Citalopram

Citalopram should start helping with depression within one to two weeks. It may take four weeks or longer for you to get the full effect.

How people respond to treatment can vary. Sometimes improvement is slow, and you may not feel any different to start with. This can be hard when your mood is low, and if you experience any side effects from your medication you may think you feel worse and not better. If you can, give your medication a chance to work and continue to take it for at least three to four weeks to see if it makes a difference.

Your parents, friends and doctor may notice an improvement in you before you feel it yourself, so it’s a good idea to talk to them.

If you think your medicine has not made any difference to how you feel after three to four weeks, you should go back to your doctor. They might recommend a change in dose or a different medication. However, it can take longer to work for some people than for others, so they may suggest you wait six to eight weeks before deciding.

For anxiety, it may take longer for the benefits to be noticed. It could take up to three months before you feel the full benefit.

For some people, anxiety symptoms briefly increase at the start of treatment, but the anxiety should decrease over time as you continue to take your medicine. To avoid or minimise this your doctor will usually start treatment with a low dose and increase this after one to two weeks.

Citalopram can cause people to lose weight when they first start taking it.

Some people find that they gain a little weight in the long term. This might be due in part to a return of their appetite.
It is not possible to predict how citalopram will affect each person before they start taking it. Talk to your doctor or pharmacist if you are concerned about your weight, or changes to your weight, while taking citalopram.

A very common side effect of citalopram is a dry mouth. Over a long time, this can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking citalopram so they can support you and help you look out for side effects.

You can feel drowsy in the first few days of taking citalopram. This should improve within a few weeks. If it makes you feel drowsy, try taking it just before you go to bed. If you have been taking citalopram for more than a month and you continue to feel very tired, sleepy or struggle to function during the day, you should go back to your doctor and discuss what changes could be made to help. This may include switching to a different medication.

Alcohol

It may be possible to drink some alcohol in moderation while taking citalopram. However, the two together might make you feel very sleepy and unsteady on your feet, especially when you first start taking the medication.

During the first few weeks of treatment, it is recommended that you don’t drink alcohol until you know how the medicine affects you.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

Cannabis can make drowsiness worse with citalopram and give you a fast heartbeat.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis.

Methadone can make drowsiness worse with citalopram. The citalopram could increase the concentration of methadone in your body. The two together can also cause serious heart problems. If you are prescribed methadone by your doctor and also need a medicine to help with depression or anxiety, citalopram may not be the best choice. They can be prescribed together, but extra monitoring would be needed and your doctor would discuss the risks with you first.
Citalopram could raise the level of cocaine in your body, giving you a bigger reaction. Your blood pressure could also increase to a dangerous level.

Taking citalopram with cocaine, ecstasy or amfetamines could bring on serotonin syndrome. You could get a high temperature/fever, agitation, confusion, trembling or weird muscle movements. You need to go to hospital urgently if this happens. Tell the doctor that you are taking citalopram.

There are many other street drugs, but we don’t know what effect taking them with citalopram will have, so it’s best to be cautious. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on drugs and alcohol.

Citalopram does not mix well with some other medicines, including herbal remedies. It may affect how they work or could cause more side effects.

Do not take citalopram if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.

Do not take citalopram if you are taking the herbal remedy St. John’s Wort. This does not mix well with citalopram, so please tell your doctor or pharmacist if you are trying this or would like to try it.
Citalopram can affect the way your heart works and should be used carefully with other medicines that can also affect the heart.

Before you start taking citalopram, tell your doctor if you are taking any other medications, including things you have bought from a pharmacy or other shop for common illnesses like colds and flu or medications that you put on your skin.

Always tell the pharmacist that you are taking citalopram if you buy any medicines from a pharmacy.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with citalopram. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

The tablets may not be suitable for you if you have problems eating some sugars or dairy foods, as they contain lactose.

The drops contain a small amount of alcohol, but not enough to affect your blood alcohol level.

There are several companies that manufacture this medicine and the non-active ingredients are likely to vary between products.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

If you need to avoid animal products such as gelatine, please note that this is often found in capsules but also in some tablet formulations. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Taking citalopram may affect your ability to do things like driving a car, riding a bike, or anything else that needs a lot of focus or balance. It can make you tremble, or feel dizzy or restless.

It is recommended that you stop driving or riding a bike for the first few days or weeks, until you know how it affects you.

