celexa (citalopram)

Tremor, brand new anxiety or exacerbation of existing anxiety, acne, disruption in your menstrual cycle. Given how Celexa 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) that Wendolene mentioned. This happens more often than I had originally thought, as both Celexa (citalopram) and Lexapro are on the list of drugs to totally avoid if you have a history of TdP/QTc/cardiac arrhythmia.

§5.3  Freaky Rare Celexa Side Effects

Rectal 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.

§5.4  What You Really Need to be Careful About with Celexa (citalopram)

Tell your doctor if you or anyone in your immediate family has had any kind of heart problem.

§5.5  Celexa (citalopram) Pregnancy Category

C-Use with caution

§6.  Celexa (citalopram) Pharmacology

§6.1  Celexa (citalopram) Half-Life & How Long Until Celexa Clears Your System

citalopram has a plasma half-life of: 35 hours. So citalopram clears your system within 6–8 days.
Clearance given here is “plasma clearance,” or how long it takes to be out of your blood so there’s nothing swimming around to attach itself to your brain and start doing stuff. Complete clearance is a complex equation based on a lot of factors which may or may not be published in the PI sheet or even figured out by independent researchers.

§6.2  Celexa (citalopram) Steady State

citalopram reaches steady state in: about a week.

§6.3  How Celexa (citalopram) Works

the current best guess at any rate
Based upon the chemical imbalance theory of mental illness (or brain cooties as we often call it), Celexa 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 Celexa, 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 Celexa and other medications work in regards to things like PMDD.

§6.4  Active Ingredient

Celexa’s active ingredient is: citalopram hydrobromide
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.

§6.5  Shelf Life

Celexa (citalopram) has a shelf life of: Tablets: 5 years. Oral solution: 2 years.

§6.6  Noted Drug-Drug & Drug-Food Interactions

Check for Other Drug-Drug & Drug-Food Interactions

Check for drug-drug interactions

§7.  Comments, Celexa (citalopram) PI Sheet, Reviews of Celexa (citalopram), and More

§7.1  Comments

Based upon its efficacy and, now that it’s available as a generic practically everywhere, cost, citalopram is 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, in which case you may as well get the med that works a little faster and sucks a little less than Celexa.

Celexa is currently the only SSRI that is approved by the FDA for depression and nothing else³. 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.

§7.2  Discussion board

If you have any questions about Celexa (citalopram), see the Crazy Meds’ Celexa (citalopram) forum.

§7.3  Your Reviews of, Comments About, and Experiences with Celexa (citalopram)

Wendolene,

While death from prolonged QT interval is rare, it’s not all that freaky. It’s a potential side effect of one fourth to one third of all the medications discussed on this site, depending on how you count “discussed.” About 25% of the meds I have articles on list various arrhythmias, almost all of which include or are exclusively QTc, as a side effect. Throw in the ones I don’t have articles on but have been brought up numerous times on the forum (E.g. Geodon) and it’s easily a third.

Hi Jerod, Thanks for the quick response! I haven’t had occasion to come here in ages (maybe since the .org days?) because hey - I was stable. So I wouldn’t have seen the discussions in the forum. I do want to say that every time I do visit this site, I smile and I nod and I learn something new. Your sense of humor combined with the basic facts are so welcome.

I posted this on the Celexa page because if a casual reader doesn’t visit the forums they might not have seen the QT interval stuff if they just came to read about meds and leave. Please know that it was not a criticism, just a suggestion.

Take care.

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§7.4  Full US PI sheet, Global SPCs & PILs, Consumer Reviews & Ratings, and Other Sites that may be of Interest

Celexa Full US Prescribing Information / PI Sheet

§7.5  Celexa Prescribing Information & Patient Information from Around the World

• Australian Cipramil PI
• Australian Cipramil Consumer Medicine Information
• Canadian Celexa 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

§7.6  Consumer Reviews of Celexa

• Everyday Health Celexa Reviews
• AskaPatient Drug Ratings for CELEXA
• PatientsLikeMe Citalopram Treatment Report
• DailyStrength Celexa User Reviews
• WebMD User Reviews & Ratings - Celexa Oral
• Drugs.com User Reviews for Celexa

§7.7  Other Sites of Interest

Drugsdb.com Citalopram page

§8.  Bibliography

Stahl’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.

¹ The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure how much of a difference that makes. The FDA says they're the same thing. As usual, the data are contradictory. So far it's looking as if the FDA is wrong again, and I need to make separate pages for Pexeva, Aplenzin, etc.
For our purposes a "branded generic name" refers to the second and third definitions.

² You'll have to talk to an Australian intellectual property lawyer to find out how an antidepressant and a Toyota are able to have the same brand name. Actually, I'd appreciate it if someone would talk to someone in Australia who knows why the hell the same brand name is being used for both products.

³ Luvox is approved to treat OCD and nothing else, making it the redheaded stepchild of SSRIs.

Date created Monday, 28 January 2013 at 17:14:56 Page Author: Jerod Poore Last edited by: Jerod Poore on May 01, 2013, at 12:01 PM

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Celexa (citalopram) side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more by Jerod Poore is copyright 2013 Jerod Poore

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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 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 Crazy Meds. 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 the forerunner to 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]

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