Citalopram is an SSRI antidepressant that increases serotonin availability in the brain by selectively inhibiting its reuptake into nerve cells. By enhancing serotonergic transmission, Citalopram can alleviate symptoms of major depressive disorder (MDD)—including low mood, loss of interest, sleep disturbances, fatigue, and impaired concentration. For many patients, consistent daily use over several weeks leads to improved mood stability and functioning, making it a mainstay therapy in primary care and psychiatry.
Beyond its FDA-approved use in MDD, clinicians may prescribe Citalopram off-label for conditions such as generalized anxiety disorder, social anxiety disorder, premenstrual dysphoric disorder, and certain forms of panic disorder. While SSRIs are often considered first-line for these conditions, appropriateness depends on the individual’s medical history, symptom profile, comorbidities, and risk of adverse events. In some cases—like obsessive-compulsive disorder—other SSRIs (e.g., fluoxetine, sertraline) may be preferred, but Citalopram is sometimes used when patients tolerate it better or have responded historically.
Patients generally start to notice early improvements—such as better sleep or less anxiety—within 1 to 2 weeks, though full antidepressant effects can take 4 to 6 weeks or longer. Treatment is typically continued for at least 6 to 12 months after symptom remission to reduce relapse risk, and some individuals with recurrent depression benefit from longer maintenance therapy. Citalopram’s once-daily dosing and relatively clean anticholinergic profile can be advantageous, especially for patients sensitive to sedation or cognitive side effects. It is, however, associated with dose-dependent QT interval prolongation, which shapes dosing limits and monitoring recommendations.
Citalopram is not a sedative or controlled substance, and it does not provide immediate relief like a benzodiazepine. Instead, it works gradually by resetting neurotransmitter signaling over time. When used as part of a comprehensive plan—including psychotherapy, sleep and exercise optimization, and substance-use reduction—Citalopram can help many people with depression reclaim daily functioning and long-term well-being.
Citalopram is taken once daily, with or without food, ideally at the same time every day. The commonly recommended starting dose for adults with major depressive disorder is 20 mg daily. Based on clinical response and tolerability, the dose may be increased after a minimum of one week. The maximum recommended dose for most adults is 40 mg daily due to the risk of QT interval prolongation at higher doses. Many patients achieve therapeutic benefit at 20 mg, while some require 40 mg for optimal effect.
Certain populations require stricter dosing limits. For adults older than 60 years, in patients with hepatic impairment, or in those who are CYP2C19 poor metabolizers—or who take strong CYP2C19 inhibitors (e.g., cimetidine, omeprazole, esomeprazole)—the recommended maximum dose is 20 mg daily. This precaution helps minimize elevated serum levels and the associated risk of QT prolongation. Your clinician may consider baseline and follow-up ECGs in patients with cardiac risk factors or those on other QT-prolonging medications.
Tablets are typically available in strengths such as 10 mg, 20 mg, and 40 mg, allowing flexible titration. Select patients—particularly those sensitive to side effects—may begin with 10 mg daily for a few days before advancing to 20 mg. Morning vs. evening dosing can be individualized: if the medicine causes insomnia or activation, take it earlier in the day; if it causes drowsiness, evening dosing may be preferable. Consistency is key for steady symptom control.
Treatment should continue through an adequate trial period—usually at least 4 to 6 weeks at a therapeutic dose—before making major changes. If partial improvement occurs, clinicians may adjust dose, address contributing factors (sleep, alcohol, other medications), or consider augmentation strategies. Do not stop Citalopram suddenly unless advised; when discontinuing, taper gradually over at least 2 to 4 weeks to reduce discontinuation symptoms such as dizziness, irritability, insomnia, and flu-like feelings. Your prescriber will tailor the taper to dose, duration, and tolerability.
As with all antidepressants, Citalopram carries a boxed warning for suicidal thoughts and behaviors in children, adolescents, and young adults. Close monitoring—especially during initiation and dose changes—is essential. If distressing side effects, new or worsening mood symptoms, or signs of cardiac issues (e.g., palpitations, syncope) occur, contact a clinician promptly.
Cardiac considerations: Citalopram can prolong the QT interval in a dose-dependent fashion. People with congenital long QT syndrome, a history of torsades de pointes, bradycardia, recent myocardial infarction, uncompensated heart failure, electrolyte abnormalities (hypokalemia/hypomagnesemia), or those taking other QT-prolonging drugs require particular caution. Your clinician may check an ECG and electrolytes when risk factors are present, keep doses at the lowest effective level, and avoid combinations that increase torsades risk.
