How it works
What does citalopram do?
Citalopram is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).
Research suggests that depression or low mood is more likely to occur when the brain doesn’t have enough serotonin.
Serotonin (also called '5HT') is a naturally-occurring chemical messenger (or “neurotransmitter”) that has an important role in areas of the brain that control mood and thinking.
Selective serotonin reuptake inhibitors (SSRIs) - like citalopram - are thought to work by increasing levels of serotonin in the brain. They do this by blocking the recycling of released serotonin back into the nerve endings.
Citalopram is often prescribed alongside a talking therapy.
How long does citalopram take to start working?
Citalopram should start helping with depression within one to two weeks. It can take a little longer for you to feel the full effects of the medication.
For anxiety, it can take up to four weeks for the benefits to be noticed. Scientists believe that the higher level of serotonin can cause you to feel a bit more anxious or on-edge at first, before settling down.
How long will I need to take citalopram?
If you’re taking citalopram for anxiety, you may need to take it for longer than six months.
You and your doctor should talk about how long you need to take citalopram before you begin treatment with the medication.
People who have had low mood or depression more than once may need to take citalopram for a couple of years or more. This is to stop themselves experiencing depression or low mood again.
Never stop the tablets suddenly because this may make you more at risk of experiencing low mood.
Speak to your doctor if you want to stop taking citalopram.
Your doctor needs to know if...
You need to talk to your doctor or pharmacist before starting treatment with citalopram if you have or have ever had any of the following:
- liver disease
- kidney disease
- diabetes (you may need an adjustment of your antidiabetic therapy)
- epilepsy or a history of seizures or fits
- a bleeding problem, or bleeding in the stomach or gut
- mania or bipolar disorder
- low blood levels of sodium
- problems with your eyes, such as glaucoma (increased pressure in the eye)
- heart problems, or a heart attack
- a low heart rate or long-lasting diarrhoea (loose poo), vomiting (being sick) or using diuretics (water tablets)
- a fast or irregular heartbeat, fainting, collapsing or dizziness when you stand up.
How can citalopram be taken?
You can take citalopram in tablets or drops.
Tablets come in 10mg, 20mg and 40mg strengths.
Oral drops (40mg per ml - each drop contains 2mg. Four drops are like one 10mg tablet).
The dose of citalopram in mg given as drops is a bit lower than that of tablets. This is because the drops are made slightly differently to the tablets, so a conversion factor is applied.
Your doctor will probably start you on a low dose (10-20mg) and then increase it slowly over two to four weeks to a dose that works for you (usually between 20mg-40mg a day). This is because citalopram may make you feel anxious or sick at first, but starting with a low dose makes this less likely to happen.
The tablets may not be suitable for you if you have problems eating some sugars or dairy (milk-based) foods, as they contain lactose.
The drops contain a small amount of alcohol, but not enough to affect your blood alcohol level.
You should only take citalopram as agreed with your doctor
You will get the best effect from citalopram if you take it regularly at the dose prescribed by your doctor.
Make sure that you know your dose. If it's not written on the label, check with your pharmacist or doctor.
You should start by taking it in the morning. This will lower the chance of it affecting your sleep.
Try to get into a routine, like taking it when you have breakfast or brush your teeth.
If you find that it makes you sleepy, you can take it at nighttime instead.
Citalopram can be taken before or after food.
Swallow the tablet with a drink of water or liquid - if you chew it, it tastes bitter.
What if I miss a dose?
If you forget to take a dose, then just take it as soon as possible.
If you forget to take it by bedtime, just start again on the next day.
Do not take a double dose.
What will happen if I forget to take my citalopram?
If you forget to take it for a few days, you may start getting withdrawal symptoms, which feel a bit like the flu. If you get these symptoms, see your doctor as soon as possible.
If you want to stop your tablets, please speak to your doctor first as it is better if they are stopped slowly over a few weeks rather than suddenly.
Stopping the use of citalopram
Stopping the medication causes the balance of chemicals in the brain to change.
When you start taking an SSRI, the brain adjusts to having a higher level of serotonin around. If you stop taking the SSRI suddenly, the levels of serotonin start to drop, and your brain can take a while to adapt to this change. You could get some symptoms from the change, which are called withdrawal symptoms.
This does not mean you are addicted to the medicine - just that your brain has become used to citalopram to control the serotonin levels.
Withdrawal symptoms usually start a few days after stopping the medicine and might include:
- dizziness or headaches
- numbness or tingling in hands or feet
- sleep disturbances (vivid dreams, nightmares, not being able to sleep)
- ‘electric shock’ feelings in the head, neck and spine (back)
- feeling anxious, confused or disorientated
- feeling or being sick or having diarrhoea (loose poo)
- sweating or shaking
- feeling restless or agitated or feeling emotional or irritable
- flu-like symptoms
- tinnitus (ringing in your ears)
- problems with your eyes, or fluttering/pounding heartbeat (palpitations) can happen, but not as often as the others symptoms listed above
You can stop taking citalopram safely with your doctor's help, who will show you how to reduce your dosage gradually.