Citalopram | SSRI Antidepressant Use and Side Effects

Medication name

Citalopram ("sit-AL-o-pram")
Brand name

Cipramil ("SIP-ram-il")
Medication type

Selective serotonin reuptake inhibitor (SSRI)

Tablets: 10mg, 20mg and 40mg strengths

Oral drops*: 40mg per ml. Four drops (8mg) is the same as one 10mg tablet.

*The drops contain a small amount of alcohol, but not enough to affect your blood alcohol level.

If you are 18 or over, the doctor can prescribe citalopram for you as a licensed medicine for depression (low mood) or panic disorder.

If you are under 18, a specialist doctor may still consider this as a treatment option. Your doctor may also consider this medicine for anxiety and obsessive-compulsive disorder.

Read our guide to depression

About citalopram

Citalopram is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).

Serotonin (also called '5HT') is a naturally occurring chemical messenger (or ‘neurotransmitter’) that has an important role in areas of the brain that control mood, thinking, feelings and emotions. Research suggests that depression or low mood is more likely to occur when the brain doesn’t have enough serotonin.

Selective serotonin reuptake inhibitors (SSRIs) like citalopram are thought to work by increasing levels of serotonin in the brain.

Depression, and other conditions like anxiety disorders, are not just caused by low serotonin levels, but a rise in serotonin levels can improve symptoms and help you to feel better.

Citalopram and everyday life

Citalopram should start helping with depression within one to two weeks. It may take four weeks or longer for you to get the full effect.

How people respond to treatment can vary. Sometimes improvement is slow, and you may not feel any different to start with. This can be hard when your mood is low, and if you experience any side effects form your medication you may think you feel worse and not better. If you can, give your medication a chance to work and continue to take it for at least three to four weeks to see if it makes a difference.

Your parents, friends and doctor may notice an improvement in you before you feel it yourself, so it’s a good idea to talk to them.

If you think your medicine has not made any difference to how you feel after three to four weeks, you should go back to your doctor. They might recommend a change in dose or a different medication. However, it can take longer to work for some people than for others, so they may suggest you wait six to eight weeks before deciding.

For anxiety, it may take longer for the benefits to be noticed. It could take up to three months before you feel the full benefit.

For some people, anxiety symptoms briefly increase at the start of treatment, but the anxiety should decrease over time as you continue to take your medicine. To avoid or minimise this your doctor will usually start treatment with a low dose and increase this after one to two weeks.

Citalopram can cause people to lose weight when they first start taking it.

Some people find that they gain a little weight in the long term. This might be due in part to a return of their appetite.
It is not possible to predict how citalopram will affect each person before they start taking it. Talk to your doctor or pharmacist if you are concerned about your weight, or changes to your weight, while taking citalopram.

A very common side effect of citalopram is a dry mouth. Over a long time, this can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking citalopram so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

You can feel drowsy in the first few days of taking citalopram. This should improve within a few weeks. If it makes you feel drowsy, try taking it just before you go to bed. If you have been taking citalopram for more than a month and you continue to feel very tired, sleepy or struggle to function during the day, you should go back to your doctor and discuss what changes could be made to help. This may include switching to a different medication.

Alcohol

It may be possible to drink some alcohol in moderation while taking citalopram. However, the two together might make you feel very sleepy and unsteady on your feet, especially when you first start taking the medication.

During the first few weeks of treatment, it is recommended that you don’t drink alcohol until you know how the medicine affects you.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

Cannabis can make drowsiness worse with citalopram and give you a fast heartbeat.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis.

Methadone can make drowsiness worse with citalopram. The citalopram could increase the concentration of methadone in your body. The two together can also cause serious heart problems. If you are prescribed methadone by your doctor and also need a medicine to help with depression or anxiety, citalopram may not be the best choice. They can be prescribed together, but extra monitoring would be needed and your doctor would discuss the risks with you first.
Citalopram could raise the level of cocaine in your body, giving you a bigger reaction. Your blood pressure could also increase to a dangerous level.

