citalopram

Adjunctive therapy

Brands: Celexa

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is citalopram?
Citalopram is an SSRI used for major depressive and anxiety disorders in patients with serious mental illness, notable for relatively low drug interactions but dose-dependent QTc prolongation.
What is Celexa?
Celexa is a brand name for citalopram.
What is Celexa (citalopram) used for?
Label indications include: Major depressive disorder.
What drug class is Celexa (citalopram)?
Selective serotonin reuptake inhibitor (SSRI).
What strengths does Celexa (citalopram) come in?
Tablets 10–40 mg; oral solution 10 mg/5 mL.

Snapshot

Class: Adjunctive therapy
Common US brands: Celexa
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Label indications

Major depressive disorder.

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Clinical Highlights

Citalopram is an SSRI used for major depressive and anxiety disorders in patients with serious mental illness, notable for relatively low drug interactions but dose-dependent QTc prolongation. Dose limited to 40 mg/day (20 mg/day in older adults/hepatic impairment/CYP2C19 inhibitors) due to QTc prolongation; consider escitalopram for lower QT risk.

For many patients, meaningful improvement begins within 2–4 weeks, but an adequate trial often requires 6–8 weeks at a therapeutic dose unless tolerability limits continuation.
The compare view alongside the citalopram evidence feed and printable resources from the citalopram print page can support shared decision-making and counseling; the bipolar disorder hub summarizes antidepressant switch and mania-risk considerations.
Common early effects include nausea and sleep changes; longer-term concerns can include sexual dysfunction and emotional blunting. Follow-up after dose changes helps distinguish side effects from residual symptoms.
Compared with many SSRIs, citalopram has fewer CYP-mediated interactions, but QTc risk is the key limiter; reviewing other QT-active medications and correcting electrolytes helps reduce avoidable risk.
Major depressive disorder (FDA 1998)
Generic: All formulations available generically.

Dosing & Formulations

Tablets 10–40 mg; oral solution 10 mg/5 mL. Typical start is 20 mg once daily; increase to 40 mg/day after ≥4 weeks if needed (limit to 20 mg/day for ≥60 years, hepatic impairment, CYP2C19 inhibitors).

Gradual tapering can reduce discontinuation symptoms.

Monitoring & Risks

Boxed warning: Antidepressants increase suicidality risk in young adults; monitor closely. Nausea: Typically transient.

Somnolence/insomnia: Dose timing adjustments may help.
Sexual dysfunction: Reduced libido/delayed orgasm common.
Dry mouth: Hydration can help.
Hyponatremia (SIADH) can occur, especially in older adults or diuretic users; sodium monitoring is considered if symptoms emerge.
QTc prolongation significant—baseline ECG is often obtained for cardiac risk or doses >20 mg in vulnerable populations.
Discontinuation symptoms can occur if stopped abruptly (dizziness, flu-like symptoms); tapering tends to be better tolerated than sudden discontinuation.

Drug Interactions

CYP2C19 inhibitors (omeprazole, fluconazole) increase levels; labeling recommends limiting dose to 20 mg/day and monitoring QTc. MAOIs/linezolid are avoided due to serotonin syndrome risk.

Additive QTc risk with antipsychotics (ziprasidone, haloperidol); ECG monitoring may be needed.
Additive bleeding risk with NSAIDs, antiplatelets, and anticoagulants; education about bruising and GI bleeding symptoms is important.

Practice Notes

Serotonin syndrome signs are typically reviewed; urgent evaluation is warranted for palpitations, syncope, or persistent nausea. Escitalopram (S-enantiomer) is often considered when higher potency is needed with similar tolerability.

When QT risk is elevated, document the risk/benefit rationale, correct electrolytes proactively, and reassess ECG after dose changes or when adding QT-active medications.
Before dose increases, review other QT-active medications and medical risk factors, and repeat an ECG when the risk profile changes.

References

Citalopram prescribing information — DailyMed (2025)
FDA Citalopram QT 2012
CANMAT 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder — Canadian Journal of Psychiatry (2016)
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)
Comparative efficacy and acceptability of 21 antidepressant drugs for major depressive disorder — The Lancet (2018)Meta-analysisdepressionefficacy