Serotonin syndrome: Combining Citalopram with other serotonergic agents (certain migraine triptans, tramadol, linezolid, methylene blue, MAOIs, St. John’s wort, high-dose dextromethorphan, lithium, tryptophan) can trigger serotonin toxicity. Symptoms include agitation, confusion, tremor, muscle rigidity, shivering, sweating, diarrhea, fever, and in severe cases, seizures or arrhythmias. Seek urgent care if such symptoms appear—especially after dose changes or when adding new medications.
Bleeding risk: SSRIs can impair platelet aggregation by depleting serotonin within platelets, increasing bleeding risk, especially when combined with NSAIDs, aspirin, anticoagulants (warfarin, DOACs), or antiplatelets (clopidogrel). Report unusual bruising, nosebleeds, or gastrointestinal bleeding symptoms. Your clinician may recommend gastroprotection or an alternative strategy if risk is significant.
Hyponatremia/SIADH: Older adults and patients on diuretics are at higher risk for low sodium, which can cause headache, confusion, unsteadiness, or seizures. Notify your clinician if these symptoms occur, particularly within the first few weeks of treatment. Periodic sodium monitoring may be considered in high-risk groups.
Mania and bipolar spectrum disorders: Antidepressants can precipitate mania or hypomania in susceptible individuals. Screening for bipolar disorder prior to initiation is advisable. If racing thoughts, decreased need for sleep, unusually high energy, or impulsive risk-taking emerge, seek prompt evaluation.
Glaucoma: SSRIs can precipitate angle-closure glaucoma in predisposed patients. Eye pain, vision changes, or eye redness warrant immediate care, especially in those with narrow angles or without prior preventive laser procedures.
Pregnancy and lactation: Untreated depression is associated with adverse maternal and fetal outcomes. Citalopram use during pregnancy has been linked in some studies to neonatal adaptation syndrome (transient irritability, jitteriness, respiratory difficulty) and a small increased risk of persistent pulmonary hypertension of the newborn when used late in pregnancy. Decisions should be individualized, weighing risks of untreated illness versus medication exposure. During breastfeeding, small amounts of Citalopram pass into milk; many infants tolerate this well, but monitoring for sedation, feeding difficulties, and weight gain is prudent.
Alcohol and impairment: Alcohol can worsen sedation, coordination impairment, and depressive symptoms. Until you know how Citalopram affects you, use caution with driving or operating machinery. Avoid combining with other sedatives unless overseen by a clinician.
Seizure risk and other conditions: Individuals with seizure disorders require careful monitoring. Those with hepatic impairment typically use lower maximum doses. While renal impairment usually does not require adjustment, caution is reasonable in severe cases. Always provide your full medical history, including supplements and over-the-counter drugs, to help your clinician mitigate avoidable risks.
Do not use Citalopram if you have a known hypersensitivity to Citalopram or any tablet components. Concurrent use with monoamine oxidase inhibitors (MAOIs) is contraindicated due to the risk of severe serotonin syndrome—allow at least 14 days between discontinuing an MAOI and starting Citalopram, and similarly wait 14 days after stopping Citalopram before initiating an MAOI. Use with linezolid or intravenous methylene blue is also contraindicated unless the benefits clearly outweigh risks and close monitoring is available.
Citalopram is contraindicated in patients taking pimozide because of a pronounced risk of QT prolongation and serious arrhythmias. It is generally avoided in congenital long QT syndrome and when uncontrolled electrolyte abnormalities, bradyarrhythmias, or decompensated heart failure create unacceptable torsades risk. Patients with recent MI should be evaluated carefully before starting therapy. If a safer alternative exists in the presence of these risks, clinicians typically select another antidepressant with less QT liability.
Most patients tolerate Citalopram well, and many side effects diminish with continued use. Common effects include nausea, dry mouth, sweating, tremor, fatigue, drowsiness or insomnia, and changes in appetite or weight. Gastrointestinal discomfort is often transient; taking with food or shifting dosing time can help. Some patients report increased anxiety or restlessness early in treatment, which typically settles within a couple of weeks as the brain adapts to serotonin changes.
