1. About citalopram
Citalopram is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI).
Citalopram helps many people recover from depression, and has fewer unwanted side effects than older antidepressants.
Citalopram is available on prescription as tablets and liquid drops that you put in a drink of water.
2. Key facts
- It usually takes 4 to 6 weeks for citalopram to work.
- Side effects such as tiredness, dry mouth and sweating are common. They're usually mild and go away after a couple of weeks.
- If you and your doctor decide to take you off citalopram, your doctor may recommend reducing your dose gradually to help prevent extra side effects.
- You can drink alcohol while taking citalopram, but it may make you feel sleepy.
- Do not take St John's wort while you're taking citalopram. It will increase your risk of side effects.
3. Who can and cannot take citalopram
Citalopram can be taken by adults and children over the age of 12 years.
Check with your doctor before starting citalopram if you:
- have had an allergic reaction to citalopram or any other medicines in the past
- have a heart problem – citalopram can speed up or change your heartbeat
- have ever taken any other medicines for depression – some rarely used antidepressants can interact with citalopram to cause very high blood pressure, even when they have been stopped for a few weeks
- are trying to become pregnant, already pregnant or breastfeeding
- have an eye condition called glaucoma – citalopram can increase the pressure in your eye
- have epilepsy or are having electroconvulsive treatment – citalopram may increase your risk of having a seizure
If you have diabetes, citalopram can make it more difficult to keep your blood sugar stable.
Monitor your blood sugar more often for the first few weeks of treatment with citalopram and adjust your diabetes treatment if necessary.
4. How and when to take citalopram
Take citalopram once a day. You can take it with or without food.
You can take citalopram at any time of day, as long as you stick to the same time every day.
If you have trouble sleeping, it's best to take it in the morning.
Citalopram tablets come in different strengths ranging from 10mg to 40mg.
The usual dose of citalopram is 20mg a day in adults. But it may be started at a lower dose and increased to a maximum dose of 40mg a day.
If you're over 65, or have liver problems, the maximum recommended dose is 20mg a day.
The usual dose of citalopram in children is 10mg a day, but this may be increased to 40mg a day.
With liquid drops of citalopram, 4 drops is equivalent to a 10mg tablet.
What if I forget to take it?
If you occasionally forget to take a dose, do not worry. Take your next dose the next day at the usual time. Never take 2 doses at the same time to make up for a forgotten one.
If you forget doses often, it may help to set an alarm to remind you.
You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
The amount of citalopram that can lead to an overdose varies from person to person.
Urgent advice: Call your doctor straight away if:
You have taken too much citalopram and have symptoms such as:
- being sick (vomiting)
- feeling sleepy
- fast heart rate
- fits or seizures
If you need to go to A&E, do not drive yourself – get someone else to drive you or call for an ambulance.
Take the citalopram packet, or the leaflet inside it, plus any remaining medicine with you.
5. Side effects
Like all medicines, citalopram can cause side effects in some people, but many people have no side effects or only minor ones.
Some of the common side effects of citalopram will gradually improve as your body gets used to it.
Some people who take citalopram for panic attacks find their anxiety gets worse during the first few weeks of treatment.
This usually wears off after a few weeks, but speak to your doctor if it bothers you. A lower dose may help reduce your symptoms.
Common side effects
Common side effects happen in more than 1 in 100 people. Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or do not go away:
- dry mouth
- sweating a lot
- being unable to sleep
- feeling sleepy
- feeling tired or weak
Serious side effects
Serious side effects are rare and happen in less than 1 in 1,000 people.
Go to A&E immediately if you get:
- chest pain or pressure or shortness of breath
- severe dizziness or passing out
- painful erections that last longer than 4 hours – this may happen even when you're not having sex
- any bleeding that's very bad or you cannot stop, such as cuts or nosebleeds that do not stop within 10 minutes
Call a doctor straight away if you get:
- thoughts about harming yourself or ending your life
- constant headaches, long-lasting confusion or weakness, or frequent muscle cramps – these can all be signs of low sodium levels in your blood (in severe cases low sodium can lead to fits or seizures)
- vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo – these can be signs of bleeding from the gut
- bleeding from the gums or bruises that appear without a reason or that get bigger
Book an appointment with your doctor if you get:
- changes in your periods, such as heavy bleeding, spotting or bleeding between periods
- weight gain or weight loss without trying
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to citalopram.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of citalopram. For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with side effects of citalopram
What to do about:
- dry mouth – chew sugar-free gum or sugar-free sweets
- sweating a lot – try wearing loose clothing, use a strong anti-perspirant and keep cool using a fan if possible. If this does not help, you may need to try a different type of antidepressant.
- being unable to sleep – take citalopram first thing in the morning
- feeling sleepy – take citalopram in the evening and cut down the amount of alcohol you drink. Do not drive or use tools or machinery if you're feeling sleepy. If this does not help, talk to your doctor.
- feeling tired or weak – do not drive or use tools or machinery if you're feeling tired. Cut down the amount of alcohol you drink as it can make you feel worse.
7. Pregnancy and breastfeeding
Citalopram and pregnancy
It's important for you and your baby that you stay well during your pregnancy.
If you become pregnant while taking citalopram, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
Citalopram has been linked to a very small increased risk of problems for your unborn baby.
But if your depression is not treated during pregnancy, this can also increase the chance of problems.
You may need to take citalopram during pregnancy if you need it to remain well.
Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.
Citalopram and breastfeeding
If your doctor or health visitor says your baby is healthy, citalopram can be used during breastfeeding.
Citalopram passes into breast milk in small amounts, and has been linked with side effects in very few breastfed babies.