Taking citalopram with cocaine, ecstasy or amfetamines could bring on serotonin syndrome. You could get a high temperature/fever, agitation, confusion, trembling or weird muscle movements. You need to go to hospital urgently if this happens. Tell the doctor that you are taking citalopram.

There are many other street drugs, but we don’t know what effect taking them with citalopram will have, so it’s best to be cautious. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on drugs and alcohol.

Citalopram does not mix well with some other medicines, including herbal remedies. It may affect how they work or could cause more side effects.

Do not take citalopram if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.

Do not take citalopram if you are taking the herbal remedy St. John’s Wort. This does not mix well with citalopram, so please tell your doctor or pharmacist if you are trying this or would like to try it.
Citalopram can affect the way your heart works and should be used carefully with other medicines that can also affect the heart.

Before you start taking citalopram, tell your doctor if you are taking any other medications, including things you have bought from a pharmacy or other shop for common illnesses like colds and flu or medications that you put on your skin.

Always tell the pharmacist that you are taking citalopram if you buy any medicines from a pharmacy.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with citalopram. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

The tablets may not be suitable for you if you have problems eating some sugars or dairy foods, as they contain lactose.

The drops contain a small amount of alcohol, but not enough to affect your blood alcohol level.

There are several companies that manufacture this medicine and the non-active ingredients are likely to vary between products.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

If you need to avoid animal products such as gelatine, please note that this is often found in capsules but also in some tablet formulations. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Taking citalopram may affect your ability to do things like driving a car, riding a bike, or anything else that needs a lot of focus or balance. It can make you tremble, or feel dizzy or restless.

It is recommended that you stop driving or riding a bike for the first few days or weeks, until you know how it affects you.

Most people drive as normal while taking citalopram. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

Pregnancy

If you become pregnant while you are on citalopram, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing citalopram and help you to make a decision that is best for you and your baby. They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking citalopram during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Untreated depression or anxiety can also be harmful to you and your developing baby, so decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that carrying on with citalopram has more benefits than risks, you should tell your midwife that you are continuing to take this at your next appointment.

Some research has reported that taking SSRI antidepressants during the month before delivery can result in a small increased risk of bleeding after you have given birth. It will be important for your doctor and midwife to know what medication you are taking so that appropriate monitoring and treatment is planned. If you are concerned about this, discuss it with your doctor and midwife.

If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with citalopram.

Post-natal

If citalopram is taken in the last five months of a pregnancy, studies have shown a small increased risk of persistent pulmonary hypertension of the new-born (PPHN). This occurs in the first 24 hours after birth and can make the baby breathe faster and look a bit blue in colour. PPHN affects around three in 1,000 babies born to mums who take SSRIs. This compares with a rate of two in 1,000 among babies born to mums who do not take SSRIs. More recent research has failed to reproduce this finding. If you are concerned about this, talk to your doctor and midwife. If this does occur, you will need help from your midwife, so it is important they are looking out for symptoms.

There are some other symptoms that can occur in new-born babies if citalopram is taken in the last three months of pregnancy. Look out for these and get help if they happen:

jerking or twitching of the muscles or shaking
being jittery, irritable or constant crying
being too hot or cold
suckling/ feeding difficulties or being sick
having stiff or floppy muscles, or overactive reflexes
being very sleepy or finding it difficult to sleep

These are usually mild and go away in a few days without treatment.

Breastfeeding

Please talk to your midwife, doctor or pharmacist if you want to breastfeed while taking citalopram.

Citalopram does pass into breast milk in very small amounts. Levels in babies breast-fed by mothers taking citalopram had very low or undetectable levels.

If your baby was born early or has health problems, then breastfeeding while you are taking citalopram may not be recommended.

If you breastfeed while taking citalopram, seek urgent medical advice if your baby becomes restless, very sleepy, or develops feeding problems.

If your medication makes you sleepy, do not to sleep with your baby in the same bed, and be cautious when handling your baby (especially if waking during the night for feeds).