Sexual side effects—reduced libido, difficulty achieving orgasm, or erectile dysfunction—may occur and can persist. These are important to discuss with your clinician; potential strategies include dose adjustment, drug holidays (not recommended without guidance due to relapse and withdrawal risk), switching to an antidepressant with lower sexual side-effect burden, or carefully considered adjunct therapies. Open communication helps balance symptom control with quality of life.
Less common but notable adverse effects include hyponatremia (manifesting as headache, confusion, weakness, or falls), abnormal bleeding (especially with NSAIDs, aspirin, or anticoagulants), and bruxism (jaw clenching or teeth grinding). Rarely, patients experience angle-closure glaucoma symptoms, rash, or allergic reactions. Emotional blunting—feeling “numb” or disconnected—can occur; if it compromises daily functioning or relationships, a medication review may be warranted.
Serious events require prompt medical attention. Seek urgent care for signs of serotonin syndrome (agitation, hallucinations, fever, sweating, shivering, rapid heart rate, muscle stiffness, coordination problems, severe nausea, vomiting, or diarrhea). Cardiac symptoms such as palpitations, dizziness, fainting, or irregular heartbeats warrant immediate evaluation, especially at higher doses or with concurrent QT-prolonging drugs. Any emergence or worsening of suicidal thoughts or behaviors—particularly in younger patients—should be reported right away. Collaborating closely with your prescriber during initiation and dose changes reduces the risk of serious complications.
Serotonergic agents: Combining Citalopram with other medications or supplements that increase serotonin heightens the risk of serotonin syndrome. This includes MAOIs (contraindicated), linezolid, methylene blue, triptans, tramadol, fentanyl, lithium, tryptophan, St. John’s wort, high-dose dextromethorphan, and many others. When necessary, clinicians use the lowest effective doses, provide education on warning signs, and avoid risky overlaps or washout periods.
QT-prolonging drugs: Co-administration with agents that prolong the QT interval increases arrhythmia risk. Examples include pimozide (contraindicated), certain antiarrhythmics (amiodarone, sotalol), macrolide antibiotics (erythromycin), some fluoroquinolones, antipsychotics (ziprasidone, haloperidol), methadone, and others. When combinations are unavoidable, prescribers consider ECG monitoring, correction of electrolytes, and keeping Citalopram dose conservative.
CYP-mediated interactions: Citalopram is metabolized primarily via CYP2C19, CYP3A4, and CYP2D6. Strong CYP2C19 inhibitors such as cimetidine, omeprazole, and esomeprazole can raise Citalopram levels and increase QT risk, prompting a maximum dose limit of 20 mg daily. Other inhibitors or inducers may necessitate dosing adjustments or monitoring for efficacy and side effects. While Citalopram is a relatively weak CYP2D6 inhibitor, caution is advisable with narrow-therapeutic-index substrates.
Bleeding-risk combinations: SSRIs combined with anticoagulants, antiplatelets, or NSAIDs can increase bleeding risk. If such combinations are clinically necessary, gastroprotection and careful monitoring may be warranted. Report signs of bleeding immediately.
Other considerations: Alcohol can intensify sedation and impair judgment. Diuretics and conditions that lower sodium raise the risk of SSRI-associated hyponatremia. Always share a full list of medications and supplements—prescription, over-the-counter, and herbal—with your clinician and pharmacist to spot preventable interactions. Avoid starting or stopping medications without checking on compatibility, especially when considering migraine therapies, cough/cold remedies, or heart medications.
If you miss a dose of Citalopram, take it as soon as you remember unless it is near the time for your next dose. If it is close to your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not double up to catch up, as this can increase side effects without improving efficacy. If you frequently miss doses, consider setting phone reminders, linking dosing to a daily routine, or discussing once-daily timing adjustments with your clinician to enhance adherence and stability.
Citalopram overdose can be serious. Symptoms may include dizziness, drowsiness, tremor, sweating, nausea, vomiting, seizures, agitation, rapid heart rate, blood pressure changes, and potentially dangerous heart rhythm disturbances due to QT prolongation (including torsades de pointes). If an overdose is suspected, call emergency services or poison control immediately. Do not induce vomiting unless instructed by a medical professional.
In a medical setting, management focuses on supportive care, airway and breathing support if needed, cardiac and ECG monitoring, correction of electrolytes (potassium and magnesium), and treatment of seizures or arrhythmias. Activated charcoal may be considered in certain time frames after ingestion. Co-exposures—such as other antidepressants, alcohol, or OTC medications—can change the risk profile and should be reported. Early intervention improves outcomes.
