Citalopram For Anxiety: What You Need To Know

Having chronic anxiety is debilitating, and it can leave you in a state of constant worry and fear about ordinary situations. Although it’s normal and common to experience occasional anxiety in stressful situations, ongoing anxiety that interferes with your daily life requires help and support.

If you’re experiencing anxiety or believe you could have an anxiety disorder, it’s important to reach out for help and see a healthcare professional. This could be your family doctor or a psychiatrist who can address your symptoms through treatment.

Medication can be a key part of your anxiety treatment. Several medications have been scientifically proven to reduce anxiety symptoms and improve your mood, one of which is citalopram. 

What is citalopram?

Citalopram, also known by the brand name Celexa, is approved by the FDA as an antidepressant. However, it can also be prescribed ‘off-label’ to treat anxiety disorders (such as generalized anxiety disorder, social anxiety disorder, and panic disorder) if your doctor believes it’s suitable for your circumstances.  

Citalopram is a selective serotonin reuptake inhibitor (SSRI). SSRIs are a group of medications that prevent serotonin from being reabsorbed and recycled back into the nerve cell that originally produced and released it. 

How does it work?

Serotonin is a chemical messenger (a neurotransmitter) that sends signals between nerve cells. It has various functions in the body and is important for regulating our mood, thoughts, digestion, behavior, and memory. You may have heard it being referred to as a ‘happy hormone.’ 

Serotonin is naturally produced within nerve cells in the brain. The nerve cell releases serotonin into the space between two nerve cells. At this point, the serotonin either binds to another nerve cell to initiate a signal and nerve impulse, or it enters a reuptake pump to be reabsorbed into the nerve cell that released it. 

This process is important because it allows serotonin to be recycled when it’s needed, but it also reduces the amount of serotonin in the brain. Insufficient amounts in the brain can lead to depression or anxiety. 

SSRIs block the reuptake pump, preventing serotonin from reabsorbing into the nerve cell. This means more serotonin is available between nerve cells, sending more signals and resulting in better mood regulation.

Although many factors can contribute to mental health conditions, low levels of serotonin¹have been associated with depression and anxiety. This is why SSRIs, such as citalopram, effectively treat anxiety because they increase serotonin levels. Also, because SSRIs are selective for serotonin (meaning they specifically target serotonin), they don’t impact the uptake of other chemical messengers in the brain. 

Who should take citalopram?

Citalopram is safe for most adults suffering from a chronic anxiety disorder. However, it’s important to recognize that chronic anxiety is different from the anxiety or worry that everyone experiences from time to time. In these cases, taking citalopram is generally not advised as the focus of treatment should instead be on developing anxiety management strategies.  

Pre-existing medical conditions

Before being prescribed citalopram, your doctor will screen you for any pre-existing medical conditions which may affect whether citalopram is right for you. 

If you have one or more of these conditions, you should advise your doctor. This may mean that you need extra guidance and monitoring of your pre-existing condition and the possible side effects of the medication. 

These pre-existing medical conditions include, but are not limited to:²

• Allergies 

• Type 1 and type 2 diabetes

• Uncontrolled epilepsy or other seizures 

• Heart conditions (such as heart attacks, heart disease, or heart rhythm problems)

• Kidney disease

• Liver disease

• Bleeding disorders

• Being in a manic phase of bipolar disorder 

• Low sodium or potassium levels in the blood 

Life stages

• Pregnancy³ — Citalopram may cause heart and lung defects in the fetus or lead to miscarriage in the first trimester. A different antidepressant or SSRI, such as sertraline or fluoxetine, should be considered. 

• Breastfeeding — Some studies have shown that citalopram can be harmful² to the infant being breastfed. Consider a different antidepressant or SSRI, such as sertraline, instead.

• Children and adolescents —  Citalopram is typically only prescribed to people over 18 due to the risk of self-harm behaviors and suicidal thoughts as a side effect in children⁴ and teenagers. 

• Older adults — Older adults (typically over 60 years old) are more likely to have low sodium levels, which could be exacerbated by citalopram use.  

How effective is taking citalopram for anxiety?

Studies have found⁵ that for people with generalized anxiety disorder, 12 weeks of treatment with citalopram has led to complete or partial improvement in anxiety symptoms. 

Another study showed that citalopram is effective for up to 24 weeks after six to eight weeks of treatment.⁶

Although there are several types of anxiety disorders (including generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, panic disorder, and post-traumatic stress disorder), citalopram is usually only prescribed for generalized anxiety disorder. 

How do you take citalopram?

Citalopram is a prescription medication that can only be taken if your doctor or psychiatrist prescribes it for you. 

Generic citalopram tends to be cheaper than the brand name alternative, Celexa. Citalopram usually costs US$0.74 per tablet, whereas Celexa costs about US$9.97 per tablet.⁷ This is important to keep in mind because both forms are equally effective. 

Citalopram is available as a liquid or tablet. 

Remember always to take medications as prescribed, but generally citalopram: 

• Can be taken with or without food

• Can be taken in the morning or at night, depending on whether it makes you feel more alert or drowsy

Once you find a time that suits you, make sure you stick to it each day.