Most people drive as normal while taking citalopram. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

Pregnancy

If you become pregnant while you are on citalopram, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing citalopram and help you to make a decision that is best for you and your baby. They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking citalopram during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Untreated depression or anxiety can also be harmful to you and your developing baby, so decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that carrying on with citalopram has more benefits than risks, you should tell your midwife that you are continuing to take this at your next appointment.

Some research has reported that taking SSRI antidepressants during the month before delivery can result in a small increased risk of bleeding after you have given birth. It will be important for your doctor and midwife to know what medication you are taking so that appropriate monitoring and treatment is planned. If you are concerned about this, discuss it with your doctor and midwife.

If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with citalopram.

Post-natal

If citalopram is taken in the last five months of a pregnancy, studies have shown a small increased risk of persistent pulmonary hypertension of the new-born (PPHN). This occurs in the first 24 hours after birth and can make the baby breathe faster and look a bit blue in colour. PPHN affects around three in 1,000 babies born to mums who take SSRIs. This compares with a rate of two in 1,000 among babies born to mums who do not take SSRIs. More recent research has failed to reproduce this finding. If you are concerned about this, talk to your doctor and midwife. If this does occur, you will need help from your midwife, so it is important they are looking out for symptoms.

There are some other symptoms that can occur in new-born babies if citalopram is taken in the last three months of pregnancy. Look out for these and get help if they happen:

• jerking or twitching of the muscles or shaking
• being jittery, irritable or constant crying
• being too hot or cold
• suckling/ feeding difficulties or being sick
• having stiff or floppy muscles, or overactive reflexes
• being very sleepy or finding it difficult to sleep

These are usually mild and go away in a few days without treatment.

Breastfeeding

Please talk to your midwife, doctor or pharmacist if you want to breastfeed while taking citalopram.

Citalopram does pass into breast milk in very small amounts. Levels in babies breast-fed by mothers taking citalopram had very low or undetectable levels.

If your baby was born early or has health problems, then breastfeeding while you are taking citalopram may not be recommended.

If you breastfeed while taking citalopram, seek urgent medical advice if your baby becomes restless, very sleepy, or develops feeding problems.

If your medication makes you sleepy, do not to sleep with your baby in the same bed, and be cautious when handling your baby (especially if waking during the night for feeds).

Sex

Citalopram can have side effects that might affect your sex life, including:

• painful erections, problems with getting an erection (getting hard) and ejaculating (coming)
• bleeding from the vagina and difficulty reaching orgasm (coming) the same way as before or not being able to have an orgasm at all
• reduced genital sensation
• lower sex drive

Most side effects occur when you first start medication and improve over time. If they do not, and this is a problem for you, make an appointment to discuss this with your doctor.

There is some evidence to indicate that some side effects affecting your sex life might continue for several months or longer after you stop your medicine. This is sometimes referred to as PSSD (post SSRI sexual dysfunction). More research is needed to understand how frequently this might happen. Discuss this with your doctor or pharmacist is you are concerned.

Untreated depression or anxiety can have a negative effect on your sex life, so if citalopram helps you to recover, positive effects can include improving your desire, experience and enjoyment of sex as your mood lifts and you become interested in life and relationships again.

Fertility

There is no evidence to show that citalopram affects fertility but you should still talk to your doctor about your citalopram if you are trying to get pregnant or planning a family.

Citalopram is not a banned substance in sport.

Most people play sports as normal while taking citalopram. However, taking citalopram may affect your concentration when doing things like riding a bike, competitive gymnastics, or anything else that needs a lot of focus. It can also make you feel very restless in the first few weeks so you may find it difficult to sit or stand still when you first start this medicine. It might be best to stop playing sports for the first few days until you know how it affects you.

If you are worried that taking citalopram might make doing the sports you enjoy more difficult, discuss this with your doctor.

Ideally it is best not to take citalopram for the first time just before your exams.

Taking citalopram may affect your sleep and make you feel more anxious or restless, which might interfere with your preparation for exams.

It is not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking citalopram.

You should talk to your doctor about any future exams if you are starting citalopram. You might decide together to delay starting it until you have done them. If they are more than a month away, however, you might find that it is better to start citalopram to lift your mood and improve your motivation and ability to study.

Most people take exams as normal while taking citalopram. If you are worried that taking citalopram might make studying for or taking your exams harder, discuss this with your doctor.