Store Citalopram tablets at room temperature, generally 68°F to 77°F (20°C to 25°C), with permitted short excursions per product labeling. Keep the medication in its original, tightly closed container to protect from moisture and light. Avoid storing in humid environments like bathrooms. Ensure child-resistant caps are secure and keep all medicines out of reach of children and pets. Do not use tablets past the expiration date, and dispose of unused or expired medication through take-back programs or according to pharmacist guidance—avoid flushing unless specifically instructed.
In the United States, Citalopram is a prescription-only medication. Buying Citalopram without a prescription is not lawful and may expose you to unsafe, counterfeit, or substandard products. Safe access requires evaluation by a licensed clinician who can confirm the diagnosis, check for contraindications and interactions, and determine the right dose and monitoring plan. This oversight is especially important due to the medication’s dose-dependent QT prolongation risk and potential for serious drug interactions.
Physician House Calls of Kansas offers a legal, structured pathway to obtain Citalopram without the hassle of an in-person clinic visit. Through a compliant telehealth evaluation, a licensed provider reviews your symptoms, medical history, and current medications. When appropriate, they issue an electronic prescription to your preferred pharmacy or coordinate delivery, ensuring authenticity and continuity of care. This model preserves safety standards while improving convenience—especially for individuals with limited mobility, transportation barriers, or busy schedules.
Key advantages of a telemedicine pathway include faster access to care, medication safety checks, and ongoing follow-up for dose adjustments, side-effect management, and relapse prevention. While marketing language may reference “buy Citalopram without prescription,” reputable services will not bypass clinical evaluation. Instead, they streamline the process so you can start therapy legally and safely, with the right dose and monitoring in place.
If you are considering Citalopram, schedule a telehealth assessment to discuss benefits, risks, alternative options, and a personalized treatment plan. This ensures you receive authentic medication, guidance on side effects and interactions, and a follow-up schedule tailored to your needs—hallmarks of safe, effective antidepressant care.
Citalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant. It increases serotonin levels in the brain by blocking its reuptake, which helps improve mood, reduce anxiety, and stabilize emotional regulation over time.
Citalopram is approved for major depressive disorder and is commonly used off-label for generalized anxiety disorder, panic disorder, and obsessive-compulsive symptoms when clinically appropriate.
Some people notice sleep, appetite, and energy changes within 1–2 weeks; mood and anxiety improvements typically take 4–6 weeks, and sometimes up to 8–12 weeks for full effect.
Most adults start at 10–20 mg once daily and may increase based on response and tolerability. The typical maximum is 40 mg/day; many older adults or those with liver impairment or certain genetic factors are limited to 20 mg/day due to heart rhythm risk.
Common effects include nausea, dry mouth, sweating, insomnia or sleepiness, headache, dizziness, tremor, and sexual dysfunction. Many side effects improve after the first couple of weeks as your body adjusts.
Seek help for signs of serotonin syndrome (agitation, sweating, fever, tremor, diarrhea), severe dizziness or fainting, irregular heartbeat, persistent vomiting, severe confusion, or thoughts of self-harm. Hyponatremia (low sodium) can occur, especially in older adults.
Yes, citalopram can prolong the QT interval, which rarely may trigger arrhythmias like Torsades de Pointes. Risk increases with higher doses, electrolyte abnormalities, congenital long QT, and other QT-prolonging drugs; your clinician may consider an ECG if risks exist.
Avoid citalopram if you use MAO inhibitors or linezolid, have known long QT syndrome, are on pimozide, or had a severe reaction to citalopram. Use caution with heart disease, electrolyte issues, seizures, bipolar disorder, liver disease, and in older adults.
Alcohol can worsen drowsiness, dizziness, and judgment and may blunt treatment benefits. Avoid or limit alcohol, especially when starting or changing doses, until you know your response.
Both are possible. Early on, some people lose weight due to nausea or reduced appetite; longer-term, modest weight gain can occur. Healthy diet, activity, and monitoring can help manage changes.
Yes, it can reduce libido, delay orgasm, or cause erectile difficulties. These may improve over time; options include dose adjustments, timing strategies, or adjunctive treatments—discuss with your clinician.
