Celexa (Citalopram HBr): Dosage, Side Effects & More

By Jenell Decker, MD
Medically reviewed checkmarkMedically reviewed
April 13, 2020

If you’ve been diagnosed with depression or anxiety, your doctor may prescribe Celexa (citalopram HBr) to help treat you. This medication, which is classified as an antidepressant, is used to effectively help treat people with clinical depression and some anxiety disorders. Keep reading to learn more about how Celexa works, and why it may be the best course of treatment for you.

What Is Celexa?

Celexa is an antidepressant (in tablet form) that’s prescribed to treat adults who experience clinical depression and/or anxiety. Celexa is part of a group of drugs called selective serotonin reuptake inhibitors (SSRIs), which work to restore balance to the patient’s brain chemistry and, consequently, enhance his or her mood. Currently, Celexa is recommended for use only in treating adults, as the Federal Drug Administration (FDA) has not yet approved its use in children.

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Celexa Generic Name

Celexa is the brand name of the generic drug, citalopram hydrobromide (HBr). In 2003, the patent on Celexa expired and generic versions of the drug became available to consumers. Both drugs work in the exact same way—the main difference between the two is price; in general, generic drugs cost less than drugs with brand names. Plus, the generic citalopram also comes in liquid form in addition to tablet form.

Citalopram Uses

The FDA has approved citalopram (Celexa) to treat clinical depression and to be used as an off-label drug. It is mainly prescribed to treat clinical depression. According to the National Institute of Mental Health clinical depression (also referred to as major depressive disorder or MDD) is a mood disorder that is quite common yet serious. Its symptoms, which persist for most of the day, almost daily for at least two weeks, can be severe and therefore profoundly affect how one thinks and feels. People diagnosed with depression will find it difficult to handle their daily activities, such as eating, sleeping, socializing or working.

Depression may occur once or multiple times throughout your life. Symptoms may include:

  • Constantly feeling sad, hopeless, empty, or tearful
  • Feeling unusually angry, frustrated, or irritable even over inconsequential issues
  • Lack of energy for or exhaustion from even the smallest of tasks
  • Loss of interest in normal activities or hobbies
  • Change in sleep patterns, including too much sleep or insomnia
  • Change in appetite, either increased or reduced appetite and respective weight gain or loss
  • Anxiety, restlessness, or agitation
  • Feeling worthless and consumed with guilt, self-blame, or past failures
  • Difficulties concentrating, thinking, or making decisions
  • Recurrent or frequent thoughts about death, suicide, or even suicide attempts

In addition to treating clinical depression, citalopram can be used to treat other conditions, including anxiety. Someone with an anxiety disorder tends to feel constant worry or fear that doesn’t go away and may even get worse over time if not treated. These feelings can negatively impact daily activities, including job or school performance and relationships.

Additional off-label uses for citalopram include the following:

  • Obsessive-compulsive disorder
  • Bipolar disorder
  • IBS
  • Premenstrual dysphoric disorder (PMDD)
  • Post-traumatic stress disorder (PTSD)
  • Menopausal symptoms
  • Eating disorders
  • Dementia

It’s worth repeating here that citalopram is not FDA approved to treat children with depression and/or anxiety. In fact, studies have shown that citalopram doesn’t fare better than using a placebo and that other FDA-approved antidepressants, like Prozac or Lexapro, are more effective when treating children.

How Does Citalopram Work?

Citalopram is a selective serotonin reuptake inhibitor (SSRI). As the name implies, this type of drug targets serotonin, a natural chemical in our brain that’s associated with regulating mood. If serotonin levels are too low, it can lead to anxiety and/or depression. Citalopram helps combat anxiety and depression by increasing the brain’s natural levels of serotonin. Since people who experience anxiety or depression are thought to have lower levels of serotonin than others, citalopram’s ability to help stabilize levels of serotonin leads to more regulated moods, decreased feelings of anxiety, and even improved sleep. This strengthens the patient’s ability to more effectively manage anxiety and depression.

