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Celexa (Citalopram) Information

Celexa (citalopram hydrobromide) is a prescription medication belonging to the class of Selective Serotonin Reuptake Inhibitors (SSRIs). It is primarily indicated for the treatment of Major Depressive Disorder (MDD) in adults. It is one of the most widely prescribed antidepressants globally. Citalopram works to improve mood, sleep, appetite, and energy levels in individuals struggling with depression. It is also often used off-label to manage symptoms of anxiety disorders, including panic disorder and social anxiety disorder. As with all antidepressants, Celexa must be taken consistently every day, and it can take several weeks of continuous therapy for the full therapeutic benefit to be established.

The mechanism of action for citalopram is one of the most selective within the SSRI class. Citalopram potently and selectively inhibits the reuptake of the neurotransmitter serotonin (5-HT) by blocking the Serotonin Transporter (SERT) in the brain. This action leads to an increased concentration of serotonin in the synaptic cleft, thereby enhancing serotonergic neurotransmission. This enhanced signalling is believed to mediate its mood-elevating and anti-anxiety effects. Importantly, citalopram has minimal affinity for other receptors (such as adrenergic, histaminergic, or cholinergic receptors) compared to older medications like tricyclic antidepressants (TCAs), which translates to a more favourable and tolerable side effect profile.

Celexa is available in Canada as a prescription-only medication in tablet and oral solution forms. The standard starting dose for adults is typically 20 mg once daily, taken with or without food. The maximum recommended dose for most patients is 40 mg once daily. However, due to the risk of a severe heart rhythm abnormality, the maximum dose is restricted to 20 mg once daily for patients over 60 years of age and those with hepatic impairment or who are taking certain interacting medications. It is approved for use in adults 18 years of age and older.

Celexa Side Effects

Common side effects of Celexa are usually mild and tend to diminish over the first few weeks as the body adjusts to the medication. These effects are often related to gastrointestinal or central nervous system activity and include nausea, dry mouth, drowsiness, insomnia, increased sweating, tremor, and dizziness. Sexual dysfunction is also a widespread side effect associated with all SSRIs, presenting as decreased libido, delayed ejaculation, or anorgasmia. However, more serious side effects can occur, although they are rare. If any of the following symptoms are experienced, the patient should stop taking the medication and seek immediate medical attention:

• Abnormal Bleeding: Increased risk of bleeding events, including ecchymosis (bruising) and gastrointestinal hemorrhage, due to citalopram's effect on platelet aggregation, mainly when used concurrently with antiplatelet agents or anticoagulants.

• Cardiac Arrhythmias (QT Prolongation and Torsade de Pointes): Citalopram can cause a dose-dependent prolongation of the heart's QT interval, which may lead to a potentially fatal, irregular heart rhythm known as Torsade de Pointes. Symptoms may include a fast or irregular heartbeat, severe dizziness, or fainting.

• Hyponatremia and SIADH: A rare but serious condition involving low sodium in the blood (hyponatremia), often resulting from the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Symptoms, which can be severe, include headache, difficulty concentrating, confusion, weakness, and unsteadiness.

• Seizures and Activation of Mania: Like all antidepressants, Celexa carries a risk of lowering the seizure threshold, requiring careful monitoring in susceptible patients. It may also precipitate a manic or hypomanic episode in patients with undiagnosed bipolar disorder. • Serotonin Syndrome: A potentially life-threatening reaction that results from an excessive amount of serotonin, typically when citalopram is combined with other serotonergic drugs (e.g., MAOIs, triptans, tramadol). Symptoms may include agitation, hallucinations, rapid heart rate, fever, muscle rigidity, and incoordination. • Suicidality and Worsening of Depression (Boxed Warning): Antidepressants, including Celexa, carry a warning for increasing the risk of suicidal thoughts and behaviour, particularly in young adults (under 25) during the initial phase of treatment or following a dose change. Any sudden or severe changes in mood, behaviour, or the emergence of suicidal ideation must be reported immediately.

Celexa Precautions

Before taking Celexa, it is essential to have a thorough discussion with a healthcare provider about your medical history and any other medications you are taking. Celexa is absolutely contraindicated for use with Monoamine Oxidase Inhibitors (MAOIs) due to the severe risk of Serotonin Syndrome and is also contraindicated with the antipsychotic pimozide due to the combined risk of cardiac QT prolongation. To mitigate the risk of severe cardiac arrhythmia, the maximum recommended dose must not exceed 20 mg per day for patients over 60, those with hepatic impairment, or individuals taking certain interacting medications (like cimetidine or ritonavir), and caution is always required in patients with pre-existing heart conditions, congenital long QT syndrome, or uncorrected electrolyte abnormalities (low potassium or magnesium). Patients with a history of seizure disorder should be monitored carefully, as citalopram may lower the seizure threshold. The drug should be used with caution in individuals with a history of bleeding disorders or those concurrently taking anticoagulants (e.g., warfarin) or NSAIDs, as citalopram can impair platelet aggregation. Furthermore, Celexa should be used with caution in patients with a history of mania/hypomania due to the risk of activating a manic episode. If you are pregnant or breastfeeding, the risks and benefits must be carefully weighed with your doctor. Finally, treatment should never be stopped abruptly; the dose must be tapered slowly under medical supervision to avoid the signs and symptoms of discontinuation syndrome.

Do I need a prescription to order Celexa?

Yes, a prescription is required from your physician to order Celexa.