What Is Serotonin Syndrome? What You Need to Know If You Take SSRIs
Serotonin syndrome is a reaction to commonly prescribed medications and supplements. Learn what serotonin syndrome is, what causes it, and how to treat it.
citalopram
Used for Depression
Used for Depression
Citalopram (Celexa) is a first-choice medication for treating depression in adults. This antidepressant belongs to the drug class called selective serotonin reuptake inhibitors (SSRIs). Citalopram (Celexa) is typically taken by mouth once daily. It typically takes a few weeks or longer of consistent treatment to notice an improvement to your mood. Common side effects include nausea and dry mouth. There's a low risk for weight gain, but suddenly stopping the medication can lead to withdrawal symptoms (e.g., upset stomach, trouble sleeping, anxiety).
What is Citalopram (Celexa)?
What is Citalopram (Celexa) used for?
How Citalopram (Celexa) works
Citalopram (Celexa) is a selective serotonin reuptake inhibitor (SSRI). It works by raising the levels of serotonin in your brain. Serotonin is important for regulating your mood.
When does Citalopram (Celexa) start working?Time passed since treatment started:
Drug facts
| Common Brands | Celexa |
|---|---|
| Drug Class | SSRI |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
More on Citalopram (Celexa) essentials
Side effects of Citalopram (Celexa)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nausea (21%)
- Dry mouth (20%)
- Sleepiness (18%)
- Trouble sleeping (15%)
- Sweating (11%)
- Tremor (8%)
- Diarrhea (8%)
- Ejaculation problems (6%)
Less Common Side Effects
- Indigestion
- Upper respiratory tract infection
- Stuffy nose
- Changes in appetite
- Anxiety
- Sexual health problems (e.g., low sex drive, trouble having an orgasm, erectile dysfunction)
Citalopram (Celexa) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts or behaviors
- Abnormal heart rhythm: chest pounding, short of breath, chest pain, feeling faint or lightheaded
- Serotonin syndrome: fast heart rate, dizziness, sweating, flushing, tremor (shakiness), muscle stiffness, muscle twitching or spasms, uncoordinated movement
- Serious bleeding: bruising that doesn't improve, black-colored stools, pink or red-colored urine, coughing up or vomiting blood, unusual bleeding from the nose or gums
- Low sodium levels: nausea, fatigue, headache, confusion, disoriented
- Seizures
When do Citalopram (Celexa) possible side effects begin and end?
Time passed since treatment started:
H
D
W
M
Nausea
Dry mouth
Changes in sleep
Sweating more
Suicidal thoughts
Seek immediate medical care if you experience this side effect.
If a line continues to the right, you'll likely keep experiencing this side effect once it starts.
More on Citalopram (Celexa) side effects
The following Citalopram (Celexa) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Agitation
blurred vision
confusion
increase in the frequency of urination or amount of urine produced
lack of emotion
loss of memory
menstrual changes
skin rash or itching
trouble breathing
Rare
Behavior change similar to drunkenness
bleeding gums
breast tenderness or enlargement or unusual secretion of milk (in females)
chills
convulsions (seizures)
difficulty with concentrating
dizziness or fainting
drowsiness
increased hunger
increased thirst
irregular heartbeat
lack of energy
lethargy
nosebleed
overactive reflexes
poor coordination
purple or red spots on the skin
rapid weight gain
red or irritated eyes
redness, tenderness, itching, burning, or peeling of the skin
shivering
slow or irregular heartbeat (less than 50 beats per minute)
stupor
sweating
swelling of the face, ankles, or hands
talking or acting with excitement you cannot control
trembling, shaking, or twitching
trouble with holding or releasing urine
unusual or sudden body or facial movements or postures
unusual tiredness or weakness
Incidence not known
Abdominal or stomach pain
back or leg pains
black, tarry stools
bloody stools
confusion as to time, place, or person
darkened urine
difficult or fast breathing
difficulty with swallowing
fast, slow, or irregular heartbeat
general body swelling
hive-like swelling on the face, eyelids, lips, tongue, or throat
holding false beliefs that cannot be changed by fact
impaired consciousness, ranging from confusion to coma
indigestion
itching, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
loss of appetite
loss of bladder control
loss of consciousness
muscle cramps or spasms
muscle tightness
muscle twitching or jerking
painful or prolonged erection of the penis
pale skin
penile erections, frequent or continuing
recurrent fainting
rhythmic movement of the muscles