Take it when you remember unless it’s close to the next dose. Do not double up. Consistency helps effectiveness and reduces withdrawal-like symptoms.
Stopping suddenly can cause discontinuation symptoms like dizziness, irritability, flu-like feelings, and sleep problems. Work with your prescriber to taper slowly over weeks.
SSRIs, including citalopram, are often used when benefits outweigh risks. Potential risks include neonatal adaptation symptoms and a small risk of PPHN; sertraline is often first choice, but citalopram can be appropriate. In breastfeeding, citalopram passes into milk in small amounts; monitor infants for irritability or poor feeding.
Yes. Risky combinations include MAOIs, other serotonergic drugs (triptans, tramadol, St. John’s wort), and QT-prolonging agents (some antiarrhythmics, antipsychotics, macrolides). NSAIDs, aspirin, and anticoagulants raise bleeding risk. Check all meds and supplements with your provider.
Yes. Though approved for depression, citalopram is often used for generalized anxiety and panic disorder, with benefits similar to other SSRIs. Start low and increase slowly to limit activation symptoms.
Some people experience transient jitteriness, restlessness, or insomnia during the first 1–2 weeks. Slow titration, morning dosing, good sleep habits, and reassurance typically help; contact your clinician if symptoms are intense.
Improving sleep, appetite, energy, concentration, and reduced worry or panic frequency often appear before full mood lift. Track symptoms weekly and discuss progress at follow-up visits to guide dose adjustments.
Older adults are more sensitive to side effects like hyponatremia, bleeding, and QT prolongation. Lower starting and maximum doses (often 20 mg/day) and periodic sodium checks and ECGs may be recommended.
In liver impairment, lower doses and slower titration are advised, with a typical max of 20 mg/day. Kidney disease has less direct impact, but caution and monitoring are prudent.
CYP2C19 poor metabolizers can have higher drug levels and greater QT risk; guidelines suggest lower maximum doses (often 20 mg/day). Pharmacogenetic results can inform safer, more tailored dosing.
Escitalopram is the active S-enantiomer of citalopram and is slightly more potent milligram-for-milligram. Both are effective; some patients respond or tolerate one better than the other.
Both SSRIs work for anxiety, but sertraline has robust evidence across multiple anxiety disorders and is often favored clinically. Individual response and side-effect profiles should guide the choice.
Fluoxetine has a very long half-life, which can reduce discontinuation symptoms but may prolong side effects and interactions. Citalopram is more neutral on activation; fluoxetine can feel more energizing for some.
Paroxetine is more anticholinergic and sedating, with higher rates of weight gain, constipation, and sexual side effects, and has a higher risk of withdrawal symptoms. Citalopram tends to be better tolerated but carries QT considerations.
Fluvoxamine has strong evidence and FDA approval for OCD; citalopram can help but is not first-line for OCD. Fluvoxamine has more drug–drug interaction potential due to CYP inhibition.
No SSRI has a reliably faster clinical onset; most take several weeks. Fluoxetine may feel activating sooner for some, while citalopram and sertraline are often perceived as more neutral.
Both can prolong the QT interval, but the effect is somewhat larger with citalopram at higher doses. Escitalopram generally has a slightly lower QT impact at therapeutically equivalent doses.
Yes, switches between SSRIs are common. Most transitions involve a direct switch at an approximately equivalent dose or a brief cross-taper, individualized to minimize discontinuation and activation symptoms.
Both can cause nausea and diarrhea initially. Sertraline is slightly more associated with diarrhea; citalopram with nausea. Taking with food and slow titration helps.
Sertraline is often preferred in pregnancy and breastfeeding due to extensive safety data. Citalopram is also commonly used when appropriate; the best choice depends on prior response and individual risk factors.
Citalopram has fewer CYP-mediated interactions than fluoxetine, which strongly inhibits CYP2D6 and has a long half-life. This makes citalopram simpler when polypharmacy is a concern.
Paroxetine has the highest risk of discontinuation symptoms among SSRIs due to its short half-life and anticholinergic effects. Citalopram’s withdrawal risk is moderate and manageable with a gradual taper.
Roughly, escitalopram is about twice as potent. For many patients, escitalopram 10 mg is similar to citalopram 20 mg, though individual responses vary.
Both are effective for panic disorder. Sertraline has robust evidence and is widely used; citalopram can work well too. Start low to minimize early activation, whichever is chosen.