Before You Take Citalopram

Patients tend to take citalopram as part of a long-term treatment plan. Therefore, before you start taking it, it’s important to consider whether there are any external factors that could interfere with its effectiveness or bring about unwelcome side effects. Such factors could include pregnancy, interactions with other medicines, a sudden halt in taking it, or alcohol consumption. It’s also good to know ahead of time what symptoms to look for that indicate an allergic reaction to taking citalopram.

Citalopram side effects from allergies

As with all medicine, there’s a risk of having an allergic reaction to citalopram. Here are some mild and severe signs to watch for after you first start taking it.

  • Signs of a mild allergic reaction:
  • Flushed or itchy skin
  • Skin rash
  • Signs of a severe allergic reaction:
  • Swelling in your hands, feet, eyelids, or lips
  • Swelling of your mouth, tongue, or throat
  • Difficulty breathing or speaking
  • If you have experienced any of these types of allergic reactions to citalopram, call your doctor right away.

Citalopram and pregnancy

Before taking citalopram, talk with your doctor if you are either currently pregnant or planning to get pregnant. The same goes for whether you are breastfeeding or plan to, as citalopram is known to pass to the baby via breast milk. Infants who were breastfed by mothers on citalopram were reported to have side effects associated with the drug, including decreased appetite, drowsiness, and weight loss.

Citalopram interactions with other medicine

In general, it’s always important to tell your doctor about any drugs and treatments you’re taking. These include any and all prescription, non-prescription, and recreational drugs, as well as herbal remedies, and dietary or nutritional supplements. Certain drug interactions can be dangerous or even fatal to your health so it’s important to talk with your doctor before taking citalopram with anything else. With regard to citalopram, here are drugs that might cause side effects if taken together:

  • Monoamine oxidase inhibitors (MAOIs): Taking citalopram with a MAOI could be fatal.
  • Antiplatelet or non-steroidal anti-inflammatory drugs: Drugs that can cause bleeding or bruising could interact with citalopram. Therefore, avoid taking it with antiplatelet drugs, non-steroidal anti-inflammatory drugs like ibuprofen, or blood thinners like Coumadin, unless directed by your physician.
  • Aspirin: Even low-dose aspirin prescribed to prevent heart attacks or stroke, might increase a bleeding risk when used with citalopram.
  • Drugs that increase serotonin levels: If you take citalopram simultaneously with other drugs that increase serotonin levels, you may be at risk of releasing too much serotonin in your brain, resulting in serotonin syndrome. Therefore, avoid herbal supplements like St. John’s wort, ecstasy, and medicine that contains escitalopram (Lexapro) and sertraline (Zoloft), which are both similar to citalopram.
  • Drugs that cause drowsiness: Since citalopram can make you drowsy, avoid taking it with medications that can also cause drowsiness, including allergy or cough and cold medicines, antihistamines, sleeping pills, muscle relaxants, and pain relievers such as codeine.

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Citalopram and alcohol

One possible side effect of citalopram is drowsiness. Therefore, drinking alcohol while taking citalopram can make you even drowsier.

Citalopram Dosage

As with any treatment that requires medicine, it’s recommended to follow the exact citalopram dosage that your doctor prescribes. His or her prescription will depend on numerous factors, including the severity of your depression and/or anxiety, if you have any other existing medical conditions, and your age.

Citalopram is available as 10 mg, 20 mg, and 40 mg tablets that you swallow. Typically, your doctor will start by prescribing a low dosage, which can be increased and/or adjusted over time to reach the right amount for you that suits your needs and brings about the desired effect. For the most effective results, it’s important to take the dosage your doctor prescribes for you.

What happens if I miss a dose?

Even with the best of intentions, life happens. If you miss a dose of citalopram, take it as soon as you can. If it’s almost time for your next dose, skip the dose you missed and take your regular dose as scheduled. Don’t make up for your missed dose by taking two doses at once.

How long does it take for citalopram to take effect?

