Serotonin is a neurochemical that produces an inhibitory effect on the CNS. Drug manufacturers promote the idea that SSRI drugs restore balance by raising the levels of serotonin. The proposed theory is that more Serotonin in the system will help lift depression. There may be a grain of truth in this idea, though ultimately, such a statement could be considered at best, incomplete, or even misleading.
For a period of time, the artificially suspended serotonin will stay trapped in the synapses and will have a temporary inhibitory effect (much like the way a stimulant such as cocaine does) which can lead to a worsening depression and other undesirable side effects likely accompanied by anxiety and emotional impulsivity.
Celexa (citalopram) is most often prescribed to lift depression, increase energy and enhance feelings of well-being.
It is also given to patients suffering from a surprising number of other conditions, such as:
It is important to note that Celexa/citalopram is often prescribed “off-label,” meaning that the drug can be prescribed to treat symptoms of conditions for which the Food and Drug Administration (FDA) has not approved the use of the drug. Mental health care specialists and physicians can allow the use of the medication to treat these “off-label” conditions if they feel justified in their reason for prescribing.
Celexa/citalopram is often used to treat depression in adults, and accompanying symptoms of depression including appetite changes, sleep disturbances, fatigue, lack of concentration, psychomotor symptoms, and chronic negative thoughts and feelings (such as guilt, shame, thoughts about death or suicide).
Celexa/citalopram is not recommended for patients suffering from heart conditions (long QT syndrome, slow heartbeat, or irregular heartbeat), magnesium deficiency (or low levels of magnesium), potassium deficiency (low potassium), high blood pressure, stroke, kidney disease, or liver disease.
Citalopram is sold under various drug manufacturers’ brand names in different countries including:
The full name for this SSRI drug is citalopram hydrobromide, sometimes written as citalopram HBr which describes its unique chemical structure. Hydrobromide refers to a chemist’s method of combining and binding elements together and is, in part, how the drug is manufactured in the lab.
The way the drug is structured is what sets it apart from all other antidepressant drugs. Because of its doubled atomic structure, it would be correct to refer to citalopram as a “bicyclic” rather than a “tricyclic” antidepressant.
Celexa should not be confused with certain drugs with a similar sounding or “look-alike” name, such as Celebrex, Cerebyx, Xanax or Lexapro. The Institute for Safe Medication Practices, (ISMP), recommends that a prescription label show both a drug’s brand name and generic name, and also the purpose for the drug, so as to reduce the risk of harm or accidental injury. (2)
Being a Selective Serotonin Reuptake Inhibitor (SSRI) class drug, physicians may also prescribe other SSRI drugs as an alternative to Celexa (citalopram). This may include the following SSRIs:
Depending on the diagnosis, and the condition present, physicians may also prescribe Selective Norepinephrine Reuptake Inhibitor (SNRI) class drugs. A newer class of drugs, SNRIs, blocks both the reuptake of serotonin and the reuptake of norepinephrine. Because of the similar chemical mechanisms of action, physicians may prescribe the following SNRIs as an alternative to Citalopram/Celexa:
The most commonly reported side effects of Celexa range from moderate to severe and include:
Some patients may experience unpredictable changes in mood and behavior. Such include a mix of both mental and physical manifestations. These may include panic attacks, increased anxiety, impulsive or aggressive feelings. Also reported are negative emotional reactions like irritability, hostility, agitation, or feeling like hurting oneself. Physical side effects may present as physical hyperactivity, muscle weakness, and a particularly troubling sensation of restlessness known as akathisia, from the Greek root, “akathemi”, which means to never sit down.
Citalopram is linked with some cases of akathisia and Serotonin Syndrome. These are severe reactions that include seizures, motor control dysfunction, respiratory impairment, potentially fatal rise in body temperature, tremors, blood pressure fluctuations, etc., and must be treated immediately due to their life-threatening implications. See below for a list of signs to watch for.
Celexa is also linked to a risk of upper gastrointestinal bleeding as well as abnormal bleeding in other areas of the body, and these are thought to be related to the adverse effect the drug can have on coagulation of the blood. (1)
Mania is another concerning side effect that occurred in .2% of 1073 patients taking part in Celexa drug trials, and in 0% of those taking placebo in the trial. (1)
A person taking Celexa may find the side effects of the drug overshadow any perceived benefits of continuing the medication. A decision may be made to stop taking the drug. Especially without proper guidance and preparation steps for tapering safely, the person may suffer symptoms of Citalopram withdrawal. These can be moderate to severe, and may include:
Once the decision has been made to stop taking Celexa, a person is likely to experience a new set of symptoms which are collectively referred to as withdrawal symptoms. Unfortunately, if adequate preparations have not been put in place, and perhaps expectations have not been clearly delineated, these may be severe enough to overwhelm a person and cause them to give up and resume their prescription.
With adequate preparatory steps in place, and educating the person as to what to expect and how to successfully mitigate the withdrawals, it is possible for a person to experience a surprisingly mild withdrawal from antidepressant drugs.
WARNING: The FDA and other regulatory bodies warn against a sudden cessation of antidepressants due to the tremendous shock this can cause to the body. What is recommended wherever possible is a gradual reduction as opposed to sudden cessation, or quitting Celexa “cold turkey.”
There is a troubling side effect of certain serotonin-targeted or serotonergic medications that can result in a build-up of too much serotonin. Celexa is one of the prescription medications which can result in what is termed “Serotonin Syndrome”.
This is a potentially life-threatening condition that requires immediate medical intervention. The remedy for this syndrome is, in part, to discontinue the medication, but this must be done under strict monitoring in a medical facility that can provide immediate emergency treatment including the use of serotonin blockers, intravenous hydration, safe sedation, blood pressure stabilization, and other forms of life support as needed.
The following is a list of some of the signs of Serotonin Syndrome that should be known. Should any of these symptoms appear, even if they seem relatively mild, do not delay but arrange immediate transport to hospital. If you are not able to arrange transport, call 911 immediately.
Here are the signs to watch for:
Once the medication has been withdrawn, and with proper medical intervention in place, many of these reactions will usually gradually abate over a number of days. However, some of these symptoms may persist for quite some time even after the medication has been stopped, requiring a lengthier period of medical treatment and hospitalization.
Questions relating to Celexa or citalopram are best directed to one’s prescribing physician, as patient history and health matters can differ greatly from one person to another. However, here are some of the most common questions that arise. It is always safest to seek medical advice from your prime caregiver whenever possible.
At the Alternative to Meds Center, we take a scientific and exacting approach to coming off SSRI medications. Each person must be assessed and monitored individually, as there are many factors that can substantially differ from person to person.
To accommodate these unique differences, we use lab testing to determine the most pertinent areas that must be individually addressed to provide a successful and mild cessation experience.
We use holistic measures to ensure a comfortable and safe withdrawal, whereby the whole process is overseen step by step. Clients are carefully monitored by a team of dedicated specialists, physicians, therapists and other caregivers to enable a thorough, gentle and health-restoring result.
We can provide much more detailed information on request, concerning all of the techniques and therapies used in our program, and how each one plays a significant role in the entire process. Our program is dedicated to helping you regain your health using effective treatments for gentle and comfortable Celexa (citalopram) withdrawal.
Dr Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona. He holds a Bachelor’s of Science degree with a major in biology and minors in chemistry and philosophy. He graduated Creighton University School of Medicine with a Doctor of Medicine. Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.