Citalopram Side Effects
Citalopram (Celexa) commonly causes nausea, sweating, tremors, nervousness, insomnia or somnolence, dizziness, and various gastrointestinal and sexual disturbances, with approximately 63% of patients experiencing at least one adverse effect during treatment. 1
Common Side Effects
Citalopram's side effect profile is well-documented, with the following common adverse effects:
Gastrointestinal effects:
- Nausea (most frequent, occurring in about 20% of patients) 2
- Diarrhea
- Dry mouth
- Vomiting (can accompany nausea)
- Decreased appetite
Neurological effects:
- Somnolence (drowsiness)
- Insomnia
- Dizziness
- Tremor
- Headache
- Paresthesia (abnormal sensations)
Other common effects:
- Increased sweating (15-18% of patients) 2
- Sexual dysfunction (decreased libido, ejaculation failure)
- Fatigue
- Anxiety
Serious Side Effects
While citalopram is generally well-tolerated, several serious side effects require immediate medical attention:
Cardiovascular Effects
- QT prolongation: Citalopram can cause dose-dependent QT interval prolongation, which may lead to potentially fatal arrhythmias including Torsade de Pointes 3
- FDA warning: Maximum recommended dose is 40 mg/day for adults under 60 years and 20 mg/day for adults over 60 years due to QT prolongation risk 3
Neuropsychiatric Effects
- Suicidality: Increased risk of suicidal thoughts or behaviors, particularly in children, teenagers, and young adults within the first few months of treatment 3
- Serotonin syndrome: A potentially life-threatening condition characterized by:
- Agitation, hallucinations, coma
- Coordination problems or muscle twitching
- Racing heartbeat, high or low blood pressure
- Sweating or fever
- Nausea, vomiting, diarrhea
- Muscle rigidity 3
Other Serious Concerns
- Abnormal bleeding: Increased risk, especially when combined with NSAIDs, aspirin, or warfarin 3
- Seizures: Citalopram may lower the seizure threshold 3
- Hyponatremia: Low sodium levels, more common in elderly patients 1
- Severe allergic reactions: Including swelling, rash, difficulty breathing 3
Special Populations
Elderly Patients
- More susceptible to hyponatremia (0.5-12% in older adults) 1
- Lower maximum dose recommended (20 mg/day) due to increased risk of QT prolongation 3
- Generally well-tolerated compared to other antidepressants 1
Pregnant Women
- SSRIs including citalopram may be associated with:
Children and Adolescents
- Increased risk of suicidality 3
- Additional side effects may include:
- Increased thirst
- Abnormal increase in muscle movement
- Nose bleeds
- Urinating more often
- Heavy menstrual periods
- Possible effects on growth rate and weight 3
Discontinuation Symptoms
Abrupt discontinuation of citalopram may lead to withdrawal symptoms including:
- Anxiety and irritability
- Mood changes
- Restlessness or sleep disturbances
- Headache and dizziness
- Electric shock-like sensations
- Sweating, nausea, confusion 3
Overdose Risk
In overdose, citalopram can cause:
- Seizures
- QT prolongation and cardiac arrhythmias
- Serotonin syndrome
- In severe cases, death (though most patients recover from overdose) 4
Monitoring Recommendations
- Watch for signs of suicidality, particularly in the first few months of treatment
- Monitor for serotonin syndrome when starting treatment or increasing dose
- Be alert for signs of abnormal bleeding, especially if taking blood thinners
- Watch for signs of hyponatremia, particularly in elderly patients
- Discontinue gradually to minimize withdrawal symptoms
Citalopram is generally well-tolerated compared to tricyclic antidepressants, with minimal anticholinergic effects and relatively nonsedating properties 5. Most side effects are mild to moderate in severity and often transient, typically improving within the first few weeks of treatment.