Can citalopram (Selective Serotonin Reuptake Inhibitor) be used to treat anxiety?

From the Guidelines

Citalopram can be used to treat anxiety, but it is crucial to carefully consider the potential risks and benefits, particularly the risk of QT prolongation at daily doses exceeding 40 mg/d, as noted in the 2020 clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. When using citalopram for anxiety, it's essential to start with a low dose and gradually increase it as needed and tolerated, with a maximum recommended dose of 40mg daily.

• The typical starting dose is 10mg once daily, which can be gradually increased to 20-40mg daily if needed.
• Improvement may begin within 1-2 weeks, but full therapeutic effects often take 4-6 weeks to develop.
• Common side effects include nausea, dry mouth, increased sweating, drowsiness, and sexual dysfunction, which are usually temporary.
• Citalopram works by increasing serotonin levels in the brain, which helps regulate mood and anxiety.
• Patients should take it at the same time each day and not stop abruptly as this can cause withdrawal symptoms, including dizziness, fatigue, lethargy, and anxiety 1. It's also important to discuss any other medications you're taking with your doctor before starting citalopram to avoid potential drug interactions, particularly with MAOIs or other serotonergic drugs, which could cause serotonin syndrome 1.
• Medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications like citalopram for anxiety.
• A conservative medication trial for mild to moderate anxiety presentations may entail increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals when prescribing shorter half-life SSRIs like citalopram 1.

From the FDA Drug Label

Citalopram tablets is a prescription medicine used to treat depression. Citalopram tablets is also used to treat: Major Depressive Disorder (MDD)

Citalopram can be used to treat anxiety as it is mentioned that anxiety is one of the symptoms that should be watched for when taking the medication, and also stopping the medication can cause anxiety. However, the primary use of citalopram is for treating depression.

• The label does mention anxiety or panic attacks as symptoms to watch for, but it does not explicitly state that citalopram is used to treat anxiety.
• It is implied that citalopram may have some effect on anxiety since it is a Selective Serotonin Reuptake Inhibitor (SSRI), and SSRIs are sometimes used to treat anxiety disorders.
• However, without a direct statement, it cannot be concluded that citalopram is intended to treat anxiety 2.

From the Research

Citalopram as an Anxiolytic

Citalopram, a Selective Serotonin Reuptake Inhibitor (SSRI), has been studied for its potential in treating anxiety disorders. The evidence suggests that citalopram can be effective in reducing anxiety symptoms in various conditions, including generalized anxiety disorder (GAD) and social anxiety disorder.

Efficacy in Generalized Anxiety Disorder (GAD)

• A study published in 2002 found that citalopram was effective in treating GAD, with 13 patients experiencing full or partial improvement in symptoms after 12 weeks of treatment 3.
• The study used the Hamilton Rating Scale for Anxiety (HAM-A) and found a significant decrease in mean baseline scores from 22.2 to 6.2 after citalopram treatment.

Efficacy in Social Anxiety Disorder

• A study published in 2003 found that citalopram was effective in treating social anxiety disorder with comorbid major depression, with response rates of 66.7% for social anxiety disorder and 76.2% for depression 4.
• The study found that depression symptoms responded more rapidly and completely than social anxiety symptoms, and that improvement in social anxiety disorder symptoms lagged behind improvement in depression.

Mechanism of Action

• A study published in 2007 found that a single dose of citalopram increased fear recognition in healthy subjects, suggesting an effect of acute SSRI treatment on the processing of anxiety-related stimuli 5.
• Another study published in 1997 found that citalopram treatment reduced the intensity and number of panic symptoms in patients with panic disorder, without modifying cardiovascular and neuroendocrine responses to cholecystokinin tetrapeptide challenge 6.

Comparison with Other SSRIs

• A study published in 2008 found that escitalopram, the S-enantiomer of citalopram, was at least as effective as other SSRIs in treating depression and anxiety disorders, and had a faster onset of action and better tolerability 7.