seeing, hearing, or feeling things that are not there
swelling of the breasts or unusual milk production
tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area
tightness in the chest
total body jerking
twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
uncontrolled jerking or twisting movements
unusual excitement
vomiting of blood or material that looks like coffee grounds
yellowing of the eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Decrease in sexual desire or ability
sleepiness or unusual drowsiness
Less common
Body aches or pain
change in sense of taste
headache (severe and throbbing)
increased sweating
increased yawning
loss of voice
pain in the muscles or joints
stuffy or runny nose
tingling, burning, or prickly feelings on the skin
tooth grinding
unusual increase or decrease in weight
watering of the mouth
Incidence not known
Bruising
inability to sit still
large, flat, blue or purplish patches in the skin
need to keep moving
uncontrolled eye movements
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Citalopram (Celexa)
Pros
- A first-choice option for treating depression
- One of the safest antidepressants for older adults
- Available as a tablet, capsule, and a mint-flavored liquid
- Taken by mouth once daily
Cons
- Can take a couple months before you feel the full effects of this medication
- Can interact with other medications, especially those affecting serotonin levels or heart rhythm
- Can cause withdrawal symptoms if you suddenly stop taking it
- Not FDA-approved for children
Pharmacist tips for Citalopram (Celexa)
- You can take citalopram (Celexa) with or without food. Keep in mind that citalopram (Celexa) commonly causes nausea, especially when you first start the medication and when your dose changes. Taking the medication with food might help lessen this stomach upset.
- If you get nauseous after you start taking citalopram (Celexa), it should get better as you continue taking the medication. Let your prescriber know if nausea doesn't go away or if it's bothersome. They might lower your citalopram (Celexa) dose or prescribe medications to help with nausea.
- Don't change your dose or suddenly stop taking citalopram (Celexa) without talking to your psychiatrist first. Otherwise, this could lead to withdrawal symptoms like nausea, headache, and sleep problems. Follow your prescriber's instructions to lower your dose slowly over a period of time to stop the medication completely.
- Citalopram (Celexa) can make some people have trouble sleeping and other people tired. Take the medication either in the morning or at night depending on how it affects your sleep. Just make sure to be consistent with when you take it (at the same time every day).
- Avoid alcohol while you're taking citalopram (Celexa). Alcohol can worsen certain side effects like drowsiness or dizziness. It might also worsen your depression symptoms.
- Don't drive or do anything requiring concentration until you know how citalopram (Celexa) affects you. It's possible for the medication to make you sleepy and lower your ability to think clearly or react fast.
- Antidepressant medications like citalopram (Celexa) can raise the risk of thoughts about self-harm. Contact your psychiatrist right away if you or your loved ones notice any new or worsening changes in your behavior or mood while you're taking this medication.
- Tell your psychiatrist, pharmacist, and primary care provider about all the medications you take. Don't start any new medications while you're taking citalopram (Celexa) without talking to your care team first. They can check whether you need any changes to your treatment plan to keep you safe from harmful citalopram (Celexa) interactions.
- Talk with your psychiatrist or primary care provider about the benefits and risks of taking citalopram (Celexa) during pregnancy. It's not completely clear how safe it is to take medication while pregnant, but a study showed that it doesn't seem to cause major birth defects when it's used during pregnancy.
- Don't breastfeed your baby while you're taking citalopram (Celexa) without talking to your psychiatrist or primary care provider first. Low amounts of the medication can get into breast milk. This means there's a risk that your baby might have side effects, such as sleepiness, restlessness, and poor feeding.
More tips for citalopram (Celexa) 10 mg/5 mL liquid:
- Make sure to use an oral syringe or medication dosing cup to measure out your citalopram (Celexa) dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose. Ask your pharmacy for extra oral syringes or dosing cups just in case you lose one.
