Citalopram (Celexa) Side Effects: Rare, Common, & Severe

What is Citalopram (Celexa)?

Citalopram is an antidepressant approved to treat symptoms of major depressive disorder (MDD) in adults. It is also sometimes used off-label* to treat anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) in adults.¹ Depression is one of the most prevalent mental health disorders affecting millions of Americans. As depression is a common symptom in other conditions such as dysthymia and premenstrual dysphoric disorder, citalopram may also be used in their treatment.²

Citalopram is the generic form of the brand name drug Celexa, primarily sold in the United States. Citalopram is a type of medication known as a  selective serotonin reuptake inhibitor (SSRI). As these drugs affect the person’s availability of serotonin in the brain, citalopram can induce side effects such as vomiting, nausea, and serotonin disorders.¹

*Off-label is when a medication is prescribed to treat a condition that is not FDA-approved. A prescriber can choose to use this medication off-label based on their professional judgment that it may provide a benefit to patients.

Side Effects of Citalopram

It is common for people to have side effects when starting citalopram as their bodies adjust to the medication. Some people, however, may not have any side effects. The antidepressant physiologically changes the chemical processes in the brain, which can impact other bodily functions, such as the digestive system leading to side effects like nausea, vomiting, and constipation. Serious side effects are not as common but still possible when taking citalopram.

Common Side Effects

Common side effects with citalopram are usually mild and may improve over time. You shouldn’t stop taking citalopram unless directed to your doctor. You can also talk with your doctor about your side effects, as they may have recommendations for you.

Common side effects of citalopram may include:

• Nausea
• Diarrhea
• Constipation
• Vomiting
• Stomach pain
• Weight loss or gain
• Increased sweating
• Drowsiness
• Dry mouth
• Appetite problems
• Runny nose
• Sexual dysfunction
• Heavy menstrual periods
• Feeling fatigued (including physical and mental fatigue)
• Muscle or joint pain

Citalopram may have more specific side effects in women such as:³

• Vaginal bleeding
• Inability to orgasm
• Low sex drive

Severe Side Effects

Clinical trials are conducted to ensure that citalopram is safe and efficacious for people. However, citalopram can still develop unwanted effects, some of which may be serious or possibly require immediate medical attention. Certain interactions, such as alcohol or MAOI inhibitors, can increase the risk of serious side effects if taken with citalopram. To learn more about interactions, see the interactions section below.

Severe side effects of taking citalopram may include:^{1, 3}

• Serotonin Syndrome: Citalopram can cause increased serotonin levels  in the central nervous system (CNS), resulting in coordination issues or muscle rigidity. If left untreated, this can be fatal.
• Manic Episodes: Taking citalopram medications to treat depressive episodes in patients with bipolar disorder can precipitate a manic episode.
• Excessive Bleeding: Citalopram is an antidepressant drug that can interfere with serotonin reuptake inhibition increasing the risks of bleeding.
• QT-Prolongation: Citalopram antidepressant causes dose-dependent QTc prolongation, which can impact your heart’s electrical activity, leading to irregular rhythms between its chambers that can cause sudden death.
• Sexual Dysfunction: Citalopram sexual side effects may develop for some people, resulting in an ejaculatory delay in male patients and decreased libido or absent orgasm in female patients.
• Hyponatremia: A more common condition among older people or those taking diuretic medications for hypertension, hyponatremia is when sodium levels become too low in the bloodstream.
• Angle-closure Glaucoma: Citalopram can increase the pressure on your eye, resulting in eye pain or blurred vision.
• Suicidal Thoughts: Children and young adults are at increased risk of experiencing suicidal ideation and behaviors when taking citalopram. Citalopram has a black box warning about the increased risk of suicide.

Additional Side Effects

Other side effects occurred during clinical trials in smaller numbers of patients, so they are not considered as common. While these side effects are not as prevalent in clinical studies, they can still pose serious health risks. You should still discuss your risk for experiencing them with your prescriber and tell them if you experience any of these side effects.

Rarer side effects of Citalopram include:^{1, 3}

• Abnormal heart rhythm
• Memory loss
• Fever
• Breathing problems
• Orthostatic hypotension
• Hyponatremia
• Excessive saliva production

Allergic Reactions to Citalopram

Patients with a history of escitalopram (Lexapro) allergies should get assistance from their prescribers before taking citalopram. This is because citalopram is an active metabolite of escitalopram, and the two are closely related. Having a mild or serious allergic reaction to citalopram is possible.

Symptoms of severe allergic reactions to citalopram can include:^{1, 3}

• Breathing problems
• Swelling of the mouth or throat
• Rash/hives
• Tightness in the chest or throat
• Wheezing
• Talking difficulties

If you experience a symptom of a severe allergic reaction, you should see emergency medical attention or call 9-1-1.

