Celexa side effects and how to avoid them

Celexa side effects | Serious side effects | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Celexa, also known by its generic name, citalopram (or citalopram hydrobromide), is a brand-name prescription medication used to treat adults with depression (major depressive disorder). It may also be used off-label to treat other conditions such as generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, or premenstrual dysphoric disorder. Celexa is often used in combination with counseling by mental health professionals. 

Celexa is approved by the FDA (but not in children) and is part of a class of antidepressants called SSRIs (selective serotonin reuptake inhibitors). SSRIs work by increasing serotonin levels in the brain, which helps symptoms of depression.

Continue reading to learn about the side effects, warnings, and drug interactions of Celexa. 

Common side effects of Celexa

As with any medication, there is a potential for adverse effects with Celexa. Celexa may take a few weeks to feel like it is working—it does not take effect immediately. After taking Celexa daily for a few weeks, patients generally notice an improvement in symptoms of depression. Patients may see improvements in mood, energy, appetite, and sleep, for example. 

Many of the common side effects of Celexa are mild and tend to go away as the body adjusts to the medication. If side effects are troublesome or do not go away, contact your healthcare professional for medical advice. 

Here is a list of the most common possible side effects of citalopram (Celexa):

• Stomach problems like nausea, vomiting, heartburn, stomach pain, constipation, or diarrhea
• Dry mouth 
• Drowsiness or tiredness
• Insomnia (trouble sleeping)
• Sweating 
• Tremor 
• Sexual dysfunction (impotence, ejaculation problems, or low libido)
• Flulike symptoms
• Decreased appetite 
• Anxiety
• Agitation 
• Menstrual cramps 
• Dizziness 
• Yawning 

Weight changes

SSRI medications have been associated with appetite loss and weight loss. However, the manufacturer’s information mentions both decreased weight and increased weight as frequent side effects. The information also states that in studies, people who took Celexa lost about one pound, compared to those who took a placebo. 

If you take Celexa and notice changes in appetite or weight, consult your prescriber. 

Serious side effects of Celexa

Celexa, less commonly, can cause some severe side effects. If you have any of these side effects, seek medical attention right away. Serious side effects include:

• Suicidal thoughts or behavior
• Worsening of depression 
• Mania or hypomania 
• EKG/heart rhythm changes
• Bleeding 
• Angle-closure glaucoma
• Seizures 
• Low sodium levels associated with SIADH (syndrome of inappropriate antidiuretic hormone secretion)
• Priapism (prolonged erection)
• Extrapyramidal symptoms (involuntary muscle movements)
• Withdrawal symptoms if abruptly discontinued
• Serotonin syndrome
• Anaphylaxis

Suicidal thoughts and behavior

All antidepressants, including Celexa, have a black box warning. A black box warning is the strongest warning required by the FDA. Antidepressants can increase the risk of suicidal thoughts and behavior. This most often occurs in children, adolescents, and young adults up to age 24 years. However, any patient taking an antidepressant should be closely monitored for mood or behavior changes and suicidal thoughts or behavior. Families and caregivers should observe the patient and report any changes to the prescriber.

Serotonin syndrome

Serotonin syndrome is a life-threatening condition caused by a buildup of serotonin. Symptoms can range from mild to severe and include nausea, diarrhea, confusion, tremor, muscle stiffness, and in extreme cases, can cause high fever, seizures, irregular heartbeat, and unconsciousness. If you have any of these symptoms, get emergency medical treatment immediately.

Sexual side effects

Sexual side effects can occur with SSRI treatment (or may be associated with the psychiatric condition). Although the incidence varies, it is something to monitor with Celexa treatment. 

In studies comparing Celexa to placebo:

• 6.1% of people who took Celexa had abnormal ejaculation, compared to 1% of people who took a placebo
• 3.8% of people who took Celexa had decreased libido, compared to less than 1% of people who took a placebo
• 2.8% of people who took Celexa experienced impotence, compared to less than 1% of people who took a placebo
• Priapism (prolonged erection) has been associated with all drugs in the SSRI class

Sexual problems related to Celexa can affect females, too. In female patients who took Celexa, 1.3% reported decreased libido, and 1.1% reported inability to reach an orgasm. 

The manufacturer information states that reliable estimates of both incidence and severity of sexual side effects are difficult to collect because sexual problems are a difficult topic of discussion. Because of this, estimates likely underestimate the actual occurrence. There are no adequately designed trials that have studied Celexa and sexual problems. 

If you take Celexa and have sexual side effects, discuss them with your doctor. 

Severe allergic reactions

Severe allergic reactions to Celexa are rare. However, if you have symptoms of anaphylaxis—such as hives, difficulty breathing, or swelling of the face, lips, or tongue— seek emergency medical treatment right away. 

How long do Celexa side effects last?

For many people, side effects tend to last a few weeks as your body adjusts to Celexa. 

If side effects persist or are troublesome, consult your doctor, who can decide if a dosage change or another medication may be appropriate. Do not stop taking Celexa on your own until you talk to your doctor, who can advise you on a tapering schedule if you need to stop taking it.

Celexa contraindications & warnings

Restrictions

Celexa is not appropriate for everyone. When discussing Celexa with your healthcare provider, be sure to tell them about any medical conditions you may have. 

