Brand & Generic Names; Drug Classes
|US brand name: Celexa|
|Generic name: citalopram|
|Primary drug class: Antidepressants|
|Additional drug class(es): Serotonin-Selective Reuptake Inhibitors|
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 India, Ireland, Russia, Tunisia, Ukraine, the UK, and most of Europe citalopram is approved to treat both the initial phases of depression and to prevent its relapse ; and Panic Disorder (PD) with or without agoraphobia .
- In Argentina, Brazil, Estonia, Israel, and South Africa citalopram is approved to treat depression and PD as above, as well as OCD .
- In the Dominican Republic Zalopram is approved to treat depression, PD, and OCD as above, and also alcoholism .
- In Taiwan citalopram is approved to treat depression and anxiety.
Off-Label Uses of Celexa
Panic/Anxiety Spectrum Disorders
If an SSRI is approved to treat only depression in the US, 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
- As noted above, Celexa is approved in South Africa to treat OCD.
- 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.
- Various forms of unpleasant behavior, including:
- A variety of eating disorders:
- Irritable Bowel Syndrome (IBS)
- Although these guys call 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 off-label meds for 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
Lundbeck and Forest recommend:
Celexa (citalopram HBr) should be administered at an initial dose of 20 mg orally once daily , with an increase to a maximum dose of 40 mg/day at an interval of no less than one week. Doses above 40 mg/day are not recommended due to the risk of QT prolongation. Additionally, the only study pertinent to dose response for effectiveness did not demonstrate an advantage for the 60 mg/day dose over the 40 mg/day dose.
It is generally agreed that acute episodes of depression require several months or longer of sustained pharmacologic therapy. Systematic evaluation of Celexa in two studies has shown that its antidepressant efficacy is maintained for periods of up to 24 weeks following 6 or 8 weeks of initial treatment (32 weeks total). In one study, patients were assigned randomly to placebo or to the same dose of Celexa (20–60 mg/day) during maintenance treatment as they had received during the acute stabilization phase, while in the other study, patients were assigned randomly to continuation of Celexa 20 or 40 mg/day, or placebo, for maintenance treatment. In the latter study, the rates of relapse to depression were similar for the two dose groups (see Clinical Trials under CLINICAL PHARMACOLOGY). Based on these limited data, it is not known whether the dose of citalopram needed to maintain euthymia is identical to the dose needed to induce remission. If adverse reactions are bothersome, a decrease in dose to 20 mg/day can be considered.
- Start with 20mg a day and give it at least a week.
- If 20mg a day isn’t doing it for you go up to 40mg a day.
- 60mg a day probably won’t work, but as long as you don’t have a history of heart problems, you can give it a shot if you want to.
- It should work for at least 8 months at whatever dosage you’re taking.
- If you’re taking 40–60mg a day you might be able to get by on 20mg a day if the side effects are a bit harsh.
I can’t find too much fault with Lundbeck’s/Forest’s recommendations. Depending on how bad your depression is and your history with Antidepressants in general or SSRIs in particular, you may want to start at 10mg a day and increase your dosage by 10mg a day until it starts working. But if you feel like whaleshit on the bottom of the ocean, start at 20mg!
Like any SSRI Celexa can take up to a month to fully work. But if it’s not doing anything for you after two or three weeks, especially if you started at 20mg and have been taking 40mg a day for at least two weeks, then it’s time to move on to something else.
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.