- Store the liquid at room temperature in the original bottle it came in from the pharmacy.
More on Citalopram (Celexa) tips
Risks and warnings for Citalopram (Celexa)
Citalopram (Celexa) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Worsening depression, suicidal thoughts, and unusual behavior
- Risk factors: Age under 24 years old | History of other mental health conditions
Taking citalopram (Celexa) can put you at risk for worsened depression and thoughts of suicide or self-harm. The risk is highest if you're 24 years of age or younger, if you just started taking the medication (during the first few weeks of starting), and if your dose just changed. Get medical help right away if you or anyone around you notices that you have suicidal thoughts or unusual behavior (e.g., anxiety, panic attacks, trouble sleeping, feeling angry or irritated, restlessness) while you're taking citalopram (Celexa).
Life-threatening abnormal heart rhythm (QT prolongation)
- Risk factors: Low blood potassium or magnesium levels | Older age | Kidney problems | History of heart problems, slow heart rate, or other abnormal heart rhythms (arrhythmias) | Personal or family history of long QT syndrome | Taking other medications that cause QT prolongation
Citalopram (Celexa) can affect your heart rhythm, which can be serious and life-threatening. More specifically, this medication can lengthen the time period from when the heart pumps and then relaxes. This is known as QT prolongation.
Your risk for QT prolongation and heart rhythm problems is higher if you have certain factors, including having abnormal electrolyte levels, having heart rhythm conditions, or taking other medications that cause heart rhythm problems, among others. To lower your risk, your psychiatrist or primary care provider might recommend that you get an electrocardiogram (EKG) done to make sure your heart rhythm is normal.
Call 911 right away if you feel your chest pounding, chest pain, short of breath, faint, or lightheaded while you're taking citalopram (Celexa). These can be symptoms of an abnormal heart rhythm.
Serotonin syndrome
- Risk factors: Taking other medications that raise serotonin levels
Some people who took citalopram (Celexa) have developed a rare, but potentially life-threatening condition called serotonin syndrome. This condition happens when there's too much serotonin in the brain.
Your risk for serotonin syndrome is higher if you take citalopram (Celexa) with other medications that can raise your serotonin levels. These medications can include certain antidepressants, mental health medications, and migraine medications. Let your psychiatrist, primary care provider, and pharmacist know about all the medications you take before you start citalopram (Celexa). Also, don't start any new medications without talking to them first.
Get medical help right away if you have any symptoms of serotonin syndrome while you're taking citalopram (Celexa). Symptoms can include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion.
Withdrawal
- Risk factors: Stopping citalopram (Celexa) suddenly
Suddenly stopping citalopram (Celexa) can cause withdrawal symptoms. You might feel nauseous, anxious, distressed, or dizzy; have flu-like symptoms; or have trouble sleeping. Ask your prescriber if you want to or need to stop taking citalopram (Celexa). Your prescriber will give you specific instructions on how to stop the medication safely over time. Never try to stop citalopram (Celexa) on your own and without your prescriber's guidance.
Higher risk of bleeding
- Risk factors: Taking blood-thinners or other medications that raise your risk of bleeding
Citalopram (Celexa) can raise your risk of bleeding or bruising. Be careful if you need to take citalopram (Celexa) along with other medications that can put you at greater bleeding risk. These other medications can include aspirin, clopidogrel (Plavix), and blood thinners like warfarin (Coumadin) and apixaban (Eliquis). Get medical help if you have signs of unusual bleeding, such as bruising that doesn't improve, black-colored stools, pink or red-colored urine, coughing up or vomiting blood, or unusual bleeding from the nose or gums.
Not for use in bipolar disorder by itself
Depression can be the first sign of bipolar disorder. If you're at risk for bipolar disorder, taking antidepressants like citalopram (Celexa) by themselves can trigger a bipolar manic episode. For this reason, citalopram (Celexa) isn't used to treat bipolar depression.
Your psychiatrist will check whether you have or are at risk for bipolar disorder before you start taking citalopram (Celexa). Talk to your psychiatrist right away if you or your loved ones notice unusual changes in your behavior, such as racing thoughts, restlessness, getting easily distracted, or unusual talkativeness. These can be symptoms of a manic episode.