It's important to continue taking citalopram to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby is not feeding as well as usual or seems unusually sleepy, or you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
For more information about how citalopram can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPs) website.
8. Cautions with other medicines
Some medicines and citalopram can interfere with each other and increase the chances of you having side effects.
Tell your doctor if you're taking these medicines before you start citalopram:
- any medicines that affect your heartbeat – citalopram can speed up or change your heartbeat
- any other medicines for depression – some rarely used antidepressants can interact with citalopram to cause very high blood pressure even when they have been stopped for a few weeks
Mixing citalopram with herbal remedies and supplements
Do not take St John's wort, the herbal remedy for depression, while you're being treated with citalopram as this will increase your risk of side effects.
For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about citalopram
How does citalopram work?
Citalopram is one of a group of antidepressants called selective serotonin reuptake inhibitors, or SSRIs.
These medicines are thought to work by increasing the levels of a mood-enhancing chemical called serotonin in the brain.
When will I feel better?
You may not notice much improvement in your symptoms for 1 or 2 weeks until citalopram begins to take effect.
It usually takes between 4 and 6 weeks before you feel the full benefits.
Do not stop taking citalopram after 1 or 2 weeks just because you feel it is not helping your symptoms.
Give the medicine at least 6 weeks to work.
How will it make me feel?
Antidepressants like citalopram help to jump start your mood so you feel better.
You may notice that you sleep better and get on with people more easily because you're less anxious.
You'll hopefully take little things that used to worry you in your stride.
Citalopram w ill not change your personality or make you feel euphorically happy. It'll simply help you feel like yourself again.
Do not expect to feel better overnight, though. Some people feel worse during the first few weeks of treatment before they begin to feel better.
How long will I take it for?
Once you're feeling better it's likely that you'll continue to take citalopram for several more months to prevent the symptoms returning.
You'll need to discuss with your doctor the pros and cons of continuing to take citalopram for longer than a few months.
The decision will depend on the type and severity of your symptoms, whether it's a one-off problem or one that keeps coming back, how well citalopram works for you, and whether you have had any bad side effects.
Is it safe to take it for a long time?
For most people, citalopram is safe to take for a long time.
A few people may get sexual side effects, such as problems getting an erection or a lower sex drive. In some cases these can continue even after stopping the medicine. Speak to your doctor if you are worried.
Otherwise there do not seem to be any lasting harmful effects from taking citalopram for many months and years.
How do I come off citalopram?
If you have been feeling better for 6 months or more, your doctor may suggest coming off citalopram.
Your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking citalopram for a long time.
This is to help prevent any extra side effects you might get as a reaction to coming off the medicine.
- feeling sick
- numbness or tingling in the hands or feet
- trouble sleeping
- feeling agitated or anxious
Do not stop taking citalopram suddenly or without talking to your doctor first.
Is citalopram better than other antidepressants?
Citalopram is not any better or worse than other antidepressants.
But sometimes people respond better to one antidepressant than to another.
Talk to your doctor if you are not feeling any better after 6 weeks.
Will I gain or lose weight?
Citalopram can make you feel less hungry, so you may lose weight when you first start taking it.
Later on, you may gain a little weight as your appetite returns.
If you start to have problems with your weight while taking citalopram, talk to your doctor or pharmacist.
Can I drive or ride a bike?
Some people cannot concentrate properly while they're taking citalopram. It might be best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.
Will it affect my fertility?
There's some evidence that citalopram can reduce the quality of sperm, but it's not known whether this reduces male fertility.
The effect should reverse once you stop taking the medicine. Speak to your doctor if you're concerned.
For women, there's no firm evidence to suggest that taking citalopram will reduce your fertility.
But speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.
Will it affect my sex life?
The good effects of citalopram may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.
Some of the possible negative effects include:
- men getting painful erections and problems getting an erection and ejaculating
- women having some vaginal bleeding and might not reach orgasm the same way as before
- a lower sex drive
Sexual side effects usually pass after the first couple of weeks. However, very rarely, they can be long lasting and may not get better even after stopping the medicine. If these happen and are a problem for you, go back to your doctor to see if there's another treatment you can try.
Can I drink alcohol with it?
You can drink alcohol while taking citalopram, but it may make you feel sleepy.
It might be best to stop drinking alcohol until you see how the medicine makes you feel.
Is there any food or drink I need to avoid?
There are no food or drinks you need to avoid while taking citalopram.
Are there other treatments that will help?
Antidepressants, including citalopram, are just one of several approaches to treating depression.
Other potential treatments include:
- talking therapy (such as cognitive behavioural therapy)
- exercise programmes
- help to get a good night's sleep
Choosing a treatment that's most suitable for you depends on how long you have had depression, your symptoms, whether you have had any previous bouts of depression, whether previous treatment has worked, how likely you are to stick with your treatment, the potential side effects, and your preferences and priorities.
What's the difference between citalopram and escitalopram?
Citalopram and escitalopram are both medicines used to treat depression.
They may sound similar, but they're different medicines.
- citalopram doses are twice as much as those of escitalopram
- the type and frequency of side effects you may get are different with each medicine
- citalopram can be used for fewer health problems than escitalopram
Will recreational drugs affect it?
Cannabis with citalopram can give you a fast heartbeat.
Cannabis can also make drowsiness worse with citalopram, especially in people who have just started taking it.
Methadone can increase the risk of side effects in people taking citalopram.
It can be potentially dangerous to take citalopram with:
- stimulants like MDMA (ecstasy) or cocaine
- hallucinogens like LSD
- novel psychoactive substances (which used to be known as legal highs) like mephedrone
Citalopram has not been properly tested with recreational drugs.
Talk to your doctor if you think you might use recreational drugs while taking citalopram.