Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Citalopram is the generic version of a prescription antidepressant called Celexa. We will use these two terms interchangeably throughout this article because they refer to the exact same active ingredient. Citalopram is a member of a drug class called selective serotonin reuptake inhibitors (SSRI), which is one of the most commonly-prescribed medications for depression.
In this article we’ll review published medical studies on citalopram to determine if the drug is safe and effective. We’ll highlight side effects of the medication and compare its efficacy to other popular antidepressants. We’ll also document a natural, over-the-counter (OTC) treatment for depression that patients averse to pharmaceutical drugs may wish to speak with their doctor about.
Does Citalopram Work?
Citalopram has been studied extensively for decades. It’s approved by the Food and Drug Administration (FDA) in the U.S. to treat major depression in adults. The drug has been on the U.S. market for over two decades.
A meta-study published in the Annals of Pharmacotherapy journal found citalopram to be more effective for depression than a placebo pill, and found that the drug was comparably effective to other antidepressants.
A medical review from 2018 analyzed 20 individual studies on citalopram and depression. The study authors documented that citalopram was effective at reducing depression scores to a statistically significant degree, and also noted that it took the drug a shorter time duration to work than most other SSRIs.
One clinical trial compared citalopram with other leading first-line antidepressants. While all of the medications were effective on average, there were some interesting results.
Citalopram was described as “significantly less effective” than escitalopram (brand name Lexapro) but more effective than paroxetine (brand name Paxil). Fewer patients suffered severe side effects when taking citalopram than those taking a class of antidepressants called tricyclics.
Overall, medical research suggests that citalopram is effective for treating all severities of depression, even major depression. This does not mean it will be effective for every patient; but rather that it reduces depression scores on average when considering an entire patient population with depression.
How Does Citalopram Work?
As noted in our Celexa for depression article, citalopram blocks reuptake of serotonin. This neurotransmitter is involved with nerve signaling and emotional regulation.
Inhibition of serotonin reuptake means that the drug delays natural processing of serotonin by the brain and body, which causes artificially elevated levels of circulating serotonin.
Since serotonin is shown in research to directly influence mood, this is thought to be the main mechanism of action by which citalopram (and other SSRIs) can treat depression. It’s theorized that patients with depression may have lower levels of serotonin than patients without depression, but this hasn’t been conclusively proven.
Citalopram Side Effects
Citalopram does cause side effects in some patients. According to a 2003 medical review, the most common side effects of the drug are nausea, sleepiness, dry mouth, and increased sweating. These side effects seem to be minor in severity.
The more rare side effects of citalopram are the more concerning ones in our opinion.
In 2017, FDA published a safety announcement about how citalopram could cause abnormal heart rhythms. The agency recommended against using the drug at daily doses higher than 40 milligrams (mg) to reduce the risk of experiencing this side effect.
Suicidal thoughts and behaviors also appears to be a rare side effect of citalopram, which unfortunately seems to be the case for a number of medications for depression.
A medical study on antidepressants and suicide found that citalopram nearly doubled the rate of suicidal ideation or attempted suicide. 7.1% of those taking citalopram in a clinical trial experienced suicidal thoughts or behaviors, compared to only 3.6% of users taking a placebo pill.
We would consider a rate of suicidality 3.5% greater than placebo to be concerning, as this is rare but not extremely rare. We strongly recommend that patients speak with their doctor about the potential for increased suicidal thoughts and behaviors if they have a personal or family history of suicidal attempts.
Citalopram may be prescribed at a wide range of doses and in various formats. As documented by StatPearls, which is one of the leading free medical databases in the U.S., citalopram is available in both tablet and liquid form, and available at dosages of 10 mg, 20 mg and 40 mg.
The StatPearls page states that adult patients typically start on a 20 mg dose, but the dose can be increased to 40 mg if the patient isn’t experiencing benefit.
Doctors will typically prescribe a starting dose at the lower end of the effective range, because this reduces the risk of side effects. If a patient can experience relief at the lowest possible dose, this is a benefit to both the patient and provider.
Can I Drink Alcohol While Using Citalopram?
Citalopram’s FDA label indicates that use of alcohol while taking the antidepressant is not advised. There isn’t a proven risk in the research literature, but SSRI drugs may increase the effects of alcohol, which can make routine tasks such as driving dangerous.
Given that the drug manufacturer recommends against using alcohol for safety reasons, we believe it may be logical for patients with alcoholism or substance abuse disorders to speak with their doctor about alternatives to citalopram which may allow for alcoholic drinks concurrent with the medication.
The ultimate goal of course would be to reduce dependence on alcohol, but if that is unlikely in the short-term it seems logical to consider medications that don’t have negative interactions with alcohol.
Does Citalopram Cause Withdrawal Symptoms?
There doesn’t appear to be conclusive evidence about whether citalopram is likely to cause withdrawal symptoms in most patients. Citalopram’s FDA label does not contain a warning about withdrawals and a medical review of antidepressants and withdrawal syndrome found citalopram to cause no negative effects to cognitive function when abruptly stopped.
That being said, there are some strange case reports about citalopram withdrawal symptoms in the medical literature.
One such report documented premature ejaculation apparently caused by citalopram withdrawal.
Another report noted hypertension (high blood pressure) as a withdrawal symptom in a patient who had abruptly stopped using citalopram.