Celexa is contraindicated in people who:

• Take a type of antidepressant known as an MAOI (monoamine oxidase inhibitor), or have taken an MAOI within 14 days of Celexa
• Are taking pimozide, linezolid, or intravenous methylene blue
• Are allergic to Celexa or any inactive ingredient in the prescription drug

Celexa also should not be used in people who:

• Have uncorrected electrolyte abnormalities
• Have heart rhythm problems like QT prolongation or ventricular arrhythmia
• Have bradycardia (slow heart rate)
• Have had a recent heart attack 
• Have congestive heart failure

Celexa should be used with caution in people who:

• Have a history of heart rhythm problems
• Are at risk for electrolyte abnormalities (your doctor will monitor labs such as potassium and magnesium)
• Use other medications that cause CNS (central nervous system) depression
• Use alcohol
• Are poor CYP2C19 metabolizers
• Are under 25 years old
• Are older adults
• Are pregnant, especially in the third trimester
• Have liver problems
• Have a history of mania or hypomania (Celexa is not approved for use in bipolar disorder—patients should be screened for bipolar disorder before taking Celexa) 
• Have angle-closure glaucoma
• Have a history of seizures
• Are dehydrated.

Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. 

Neonates who were exposed to certain antidepressants, including Celexa, during the third trimester of pregnancy, have developed complications leading to prolonged hospitalizations, requiring tube feeding and breathing assistance. Neonates who were exposed to SSRIs in pregnancy also may have an increased risk of PPHN (persistent pulmonary hypertension of the newborn). 

Withdrawal

Although Celexa is not classified as a controlled substance, it still should not be stopped abruptly. If you need to stop taking Celexa, do not just stop taking it—ask your doctor for a tapering schedule, so you can slowly stop taking the medication over a few weeks. Abruptly discontinuing an antidepressant, like Celexa, can cause withdrawal symptoms. Withdrawal symptoms generally resolve on their own but can sometimes be severe. Symptoms of withdrawal include: 

• Irritability
• Mood swings (which can be very strong)
• Agitation 
• Dizziness
• Electric shock sensations 
• Anxiety 
• Confusion 
• Headache
• Lethargy 
• Insomnia 
• Hypomania 

Overdose 

When taking Celexa, follow the dosing instructions provided by your healthcare professional. The manufacturer recommends taking Celexa once daily, in the morning or evening. 

Although individual situations vary, Celexa is usually started at a lower dose and slowly increased if needed, under close supervision of your doctor. 

Doses above 40 mg per day are not recommended due to the risk of QT prolongation (electrical disturbance of the heart), and because efficacy studies did not show that doses above 40 mg daily were effective.

The recommended maximum dose is 20 mg per day in:

• Adults over 60 years old
• Patients with liver problems
• Patients who are poor CYP2C19 metabolizers
• Patients who take cimetidine or another CYP2C19 inhibitor

People with mild or moderate kidney problems do not require a dosage adjustment. However, Celexa should be used with caution in patients with severe kidney problems. 

Celexa interactions

Before taking Celexa, tell your doctor about all of the medications you take, including prescription drugs, over-the-counter (OTC) medications, and vitamins or dietary supplements. Celexa has some drug interactions to be aware of: 

• MAOI antidepressants: MAOI (monoamine oxidase inhibitor) antidepressants should not be taken within 14 days of Celexa due to the risk of serotonin syndrome. Examples of MAOIs include phenelzine, tranylcypromine, selegiline, and isocarboxazid. 
• Other drugs that increase serotonin: Celexa increases serotonin levels, and can interact with other medications that increase serotonin, causing serotonin syndrome. These medications include other antidepressant medications, triptans for migraine, lithium, tryptophan, opioid pain medications (such as tramadol), St. John’s Wort, and dextromethorphan (a popular cough suppressant found in many cough and cold products, both prescription and OTC).
• CNS depressants: Drugs that slow down the central nervous system, such as sedatives, tranquilizers, and sleep medications, should be used cautiously in people who take Celexa.
• Alcohol: Avoid alcohol while taking Celexa.
• NSAIDs and blood thinners: Nonsteroidal anti-inflammatory drugs (such as ibuprofen, aspirin, and naproxen) and blood thinners (such as warfarin) may increase the risk of bleeding when taken with Celexa.

This is not a full list of drug interactions, and other drug interactions can occur. Consult your doctor for a full list of drug interactions. 

How to avoid Celexa side effects

1. Dosage: Follow appropriate dosing instructions as given by your doctor. The starting dose varies based on your medical history. Take Celexa once daily as directed, with or without food. If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take your regular dose at the usual time—do not double up. The length of treatment with Celexa can vary. Your healthcare provider can advise you on the length of treatment that is right for you. Do not change your dose or stop taking your medication unless your doctor has given you specific instructions on how to do so. 
2. Medical history: Discuss any medical conditions and history with your doctor, so he or she can determine if Celexa is safe for you. 
3. Interactions: Because Celexa has potential drug interactions, be sure to review all of the medications you take with your prescriber. This includes prescription, OTC, and any vitamins or dietary supplements you take. Any time you take a new medicine (prescription or OTC), ask your doctor or pharmacist if it is safe to take with Celexa. Avoid alcohol when taking Celexa.
4. Communicate: Talk to your doctor and/or pharmacist. If you experience mild side effects, your healthcare provider may be able to give you tips on avoiding them. Keep a journal with any side effects and what helps them. For example, if Celexa makes you tired, you may try taking it at bedtime. If you have serious side effects, tell your doctor right away or seek emergency medical attention when needed.
5. Read the Medication Guide: When you fill or refill your Celexa prescription, you will receive a medication guide. This guide reviews side effects and warnings. Read the guide each time you fill your prescription, which will help keep important information about Celexa fresh in your mind.