Long-Term Effects of Citalopram

Citalopram medication is not usually prescribed long-term. Once symptoms of depression have improved, the medication is usually continued for another 6 to 9 months. Taking citalopram will be closely monitored by a doctor to ensure it is safe and does not cause long-term effects for someone. Chronic conditions that could be caused by prolonged use of citalopram include:⁴

• Liver Damage
• Heart rhythm abnormalities
• Chronic weight gain

Interactions with Citalopram (Celexa)

Taking certain medications, herbs, or supplements alongside citalopram can change how citalopram works in your body or increase the risk for serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some substances that can have harmful interactions with citalopram include:^{5, 6}

• MAOI: the interaction of citalopram with an MAOI increases the risk of serotonin syndrome
• NSAIDs: this substance, when mixed with citalopram, increases the risk of sudden bleeding
• Alcohol: the interaction between alcohol and citalopram can increase the effects of drowsiness
• St John’s Wort: increases the risk of bleeding
• Blood Thinners: can increase the risk of bleeding
• Migraine Drugs: the interaction can increase the risk of serotonin syndrome

Who Experiences Side Effects More?

The side effects of citalopram can vary from person to person. While most will experience mild side effects, others have a higher risk of severe side effects due to their health conditions. Before taking citalopram, you should consult your doctor or prescriber about your medical history to help them find better ways to prescribe citalopram and avoid further complications from taking the drug.

Health conditions to mention to your doctor before taking citalopram include:

• Heart problems
• Bipolar disorder or other mental health disorders
• History of suicide attempts
• Seizures
• Bleeding problems

Citalopram Side Effects on Pregnancy & Breastfeeding

Citalopram can cause specific side effects for breastfeeding or pregnant individuals. Breastfeeding while taking citalopram puts infants at greater risk of side effects of citalopram, as it has been found in breast milk. Exposure to citalopram may cause adverse reactions such as decreased feeding, weight loss, restlessness, and irritability in infants.

Citalopram may or may not be recommended during pregnancy. Some data shows that babies exposed to citalopram in the third trimester have had complications. But it’s important to recognize that pregnant individuals who discontinue citalopram have a higher chance of experiencing a relapse of major depression than those who continue with the antidepressants during pregnancy. Pregnant individuals will have a higher risk of side effects if they have a family history of depression, alcoholism, attempted suicide, or substance use disorders.

It will be important for a patient to talk with their doctor about the risks and benefits of taking citalopram while pregnant or breastfeeding.

Withdrawal Symptoms from Citalopram

Citalopram medication is only normally prescribed for 6 to 9 months after depression symptoms improve. This length of use can develop a physiological change as the body gets used to having more serotonin. Therefore, it is important to consult your prescriber before discontinuing your citalopram medication.⁷

Stopping citalopram abruptly can result in one or more withdrawal symptoms, including:

• Irritability
• Headache
• Nausea
• Vomiting

To stop taking citalopram safely, talk with a doctor. They will help you to taper the dose over time to avoid side effects from stopping the medication.

Questions to Ask Your Health Team About Citalopram Side Effects

Taking citalopram should be done under the guidance of a doctor. Patients should strictly follow every instruction to prevent severe side effects of citalopram. Before you take citalopram, you should ask your doctor several questions about citalopram and its side effects on a person.

Questions to ask your care team when considering the side effects of citalopram are:

1. Can I use citalopram for myself to treat my symptoms of depression?
2. Given my health history, should I be worried about the side effects of citalopram?
3. How long will it take for me to adjust to taking citalopram?
4. Will a previous history of addiction make me more susceptible to dependency?
5. What is the best dosage to ensure fewer side effects of citalopram?
6. Are there drugs I am taking that could have harmful interactions with citalopram?
7. When should I reach out to you if I am experiencing side effects?
8. Is there anything I should tell my therapist about this new medication?
9. If I am feeling better, should I stop taking citalopram?
10. I want to stop taking this medication. What should I do?
11. I stopped taking my medication. Should I start immediately again?

Final Thoughts

Citalopram is an antidepressant approved to treat major depressive disorder and anxiety in adults. This antidepressant can have mild to severe side effects that may require medical attention. Severe side effects of citalopram can be worsened by health conditions or interactions of the antidepressant with other substances. Common side effects of citalopram can include nausea and vomiting, while severe side effects can include serotonin syndrome and heart problems. People with a previous history of allergic reactions to citalopram, who are breastfeeding or pregnant, those who drink alcohol, and young adults are at increased risk of side effects from citalopram.

For Further Reading

• Anxiety Disorders | MentalHealth.gov
• SAMHSA’s National Helpline
• How to Get Antidepressants: Everything You Need to Know
• How to Get Anxiety Medication: Everything You Need to Know