Glaucoma
- Risk factors: History of angle-closure glaucoma
Citalopram (Celexa) can lead to or worsen angle-closure glaucoma. Be sure to visit your optometrist for regular eye exams to check your eyes and vision while you're taking this medication. Contact your optometrist or psychiatrist if you notice changes in your vision after you start taking citalopram (Celexa).
Low sodium levels
- Risk factors: Older people | Taking diuretics (water pills)
Citalopram (Celexa) can cause low sodium levels in the blood. Watch out for symptoms of low sodium levels, such as weakness, headache, trouble concentrating, and confusion. Get medical help right away if you notice these symptoms because having low sodium levels is a medical emergency.
More on Citalopram (Celexa) warnings
Citalopram (Celexa) dosage
The average cost for 30 tablets of 20mg of Citalopram (Celexa) is $9.00 with a free GoodRx coupon. This is 0.00% off the average retail price of $9.00.
Typical dosage for Citalopram (Celexa)
The typical starting dose is 20 mg by mouth once daily. If needed, your prescriber might raise your dose to 40 mg once daily after a week. The maximum recommended dose is 40 mg daily.
Your dose might be lower if you're an older adult or if you have liver problems.
More on Citalopram (Celexa) dosage
Interactions between Citalopram (Celexa) and other drugs
Citalopram (Celexa) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Citalopram (Celexa). Please note that only the generic name of each medication is listed below.
More on Citalopram (Celexa) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bromopride
- Cisapride
- Clorgyline
- Dronedarone
- Fluconazole
- Furazolidone
- Iproniazid
- Isocarboxazid
- Ketoconazole
- Levomethadyl
- Linezolid
- Mesoridazine
- Methylene Blue
- Metoclopramide
- Moclobemide
- Nelfinavir
- Nialamide
- Pargyline
- Phenelzine
- Pimozide
- Piperaquine
- Posaconazole
- Procarbazine
- Rasagiline
- Selegiline
- Sparfloxacin
- Terfenadine
- Thioridazine
- Toloxatone
- Tranylcypromine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abciximab
- Aceclofenac
- Acemetacin
- Acenocoumarol
- Alfentanil
- Alfuzosin
- Almotriptan
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Amphetamine
- Amtolmetin Guacil
- Anagrelide
- Ancrod
- Anisindione
- Antithrombin III Human
- Apixaban
- Apomorphine
- Ardeparin
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Artemether
- Asenapine
- Aspirin
- Astemizole
- Azithromycin
- Bedaquiline
- Bemiparin
- Benzhydrocodone
- Benzphetamine
- Bivalirudin
- Bromfenac
- Bufexamac
- Buprenorphine
- Bupropion
- Buserelin
- Butorphanol
- Cangrelor
- Celecoxib
- Ceritinib
- Certoparin
- Chloramphenicol
- Chloroquine
- Chlorpromazine
- Choline Salicylate
- Cilostazol
- Cimetidine
- Ciprofloxacin
- Clarithromycin
- Clofazimine
- Clomipramine
- Clonixin
- Clopidogrel
- Clozapine
- Codeine
- Crizotinib
- Cyclobenzaprine
- Dabrafenib
- Dalteparin
- Danaparoid
- Dasatinib
- Defibrotide
- Degarelix
- Delamanid
- Dermatan Sulfate
- Desirudin
- Deslorelin
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexfenfluramine
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Dextromethorphan
- Diclofenac
- Dicumarol
- Diflunisal
- Dihydrocodeine
- Dipyridamole
- Dipyrone
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Droperidol
- Droxicam
- Duloxetine
- Edoxaban
- Efavirenz
- Eletriptan
- Encorafenib
- Enoxaparin
- Entrectinib
- Epoprostenol
- Eptifibatide
- Erythromycin
- Escitalopram
- Eslicarbazepine Acetate
- Esomeprazole
- Etodolac