Sex

Citalopram can have side effects that might affect your sex life, including:

painful erections, problems with getting an erection (getting hard) and ejaculating (coming)
bleeding from the vagina and difficulty reaching orgasm (coming) the same way as before or not being able to have an orgasm at all
reduced genital sensation
lower sex drive

Most side effects occur when you first start medication and improve over time. If they do not, and this is a problem for you, make an appointment to discuss this with your doctor.

There is some evidence to indicate that some side effects affecting your sex life might continue for several months or longer after you stop your medicine. This is sometimes referred to as PSSD (post SSRI sexual dysfunction). More research is needed to understand how frequently this might happen. Discuss this with your doctor or pharmacist is you are concerned.

Untreated depression or anxiety can have a negative effect on your sex life, so if citalopram helps you to recover, positive effects can include improving your desire, experience and enjoyment of sex as your mood lifts and you become interested in life and relationships again.

Fertility

There is no evidence to show that citalopram affects fertility but you should still talk to your doctor about your citalopram if you are trying to get pregnant or planning a family.

Citalopram is not a banned substance in sport.

Most people play sports as normal while taking citalopram. However, taking citalopram may affect your concentration when doing things like riding a bike, competitive gymnastics, or anything else that needs a lot of focus. It can also make you feel very restless in the first few weeks so you may find it difficult to sit or stand still when you first start this medicine. It might be best to stop playing sports for the first few days until you know how it affects you.

If you are worried that taking citalopram might make doing the sports you enjoy more difficult, discuss this with your doctor.

Ideally it is best not to take citalopram for the first time just before your exams.

Taking citalopram may affect your sleep and make you feel more anxious or restless, which might interfere with your preparation for exams.

It is not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking citalopram.

You should talk to your doctor about any future exams if you are starting citalopram. You might decide together to delay starting it until you have done them. If they are more than a month away, however, you might find that it is better to start citalopram to lift your mood and improve your motivation and ability to study.

Most people take exams as normal while taking citalopram. If you are worried that taking citalopram might make studying for or taking your exams harder, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking citalopram

Your doctor will advise you on how long it is best to keep taking your medication. This may vary depending on what you’re taking it for and how many times you’ve been unwell.

If you are prescribed citalopram for low mood or depression, it is recommended that you take it for at least six months after you feel well again. This means that most people take it for at least seven to nine months. Research has shown that stopping it sooner, or immediately after you start to feel better, increases the risk of your low mood returning.

If you have had low mood or depression more than once, or if there is a higher risk of you becoming unwell again, your doctor may advise you to continue citalopram for at least two years after you feel well again.

If you are prescribed citalopram for anxiety or obsessional-compulsive disorder (OCD), it is recommended that you take citalopram for at least one year after you feel well again. Research has shown that stopping it sooner, or immediately after you start to feel better, increases the risk of your symptoms returning.

If you have bipolar disorder, it is likely that the doctor will advise for the citalopram to be stopped sooner. This is because there is a risk of your mood becoming too high if an antidepressant is used for too long.

You will get the best effect from citalopram if you take it every day at the dose prescribed by your doctor.

You should start by taking it in the morning. This will lower the chance of it affecting your sleep. However, some people find this medicine makes them feel tired, so you may prefer to take it in the evening instead.

When you have worked out what time of day is best for you, it is recommended that you take your medication at roughly the same time every day.

Try to get into a routine, like taking it when you have breakfast or brush your teeth.

Citalopram can be taken before or after food, but taking it with or just after food may help to minimise side effects like feeling sick.

Swallow the tablet with a drink of water or liquid – if you chew it, it tastes bitter.

If you forget to take a dose, then just take it as soon as possible when you remember.

If you forget to take it by bedtime, just start again on the next day. Do not try and catch up by taking a double dose.

If you forget to take it for a few days, you may start getting withdrawal symptoms.

Withdrawal symptoms should improve quickly after you start taking citalopram again. If they do not, seek advice from your doctor or pharmacist.

If you regularly forget to take it every day, your medicine may not work as well and it could increase the risk of you becoming unwell again.

