Citalopram is used, among other things, to treat depression. The active ingredient belongs to a group of selective serotonin reuptake inhibitors (SSRIs).
What is citalopram?
The drug citalopram is a development by the Danish pharmaceutical company Lundbeck. The patent was granted in 1989. The patent for the antidepressant expired in 2003, so that there are now numerous generic drugs on the market.
Citalopram is the most frequently prescribed psychopharmacologically effective preparation in Germany. The defined daily dose (DDD) is 338 million. The active ingredient was originally developed to treat epilepsy. However, it quickly became apparent that due to its mood-balancing effect, citalopram can also be used to treat depression associated with emotional instability.
Pharmacological effect
Citalopram is a selective serotonin reuptake inhibitor. SSRIs work in the synaptic cleft. They inhibit the reuptake of the neurotransmitter serotonin (5-HT) in the presynapse. Serotonin is both a hormone and a neurotransmitter. The substance occurs, among other things, in the cardiovascular system and the central nervous system.
Serotonin has a big impact on mood. The neurotransmitter conveys a feeling of contentment, serenity and inner calm. Serotonin dampens aggression, fears and grief. It is believed that a lack of serotonin or a lack of the serotonin precursor tryptophan is behind many depression and anxiety disorders.
Citalopram inhibits the reuptake of serotonin from the synaptic cleft into the presynapse. Because the existing serotonin remains in the synaptic gap longer, the effect of the neurotransmitter is increased. However, the neurophysiological adaptation that occurs initially prevents the effect. The very high serotonin level in the synaptic gap has an influence on the autoreceptors of the presynapse. These serve as feedback sensors. They are activated by the high concentration of serotonin and convey the information to the cell that serotonin production must be reduced because there is too much serotonin. This initially creates another deficiency. However, since the receptor is permanently stimulated by the SSRI, the body reduces the sensitivity of the autoreceptors. However, it may take a few weeks for this process to complete. This is the reason why the antidepressant effect of citalopram often only sets in after a few weeks.
Medical application & use
The main area of application for citalopram is depression. Citalopram is used in particular for depression, which is associated with emotional instability. These include, for example, bipolar disorder and borderline disorder. Bipolar disorder is one of the affect disorders. Initially, the disorder was known as manic-depressive illness. The borderline personality disorder is mainly characterized by impulsiveness, unstable interpersonal relationships, moods and a fragile self-image. When treating bipolar disorder, however, it must be taken into account that citalopram can trigger a manic phase.
Citalopram is also used to treat obsessive-compulsive disorder. However, the drug has to be dosed very high. The same applies to the treatment of panic disorder and post-traumatic stress disorder (PTSD) with citalopram.
When treating depression, it should be noted that not all patients will respond to citalopram. Symptoms only improve in around 50 to 75 percent of patients. In comparison, 25 to 33 percent respond to placebos. In the case of mild depression, many comparative studies even found no difference in the effect compared to placebos.
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➔ Medicines against depressive moods & to lighten the moodRisks & side effects
Adverse drug effects such as insomnia, nausea, dry mouth, nervousness, headache, tremors, and profuse sweating often occur within the first few days after starting the drug. These side effects usually go away on their own after a few days. However, sexual disorders can occur. In particular, the patients suffer from difficulty orgasm. However, these sexual dysfunctions are usually temporary and go away after you stop taking the drug. In rare cases, however, the sexual dysfunction persists for months or years after citalopram has been discontinued. This syndrome is also known as Post SSRI Sexual Dysfunction.
A very common side effect of citalopram is rhinitis (chronic runny nose). In very rare cases the so-called serotonin syndrome can develop. The risk of serotonin syndrome is greatly increased, especially if other serotonergic drugs are taken at the same time. The syndrome manifests itself as a high fever, tremors, muscle twitching, confusion, and excessive excitement. Therefore, Citalopram must not be used together with MAO inhibitors, tramadol, tryptophan and the pain reliever fentanyl. There are also interactions with St. John's wort preparations.
When taking citalopram for the first time, thoughts of suicide have also been observed. Citalopram appears to increase the risk of suicide, particularly in patients under the age of 25.
Although citalopram does not show any potential for dependence in the strict sense of the word, sudden discontinuation can lead to dizziness, nausea, sensory disturbances, anxiety, palpitations, increased sweating and sleep disorders. Citalopram should therefore always be discontinued gradually.
Citalopram should only be used in exceptional cases during pregnancy. There are currently insufficient data to justify use in pregnancy. However, suddenly stopping the drug during pregnancy should also be avoided. If citalopram was used in the last trimester of pregnancy, the newborn should be closely monitored after birth. Withdrawal symptoms such as tremors, constant crying, constipation, muscle twitching, or diarrhea may appear.