Because citalopram can cause you to feel drowsy, you should avoid driving or operating heavy machinery after taking it. It’s also recommended to avoid alcohol because the combination of citalopram and alcohol can impair your judgment, coordination, and motor skills. 

Dosage

The typical doses are 10mg, 20mg, or 40mg per day. Your doctor will start you with a low dose to prevent any possible side effects. If needed, you can gradually increase the dose over time to a maximum of 40mg per day. However, 20mg should be the maximum dose⁸ for people over 65.  

If you miss a dose, you should take it as soon as you remember to prevent withdrawal symptoms and a sudden return of your anxiety. However, if it’s close to the time of your next dose, it’s better just to skip the forgotten dose and wait until the next one, as a double dose can be dangerous. 

How long does citalopram take to work?

Everyone has different experiences with anxiety and different reactions to medications, so you can’t predict how long it will take for citalopram to work for you. 

It’s important to be aware that citalopram won’t work immediately. It takes time for it to take full effect because serotonin levels need to build up and become balanced in the brain to regulate our mood and help reduce anxiety. 

As a guideline, when citalopram is prescribed for anxiety, it generally takes around four to six weeks to reach its full potential. However, even after a couple of weeks, it’s likely that you’ll experience small improvements in your daily life that may be affected by your anxiety, such as better appetite control, improved sleep, and higher energy levels. 

Even though you may not see a significant improvement in your anxiety and mood for some weeks, it’s important to keep taking citalopram unless your doctor has advised otherwise.

Taking it consistently 

When you notice that citalopram is working for you, it’s important to continue taking it. If you suddenly stop because you feel better, your body will experience a rapid drop in serotonin levels because your brain has adapted to having higher levels of serotonin. 

This can cause your anxiety to return or even severe withdrawal-like symptoms, such as dizziness, restlessness, flu-like symptoms, and poor sleep. 

In most cases, you’ll probably need to take citalopram for at least six months before gradually reducing the dose and eventually stopping. This is usually carried out over two weeks. 

What are the benefits and risks of taking citalopram?

Benefits

Compared to other SSRIs and antidepressants, citalopram has fewer side effects and fewer negative interactions⁹ with other drugs compared to other SSRIs. 

SSRIs, such as citalopram, are also not addictive in the same way that some other antidepressants are, making them safe for both short-term and long-term use. 

Risks 

Contraindications

Citalopram can negatively interact with other medications and herbal remedies. You should not take citalopram if you are on any of the following medications: 

• Any medications that increase serotonin levels — Because citalopram increases serotonin, taking another drug that does the same thing will cause an additive effect, which can lead to a rare but serious condition called serotonin syndrome. Examples include the herbal remedy St. John’s wort, some migraine medications, and monoamine oxidase inhibitors. 

• NSAIDs, warfarin, and antiplatelets, such as aspirin — These medications increase your risk of bleeding. 

• Drugs for treating abnormal heartbeats (antiarrhythmics) — These include medications that prolong the QT interval of the heart, as citalopram is more likely to cause cardiac-related side effects than other SSRIs, especially at a high dose of 40mg per day. 

Pre-existing medical conditions 

The FDA advises against taking citalopram¹⁰ if you also take drugs that prolong the QT interval or antiarrhythmics. 

Side effects

Like all SSRIs, citalopram can also have side effects,¹¹ including:

• Sexual disturbances — Poor sex drive or difficulties generating an orgasm or erection.

• Anxiety-like symptoms — Shakiness, restlessness, and agitation.

• Sleep problems — Insomnia or drowsiness.

• Physical symptoms — Dry mouth, headache, or nausea.

• Digestive problems — Loss or gain of appetite, diarrhea, or constipation.

However, these side effects are mostly mild and can be easily managed. They are most likely to occur in the first few weeks of starting citalopram or when you change your dose. As long as you continue the treatment, the side effects should subside. 

There are also a few rare but severe side effects, which include:

• Self-harm or suicidal thoughts, especially if you are under 25 years old. The citalopram container must carry a ‘black box’ warning for this. 

• Chest pain

• Shortness of breath

• Bleeding that doesn’t stop

Serotonin syndrome

There is also a risk of developing serotonin syndrome. This may cause symptoms such as:

• Agitation

• Shaking or twitching

• Hallucinations

• Sweating

• Fever

• Coma

This is an important risk to be aware of because the likelihood of overdose, which can cause serotonin syndrome, is greater for citalopram than for other SSRIs. 

Low blood sodium levels

This is an especially important consideration for older adults, who may already have low sodium levels. If sodium levels become too low, muscle weakness, disorientation, and coma may occur.

You should always report any side effects to your doctor, even if they are mild. Your doctor will need to monitor you over a couple of weeks to see if the side effects subside and reduce your dose of citalopram if needed. 

The lowdown

Citalopram can be an effective treatment for anxiety disorders as it helps regulate mood and ensure your brain has adequate serotonin levels. If you’re experiencing anxiety, especially severe anxiety that interferes with your daily life, speak with your doctor about whether citalopram treatment would be a good fit for you. 

Remember that citalopram is just one of several medications that can be used for anxiety, so if it’s not suitable for you, you have other options.