Can citalopram (Selective Serotonin Reuptake Inhibitor) cause frequent urination?

Citalopram and Frequent Urination

Yes, citalopram can cause frequent urination in some patients, with research showing SSRIs like citalopram are associated with an increased risk of urinary incontinence. 1

Mechanism and Evidence

• Selective Serotonin Reuptake Inhibitors (SSRIs) like citalopram can affect urinary function through their impact on serotonergic pathways that regulate bladder and urethral function 1
• A retrospective study found that SSRI use was associated with a 61% increased risk of developing urinary incontinence (adjusted relative risk 1.61,95% CI 1.42-1.82) 1
• Approximately 15 out of 1000 patients treated with an SSRI per year developed urinary incontinence, with elderly patients being at higher risk 1

Urodynamic Effects of Citalopram

• Interestingly, a recent randomized controlled trial in healthy women found that citalopram actually slightly increased urethral pressure compared to placebo, suggesting a complex relationship between the medication and urinary function 2
• The study showed citalopram increased opening urethral pressure by 6.6 cmH2O in resting condition (p=0.048) and 7.1 cmH2O in squeezing condition (p=0.01) 2
• This contradicts epidemiological findings and suggests individual responses may vary significantly 2

Risk Factors for Urinary Side Effects

• Elderly patients appear to be at significantly higher risk, with up to 60 extra cases of urinary incontinence per 1000 elderly patients treated per year 1
• Patients taking other medications that affect urinary function may experience additive effects 3
• Patients with pre-existing lower urinary tract symptoms may be more susceptible to these effects 1

Management Considerations

• If frequent urination develops after starting citalopram:
  • Evaluate for other causes of urinary symptoms 3
  • Consider dose reduction if symptoms are troublesome 3
  • In severe cases, switching to a different antidepressant may be necessary 4
  • Document the adverse effect appropriately 3

Other Important Side Effects of Citalopram

• Common side effects include nausea, sleepiness, weakness, dizziness, anxiety, trouble sleeping, sexual problems, sweating, dry mouth, constipation, and diarrhea 3
• More serious side effects include:
  • Serotonin syndrome (high fever, muscle spasms, confusion) 3
  • QT prolongation at doses exceeding 40mg/day 4
  • Increased risk of bleeding, especially when combined with NSAIDs 4

Conclusion

While citalopram can cause frequent urination in some patients, individual responses vary. The medication's effect on urinary function appears to be complex, with some studies showing increased urethral pressure while epidemiological data shows increased incidence of urinary incontinence. Monitoring for this side effect is important, especially in elderly patients who appear to be at higher risk.