- Etofenamate
- Etoricoxib
- Felbamate
- Felbinac
- Fenfluramine
- Fenoprofen
- Fentanyl
- Fepradinol
- Feprazone
- Fingolimod
- Flecainide
- Floctafenine
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Formoterol
- Foscarnet
- Fostemsavir
- Frovatriptan
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Heparin
- Histrelin
- Hydrocodone
- Hydromorphone
- Hydroxychloroquine
- Hydroxytryptophan
- Hydroxyzine
- Ibuprofen
- Ibutilide
- Iloperidone
- Iloprost
- Indomethacin
- Inotuzumab Ozogamicin
- Iobenguane I 123
- Iobenguane I 131
- Itraconazole
- Ivabradine
- Ivosidenib
- Ketoprofen
- Ketorolac
- Lansoprazole
- Lapatinib
- Lasmiditan
- Lefamulin
- Lenvatinib
- Leuprolide
- Levofloxacin
- Levomilnacipran
- Levorphanol
- Lisdexamfetamine
- Lithium
- Lofexidine
- Lopinavir
- Lorcaserin
- Lornoxicam
- Loxoprofen
- Lumefantrine
- Lumiracoxib
- Macimorelin
- Meclofenamate
- Mefenamic Acid
- Mefloquine
- Meloxicam
- Meperidine
- Metaxalone
- Methadone
- Methamphetamine
- Metronidazole
- Mifepristone
- Milnacipran
- Mirtazapine
- Modafinil
- Morniflumate
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nabumetone
- Nadroparin
- Nafarelin
- Nalbuphine
- Naproxen
- Naratriptan
- Nepafenac
- Niflumic Acid
- Nilotinib
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Omeprazole
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxaprozin
- Oxcarbazepine
- Oxycodone
- Oxymorphone
- Oxyphenbutazone
- Ozanimod
- Paliperidone
- Palonosetron
- Panobinostat
- Pantoprazole
- Parecoxib
- Parnaparin
- Paroxetine
- Pasireotide
- Pazopanib
- Pentamidine
- Pentazocine
- Pentosan Polysulfate Sodium
- Phenindione
- Phenprocoumon
- Phenylbutazone
- Piketoprofen
- Pimavanserin
- Piroxicam
- Pitolisant
- Ponesimod
- Pranoprofen
- Prasugrel
- Probenecid
- Procainamide
- Prochlorperazine
- Proglumetacin
- Promethazine
- Propafenone
- Propyphenazone
- Proquazone
- Protriptyline
- Quetiapine
- Quinidine
- Quinine
- Ranolazine
- Remifentanil
- Reviparin
- Ribociclib
- Risperidone
- Rivaroxaban
- Rizatriptan
- Rofecoxib
- Safinamide
- Salicylic Acid
- Salsalate
- Saquinavir
- Selexipag
- Selpercatinib
- Sertraline
- Sevoflurane
- Sibutramine
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Sodium Salicylate
- Solifenacin
- Sorafenib
- Sotalol
- St John's Wort
- Sufentanil
- Sulfinpyrazone
- Sulindac
- Sumatriptan
- Sunitinib
- Tacrolimus
- Tapentadol
- Telithromycin
- Tenoxicam
- Tetrabenazine
- Tiaprofenic Acid
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Topiramate
- Toremifene
- Tramadol
- Trazodone
- Treprostinil
- Triclabendazole
- Trifluoperazine
- Trimipramine
- Triptorelin
- Tryptophan
- Valdecoxib
- Vandetanib
- Vardenafil
- Vemurafenib
- Vilazodone
- Vinflunine
- Voclosporin
- Vorapaxar
- Voriconazole
- Vortioxetine
- Warfarin
- Zolmitriptan
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Desipramine
- Ginkgo
- Imipramine
- Irinotecan
- Metoprolol
- Rifampin
How much does Citalopram (Celexa) cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Citalopram (Celexa) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Citalopram (Celexa) will not be safe for you to take.
- Currently take or have taken an MAOI, linezolid (Zyvox), or methylene blue (ProvayBlue) in the last 14 days
- Take pimozide
What are alternatives to Citalopram (Celexa)?
There are a number of medications that your doctor can prescribe in place of Citalopram (Celexa). Compare a few possible alternatives below.
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Citalopram (Celexa) images
