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), including citalopram, have been associated with urinary side effects through their impact on serotonergic pathways that influence bladder 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
• Interestingly, a randomized controlled study in healthy women found that citalopram actually slightly increased urethral pressure, suggesting complex effects on urinary function 2

Risk Factors

• Elderly patients are at significantly higher risk, with up to 60 extra cases of urinary incontinence per 1000 patients per year 1
• Patients taking other medications that affect urinary function may experience compounded effects 3
• Dosage may play a role, as higher doses of citalopram could potentially increase the risk of urinary side effects 3

Management Considerations

• If a patient develops frequent urination while on citalopram:
  • Evaluate for other causes of urinary symptoms 4
  • Consider whether the benefits of citalopram outweigh this side effect 3
  • If urinary symptoms are significantly impacting quality of life, consider switching to a different antidepressant with potentially fewer urinary side effects 4

Other Important Side Effects of Citalopram

• Common side effects include nausea, sleepiness, weakness, dizziness, anxiety, sexual problems, sweating, and dry mouth 3
• More serious potential side effects include:
  • QT prolongation at doses exceeding 40 mg/day 4
  • Serotonin syndrome when combined with other serotonergic medications 4, 5
  • Risk of suicidal ideation, particularly in adolescents 4
  • Rare cases of priapism (prolonged erection) have been reported, especially with overdose 6

Clinical Implications

• When prescribing citalopram, inform patients about the potential for urinary symptoms 3
• Monitor elderly patients more closely for urinary side effects 1
• Consider starting at lower doses in patients with pre-existing urinary issues 3
• Avoid combining with other medications that might exacerbate urinary symptoms when possible 3

Remember that while urinary symptoms can occur with citalopram, they must be weighed against the therapeutic benefits in treating depression, anxiety, and other conditions for which citalopram is prescribed 4.