Citalopram

Listlessness, bad mood and no friends in everyday activities are typical of inhibited apathetic  depression . The antidepressant citalopram can help to lighten the mood and find new motivation. It has been prescribed since the mid-1980s and has been one of the most widely used antidepressants since the 1990s.

SSRIs and citalopram

According to the current state of research, a lack of certain messenger substances in the brain is primarily responsible for the moodiness and lack of joy that one feels during depression. It lacks both norepinephrine, an activating messenger, and  serotonin , which is primarily responsible for mood. Citalopram intervenes at this point.

Citalopram belongs to the group of selective serotonin reuptake inhibitors, the SSRIs. Characteristic of the SSRI is their activating and mood-enhancing effect. This is in contrast to other antidepressants such as  mirtazapine which tend to be more depressant as well as sedative. The increase in drive is desirable, but there is a risk that this will result in inner unrest. Therefore, patients or relatives must be very vigilant, especially at the beginning of therapy, and go to the doctor immediately as soon as they notice a worsening of the depression while taking the new drugs.

Increased drive and mood improvement

However, the drive increase of citalopram and especially this entire group of drugs also harbors another side effect as a danger. The increased drive occurs shortly after the start of intake, while the mood improvement and thus the antidepressant effect only become fully effective after three to four weeks. Due to this delay, citalopram, but also the other SSRIs, can increase the risk of suicide in the first few weeks.

The other drugs in the SSRI class –  fluoxetine , fluvoxamine, paroxetine,  sertraline  – work very similarly to citalopram. The advantage of citalopram over other SSRIs is that a special liver enzyme (cytochrome P450) is less blocked when it is broken down. These enzymes are important because they break down not only antidepressants but many other drugs as well. If they are blocked by SSRIs, the breakdown of other drugs may be delayed. In the worst case, this can lead to drug poisoning as a side effect.

effect of citalopram

SSRIs selectively block the transporter for the reuptake of serotonin into nerve cells. As a result, citalopram increases the concentration and effect of serotonin on the special serotonin receptors on the nerves in the brain and thus leads to an improved mood. In contrast to other antidepressants, such as tricyclic antidepressants, citalopram has hardly any effect on receptors in the brain and nervous system. Therefore, citalopram has a lower spectrum of side effects.

citalopram side effects

The most significant side effects of citalopram and the SSRIs in general are  nausea  and vomiting in particular. Insomnia and headaches are also relatively common side effects of citalopram. Rarely, manic reactions, dizziness and inner restlessness occur as side effects. Delayed ejaculation has also been reported in some cases.

The side effects of SSRIs are generally lower than those of tricyclic antidepressants thanks to their specific point of attack on the serotonin receptor. Since they bind less to histamine receptors, weight gain is less likely. Like weight gain, side effects such as dry mouth,  tachycardia , low blood pressure, blurred vision and glaucoma attacks should hardly occur in contrast to therapy with tricyclic antidepressants.

Interactions with citalopram

When citalopram is taken at the same time as other psychotropic drugs, the breakdown of these drugs in the body is usually slower. It may therefore be necessary to adjust the dose of the individual medications. Substances that remain in the body at increased levels when combined with citalopram include tricyclic antidepressants, haloperidol, phenytoin, carbamazepine, diazepam and lithium salts.

A combination of citalopram and other SSRIs with monoamine oxidase inhibitors (MAOIs) is even contraindicated. Taking both antidepressants at the same time can lead to a mutual intensification of the effect. This would lead to an excessively increased and difficult to control serotonin level in the brain. This is accompanied by the risk of seizures and poisoning, which can ultimately lead to serotonin syndrome. This poisoning causes nausea, vomiting,  flushing , confusion, involuntary shaking ( tremor ), and convulsions.

Notes on the drug citalopram

• Effective antidepressant
• Discuss application and dosage with a psychiatrist in any case
• If individual symptoms improve, do not discontinue on your own
• Fewer side effects than other antidepressants
• Contraindication is the simultaneous intake of MAO inhibitors, another class of antidepressants.
• A relative contraindication is simultaneous lithium therapy
• Not suitable for pregnant or breastfeeding women