What is the use of Citalopram (Celexa)?

From the Guidelines

Citalopram is a commonly prescribed antidepressant medication that belongs to the selective serotonin reuptake inhibitor (SSRI) class, primarily used to treat major depressive disorder, panic disorder, anxiety, and other mood disorders. The typical starting dose for adults is 20mg once daily, which can be increased to a maximum of 40mg daily if needed after at least one week 1. For elderly patients or those with liver impairment, lower doses are recommended, usually starting at 10mg daily. Citalopram works by increasing serotonin levels in the brain, a neurotransmitter that helps regulate mood, emotion, and sleep. Patients should be aware that the full therapeutic effect may take 2-4 weeks to develop, so it's essential to continue taking the medication even if benefits aren't immediately noticeable.

Key Considerations

• Citalopram carries a black box warning about increased risk of suicidal thoughts in young adults and adolescents, particularly during the first few weeks of treatment 1.
• It should not be combined with monoamine oxidase inhibitors (MAOIs) and requires careful monitoring when used with other medications that affect serotonin levels to avoid serotonin syndrome, a potentially dangerous condition.
• The medication has been associated with a risk of QT-interval prolongation, and the maximum recommended dose is limited, especially for patients older than 60 years of age 2.
• Common side effects include nausea, dry mouth, increased sweating, drowsiness, insomnia, and sexual dysfunction, which often improve over time.

Treatment Duration

• Treatment for a first episode of major depression should last at least four months, and patients with recurrent depression may benefit from prolonged treatment 1.
• Clinicians should assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis, beginning within 1 to 2 weeks of initiation of therapy, and modify treatment if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder 3.

Patient Selection

• For treatment-naive patients, all second-generation antidepressants, including citalopram, are equally effective, and medication choice should be based on patient preferences, with adverse effect profiles, cost, and dosing frequency taken into consideration 1.
• Preferred agents for older patients with depression include citalopram, escitalopram, sertraline, mirtazapine, venlafaxine, and bupropion, while paroxetine and fluoxetine should generally be avoided due to higher rates of adverse effects in older adults 1.

From the FDA Drug Label

Citalopram tablets, USP (citalopram Hbr) is indicated for the treatment of depression. Citalopram tablets is a prescription medicine used to treat depression. Citalopram tablets is also used to treat: Major Depressive Disorder (MDD)

The use of Citalopram (Celexa) is for the treatment of:

• Depression
• Major Depressive Disorder (MDD) 4 5 6

From the Research

Use of Citalopram (Celexa)

• Citalopram is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of major depressive disorder 7, 8, 9.
• It is approved for use in 69 countries and has been shown to be effective in treating moderate-to-severe depression 7.
• The recommended dose of citalopram is 20 mg per day, with the option of increasing the dose in non-responders, particularly those with more severe depression 9.
• Citalopram has been compared to other antidepressants, including sertraline, bupropion, and tricyclic antidepressants, and has been found to be effective in treating depression with minimal risk of adverse cardiovascular effects 10.
• The active enantiomer of citalopram, escitalopram, has also been studied and has been found to have a dose-response relationship in severely depressed patients, with 20 mg being superior to 40 mg citalopram after 8 weeks of treatment 11.

Efficacy of Citalopram

• Citalopram has been shown to be significantly more effective than placebo in treating moderate-to-severe major depression, especially symptoms of depressed mood and melancholia 7.
• Patients who received 40 mg/day and 60 mg/day of citalopram showed significantly greater improvement than placebo on all efficacy measures 7.
• Citalopram has also been found to be well tolerated, with only 15% of patients discontinuing due to adverse events 7.

Safety of Citalopram

• Citalopram has been found to have a low incidence of anxiety, agitation, and nervousness, and is generally well tolerated 7.
• The most common side effects associated with citalopram treatment are nausea, dry mouth, somnolence, insomnia, and increased sweating 7.
• Citalopram has been found to have no significant effect on QTc interval, a measure of heart rhythm, at therapeutic doses 10.