As each person is different and has varying degrees of symptoms, reaction times to any medicine, let alone citalopram, will differ. In general, a person may see early signs of improvement in their levels of energy, sleep, or appetite within the first one to two weeks of taking citalopram. For people who experience a depressed or anxious mood or lack of interest in daily activities, they may need up to 6-8 weeks to see and/or feel full improvement.

Can you stop citalopram cold turkey? Does citalopram cause withdrawal symptoms?

Before coming off citalopram, it’s extremely important to consult with your doctor. He or she will help you slowly taper off the dose. If you stop taking citalopram abruptly, you may develop withdrawal symptoms, which can include:

  • Headache
  • Dizziness
  • Agitation
  • Irritability
  • Anxiety
  • Confusion
  • Tiredness
  • Seizures

In most cases, these withdrawal symptoms lessen over time. However, a great way to minimize or avoid them altogether is to only discontinue citalopram under your doctor’s supervision.

Common Side Effects

As with any drug, citalopram can cause side effects in those who take it. Each person is different, and therefore their reaction to citalopram will vary. Here are some of the more common side effects associated with citalopram:

For most people, these side effects tend to disappear after a few days or weeks. If they don’t, or if they become more severe, talk with your doctor. Your pharmacist may also be able to give advice about how to handle any unwelcome side effects. Be sure to continue with your prescribed dosage until you have spoken with your doctor.

Does citalopram cause weight gain?

Any medicine containing selective serotonin reuptake inhibitors (SSRIs), which is used to treat anxiety or depression, can lead to weight gain or weight loss. This includes citalopram, which can cause either side effect. However, depending on the person, it’s also possible that citalopram will cause no changes in weight at all.

Why is weight gain or weight loss common when taking SSRIs? Such medicines can increase or decrease your appetite and affect your metabolism. Therefore, it’s not that citalopram itself will cause you to gain or lose weight, rather that it may cause you to feel hungry more or less often and affect how much you eat.

While studies have shown that citalopram does affect appetite, it also depends on the person. It’s difficult to predict from the outset whether you will gain or lose weight. The good news is that if you experience one or the other, it’s typically minor, involving only a few pounds.

Citalopram Alternatives

While citalopram is an effective drug to treat depression and anxiety, there are other brand-name antidepressant drugs that are available to help manage your symptoms as well. In fact, some alternatives may suit your needs even better. If for whatever reason citalopram isn’t alleviating your symptoms of depression or anxiety, talk to your doctor about alternative medications. Below are details about two popular FDA-approved alternatives to citalopram, including their similarities and differences. It’s worth discussing them with your doctor to figure out what may work best for you.

Celexa vs. Lexapro

Both citalopram and Lexapro (escitalopram) are SSRIs and therefore similarly and effectively treat anxiety and depression. As citalopram and Lexapro belong in the same category of drugs, both medications can cause very similar side effects. Both are typically taken once a day, though they come in different strengths and, more importantly, each one has a different recommended starting dosage and daily dosage to work up to. Therefore, it’s important to consult your doctor before taking either.

While citalopram is an off-label drug to treat anxiety, Lexapro is FDA-approved to treat adults with anxiety. Additionally, while citalopram has FDA approval to treat adults with depression, Lexapro is FDA-approved to treat depression in adults as well as in children aged 12-17 years. Citalopram and Lexapro are both available as tablets to swallow, only Lexapro is available in liquid form.

Though both citalopram and Lexapro may pose similar issues with drug interactions, Lexapro may interact with fewer drugs. It may also treat a wider variety of anxiety disorders. However, each person reacts differently to each medicine—it’s important to have your doctor help you decide which one may be best for you.

Celexa vs. Zoloft

Like citalopram, Zoloft (sertraline) is also an SSRIs and therefore similarly and effectively treats anxiety and depression. Both medications can cause very similar side effects and are typically taken once a day. They each come in different strengths and, more importantly, your doctor needs to determine what starting dosage is right for you and what daily dosage you should gradually work up to. Therefore, it’s important to consult your doctor before taking either.

