Citalopram

NHS Choices

About citalopram

Citalopram is a type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor).

It's often used to treat depression and also sometimes for panic attacks.

Citalopram helps many people recover from depression, and it has fewer unwanted effects than older antidepressants.

Citalopram is available on prescription as tablets and as liquid drops that you put in a drink of water.

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 are usually mild and go away after a couple of weeks.
Citalopram can affect an unborn baby. Tell your doctor straight away if you’re trying to get pregnant or become pregnant while taking it.
Citalopram can cause withdrawal symptoms so don't stop taking it without talking to your doctor.
Citalopram is called by the brand name Cipramil.

Who can and can't take citalopram

Citalopram can be taken by adults and children over the age of 12 years.

Check with your doctor before starting to take citalopram if you:

have had an allergic reaction to citalopram or any other medicines in the past
have a heart problem - as 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, are already pregnant or are breastfeeding - citalopram is usually not recommended in pregnancy or while breastfeeding
have an eye condition called glaucoma because citalopram can increase the pressure in your eye

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.

How and when to take it

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.

How much will I take?

Citalopram tablets come in different strengths ranging from 10mg to 40mg.

The usual dose of citalopram is 20mg a day in adults. However, it may be started at a lower dose and increased to a maximum dose of 40mg a day. If you are 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, don't 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?

Ask your doctor for advice straight away. An overdose can lead to potentially serious symptoms such as:

vomiting
shaking
feeling sleepy
fast heart rate
seizures

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 don’t 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. Tell a doctor straight away if you get:

headache, trouble focusing, memory problems, not thinking clearly, weakness, seizures, or losing your balance - these can be signs of low sodium levels
thoughts about harming yourself or ending your life
chest pain or pressure or shortness of breath
severe dizziness or passing out
putting on or losing weight without trying to
changes in your periods such as heavy bleeding, spotting, or bleeding between periods
painful erections that last longer than 4 hours - this may happen even when you're not having sex

Or, if you develop any signs of abnormal bleeding including:

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
any bleeding that is very bad or that you cannot stop

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction to citalopram.

A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

The warning signs of a serious allergic reaction are:

getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
wheezing
tightness in the chest or throat
having trouble breathing or talking
swelling of the mouth, face, lips, tongue, or throat

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 to the UK safety scheme.

How to cope with side effects

What to do about:

feeling sleepy - cut down the amount of alcohol you drink
dry mouth - chew sugar-free gum or sugar-free sweets
being unable to sleep - take citalopram first thing in the morning

You can reduce the chance of having a side effect that bothers you if you take citalopram in the evening. That way you're asleep when the level of medicine in your body is highest.

Pregnancy and breastfeeding

Citalopram is generally not recommended in pregnancy or while breastfeeding.

No medicines for depression are considered completely safe to take in pregnancy or while breastfeeding. Your doctor will want to prescribe citalopram only when the benefits of you taking the medicine outweigh the risks.

Citalopram and similar antidepressants have been linked with a small risk of problems for the unborn baby when they're taken in early or late pregnancy.

Citalopram and breastfeeding

Citalopram passes into breast milk and has been linked with side effects, including withdrawal symptoms, in breastfed babies.

Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

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've been stopped for a few weeks

Mixing citalopram with herbal remedies and supplements

Don't take St John's wort, the herbal remedy for depression, while you are being treated with citalopram as this will increase your risk of side effects.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

Common questions

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 a week or 2 until citalopram begins to take effect. It usually takes between 4 and 6 weeks before you feel the full benefits.

Don't stop taking citalopram after a week or 2 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 will hopefully take little things that used to worry you in your stride.

Citalopram won't change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.

Don't 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 will 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?

Citalopram is safe to take for a long time. There don’t seem to be any lasting harmful effects from taking it for many months and years.

However, taking citalopram for more than a year has been linked to a small increased risk of getting diabetes. But you will be regularly checked for this.

Is citalopram better than other antidepressants?

Citalopram isn't any better or worse than other antidepressants. However, sometimes people respond better to one antidepressant than to another. Talk to your doctor if you aren't 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 can't 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 contraception?

For women, citalopram will not affect contraceptive pills or the morning after pill.

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, problems with getting an erection and problems with ejaculating
women having some vaginal bleeding and might not reach orgasm the same way as before
a lower sex drive

Sexual side effects should pass after the first couple of weeks. If they don't, and this a problem for you, go back to your doctor to see if there's another antidepressant 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.

Will recreational drugs affect it?

The sleep-inducing effects of cannabis can add to those of citalopram, especially in people who have just started taking it. Cannabis with citalopram can also give you a fast heartbeat.

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.

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've had depression, your symptoms, whether you've 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.

Differences include:

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