Even though the risk of withdrawal symptoms from citalopram doesn’t seem high, we would recommend that patients notify their doctor if they’re intending to quit the medication. A doctor can set up a tapering schedule that can reduce uncomfortable symptoms and reduce the risk of withdrawal.
Citalopram Vs. Lexapro
Lexapro is another commonly-prescribed antidepressant medication, so patients are often curious about which drug is more effective. There have been medical studies directly comparing the efficacy and safety of the two.
One such study comparing citalopram and Lexapro for treating major depressive disorder (MDD) found that Lexapro was significantly more effective, and that the differential effects were observable in the data as early as the first week of treatment.
Another clinical trial on citalopram versus Lexapro, published in the Current Medical Research and Opinion journal, compared effects of the drugs when used by an elderly patient population with depression.
Those taking Lexapro were less likely to discontinue treatment, suggesting that Lexapro may be more effective in a geriatric population.
One medical study analyzed results from eight separate trials on citalopram versus Lexapro and concluded that Lexapro was more effective as an antidepressant.
Based on the available research, we consider Lexapro to be more effective overall for treating depression than citalopram. We would recommend that patients speak with their doctor about Lexapro over citalopram if they’re suffering with depression.
Citalopram Vs. Zoloft
Another popular SSRI is Zoloft, and there exists medical research comparing these two drugs.
A review published in the Human Psychopharmacology journal found citalopram to reduce average depression scores more than Zoloft. Citalopram was also found to be effective for a greater number of patients overall.
Another medical trial comparing Zoloft and citalopram in patients diagnosed with MDD found that citalopram was more effective, but not to a statistically significant degree. 81% of participants were positive responders to citalopram, while 76% were positive responders to Zoloft.
We will consider citalopram more effective than Zoloft based on medical research.
Should I Take The Branded Version of Citalopram?
As we discussed in the intro of this article, the branded version of citalopram is called Celexa. Many patients consider branded versions of drugs to be more effective due to advertising, but there should be no difference in efficacy because both drugs contain the exact same active chemical compound.
A study comparing generic drugs to branded drugs found that there was no average difference in efficacy. The study analyzed data from hundreds of thousands of patients taking prescription medication; some taking branded versions of a drug and some taking generics.
We would recommend that patients speak with their doctor about citalopram rather than Celexa if they’re interested in taking this medication. Generic versions of drugs are often cheaper, and can be more accessible in some cases.
Natural Depression Treatment - St. John’s Wort
Given that citalopram may cause severe side effects like suicidal thoughts and behaviors, patients searching for an antidepressant may benefit from speaking with their doctor about an herbal supplement called St. John’s Wort which has been studied extensively in medical research. It doesn’t appear to confer any side effects when properly dosed.
For mild-to-moderate depression, St. John’s Wort was found in a thorough medical study to be just as effective as SSRIs. The study authors analyzed data from 27 individual clinical trials on St. John’s Wort to treat depression. The studies ranged from 4-12 weeks so the long-term safety of this herb isn’t as well-established as the long-term safety data of prescription medication.
It’s worth noting that St. John’s Wort has not been conclusively proven to be effective for treating major depression, so we would recommend that patients with this condition speak to their doctor about pharmaceutical treatment.
Since herbal supplements vary significantly in terms of quality, we believe it’s worth noting that most of the St. John’s Wort supplements used in the medical trials are standardized to 2-5% hyperforin and 0.3% hypericin. These are the active chemical constituents of the plant, and standardized supplements guarantee potency.
Citalopram User Reviews
Citalopram has been reviewed over 2,000 times on Drugs.com. This website allows users of prescription medications to publish personal reviews, so we find it to be a valuable resource. However, we cannot guarantee the accuracy or authenticity of any information on this site.
Citalopram’s average rating for depression on Drugs.com is 7.2/10, which is relatively good, and better than many antidepressants we’ve previously reviewed on Illuminate Health.
The top positive review is written by a user named “Lefty” who claims the drug successfully treated both their depression and anxiety:
“I have taken [citalopram] for a month, and I feel normal. I realize now that I have been suffering from at least mild depression and anxiety for years. I don’t remember feeling normal like this ever. I believe I would have been a much better husband and father all of these years if I would have dealt with this earlier.”
The top negative review comes from a user named “Yikes” who gave the drug a 2/10 rating and claims it caused them to experience suicidal thoughts:
“After a year or so of all-consuming numbness, I began slipping. By the end of the 2nd year, I had spiraled into the darkest place I have ever been in my life. Suicide was the only thing on my mind. I had such violent intrusive thoughts that I could hardly sleep, I could hardly lay still even.”
Citalopram for Anxiety
Citalopram is not FDA-approved for treating anxiety, but there are some medical studies testing the efficacy of the drug for treating this condition.
A 2002 clinical trial on citalopram for anxiety documented impressive results. All 13 of the patients enrolled in the trial experienced significant improvements in anxiety score, and the researchers noted that these positive effects caused “meaningful improvement in social and occupational functioning.”
A separate medical study found that citalopram successfully treated social anxiety disorder in patients with both social anxiety disorder and depression. The clinical improvements in social anxiety disorder were not as strong as the improvements in depression. This does not prove that citalopram is effective at treating social anxiety disorder in patients without comorbid depression.
We can conclude from the available research that citalopram may be effective at treating anxiety, but we would not recommend using the drug for this purpose as it would be an off-label use. We would consider the potential for anxiety reduction to be a secondary benefit of the drug for patients with both anxiety and depression, but we would not recommend taking the drug for anxiety alone.