In addition to FDA approval to treat depression, Zoloft also has FDA approval to treat other disorders, including social anxiety disorder, panic disorder, and PTSD, among others, while citalopram is an off-label drug to treat these conditions. Similar to Lexapro, Zoloft is offered in both tablet and liquid form. Citalopram is currently only available as a tablet.

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When to See a Doctor

Though we listed common side effects that can occur when taking citalopram, there are also more concerning ones that could occur in rare cases. You should see your doctor immediately if you suspect you may have serotonin syndrome. Since citalopram is a SSRI, it increases serotonin levels in your brain. Sometimes, if you’ve increased dosages or are taking a new medication, you can experience overly high levels of serotonin to be released into your body. While mild forms of serotonin syndrome may disappear within 24 hours of stopping the medication(s) that cause the symptoms, if severe serotonin syndrome is left untreated, it can be fatal. You may have serotonin syndrome if you’re experiencing:

  • Diarrhea
  • Cough
  • Headache
  • Confusion
  • Vision changes such as dilated pupils, tunnel vision, blurred vision, seeing halos around lights, or eye swelling or pain
  • Easy bruising
  • Chills or shivering
  • Irritability or restlessness
  • Severe weakness and loss of coordination
  • Stiff and rigid muscles with tremors
  • Fever
  • Sweating

Seek emergency medical attention if you experience any of the following symptoms:

  • Seizure
  • Hallucinations
  • Fast or uneven heartbeats
  • Unconsciousness

In addition to serotonin syndrome, the following side effects and symptoms, while not common, are worth knowing about and consulting your doctor over:

  • Thoughts of suicide or self-harm
  • Worsening anxiety or depression
  • Increased irritability or restlessness
  • Feeling aggressive
  • Experiencing withdrawal symptoms after you stop taking citalopram
  • Headache or dizziness
  • Feeling weak
  • Fainting
  • Mania or hypomania (racing thoughts)
  • Trouble sleeping
  • Increased bruising
  • Sweating or high fever

If you’re having a mental health emergency, call 911 or go to the nearest emergency room. You can also get free 24/7 support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.

The following signs may be serious symptoms that require emergency medical care. Additionally, if you suspect an overdose, seek emergency medical attention (by calling 911), or call the poison help line at 1-800-222-1222. Serious side effects or symptoms of an overdose can include:

  • Seizures
  • Dizziness
  • Tremors
  • Drowsiness
  • Palpitations
  • Confusion
  • Changes in heart rate
  • Changes in blood pressure or eyesight
  • Bleeding, whether nose bleeds or blood in urine or stool
  • Unconsciousness

Before you start taking citalopram, be sure to know what potential side effects or allergic reactions may look like. And, after you start taking citalopram, if you experience any feeling or behavior that seems off to you, consult with your doctor immediately. Remember, citalopram has been prescribed to help you feel better, not worse.

When to Seek Emergency Care

If you ever experience thoughts, intent, and/or plans to hurt yourself, take the following immediate steps to get through these challenging periods as safely as possible:

  1. Call 988, the national Suicide and Crisis Lifeline
  2. Go to your nearest emergency room if you believe that you are in immediate danger of killing yourself.
  3. If you are not in immediate risk of suicide but are having suicidal thoughts, call or text 988, a 24-hour suicide prevention line that can be called from anywhere in the U.S.

Visit Suicide Prevention Lifeline here

How K Health Can Help

Think you might need a prescription for Celexa (citalopram)?

K Health has clinicians standing by 24/7 to evaluate your symptoms and determine if citalopram is right for you.

Get started with our free assessment, which will tell you in minutes if treatment could be a good fit. If yes, we’ll connect you right to a clinician who can prescribe medication and have it shipped right to your door.

Jenell Decker, MD

Dr. Decker is a family medicine physician who completed her residency at East Carolina University School of Medicine. She graduated medical school from Marshall University School of Medicine.

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