If you have been taking citalopram regularly for more than one to two months, it is recommended that you stop gradually (ideally over at least four weeks).

Discuss stopping your medication with your doctor. If you have important events coming up or going through a period of life which is very demanding, it might not be the best time to stop your medication. Planning and support are important to stopping your antidepressant medication successfully.

Antidepressants are not addictive, but if stopped suddenly they can cause discontinuation or withdrawal symptoms. These are caused by the receptors and levels of chemical transmitters in your brain readjusting after you reduce or stop your medication (and can also occur if you miss doses of medication).

Some of the symptoms you get may be like symptoms you had when you were unwell, so understandably, you might feel anxious or upset that your illness could be returning.

If you experience symptoms immediately or soon after stopping medication (days rather than weeks), this is usually a withdrawal symptom caused by your body adjusting to not having the medication anymore. If the symptoms start after a month or more after stopping your medicine, this might be a sign that you are becoming unwell again.

Withdrawal symptoms usually start within a few days of stopping (or sometimes reducing) your medication. A wide range of symptoms have been reported and are listed below. You may experience a few or a range of these:

dizziness and/or feeling unsteady
headaches
numbness or tingling in hands or feet
sleep disturbances (vivid dreams, nightmares, not being able to sleep)
electric shock-like feelings in the head, spine, arms, legs or hands
feeling anxious, agitated or irritable and/or restless
confused or disorientated and reduced concentration
poor appetite, feeling or being sick or having diarrhoea (loose poo)
sweating or shaking
feeling emotional, low mood and tearful
flu-like symptoms/muscle aches and pains
tinnitus (ringing in your ears)
problems with your eyes, or fluttering/pounding heartbeat (this is not as common as the other symptoms listed above)

It is not possible to predict if you will experience withdrawal symptoms, or how bad they will be if you do experience them, but studies report about half of people may get them. The risk appears to be higher if:

you have been taking your medication for six to eight weeks and you stop taking it suddenly
you are a child or young person
you experienced an increase in anxiety symptoms when you started medication
you have experienced withdrawal symptoms with another antidepressant before

If you do experience symptoms, they are usually mild and don’t last long (two to three weeks for most people), but for a few these could be severe enough to make you feel very unwell and last longer (two to three months or more). Arrange an appointment with your doctor to discuss your symptoms and seek advice if you are concerned or unable to tolerate them.

You can stop taking citalopram safely with your doctor’s help. Planning a gradual withdrawal together can help to minimise or prevent the withdrawal symptoms you experience.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

changes in your heartbeat, going fast or unevenly
nausea (feeling sick) or being sick
having a seizure or fit
excessive sweating
feeling sleepy
passing out
feeling shaky (tremor) or dizzy
changing blood pressure (this might mean you feel dizzy when you stand up)
feeling agitated
eye pupils getting bigger (dilating)
skin taking on a blue tinge
fingers and toes feeling cold
fast breathing

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Suicidal thoughts

Depression (and other mental illnesses) can sometimes cause you to have thoughts about hurting yourself or taking your own life. While uncommon, this could also be a side effect of your medicine. This can happen to anyone but is more likely to happen if you are under 25 years old.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Read our guide to suicidal feelings

Serious side effects

Citalopram can sometimes cause serious side effects, including allergic reactions.

Stop taking citalopram and go to a hospital straight away if you get any of the following symptoms:

difficulty breathing
an allergic reaction or allergy (including symptoms such as swelling of your face, eyelids, lips, tongue or throat so that you cannot swallow or breathe, or really bad itching of the skin with raised lumps)
fast, uneven heartbeat and fainting (this could mean a life-threatening condition called Torsades de Pointes)
any combination of the following symptoms: high fever, agitation, confusion, trembling, sweating, diarrhoea (loose poo), fast heartbeat or weird movements of your muscles (this could be serotonin syndrome)
you start having seizures or fits for the first time
a painful erection (priapism) that lasts longer than three hours

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking citalopram, if you get any of the following symptoms:

your behaviour changes because you feel very happy or over-excited
any unusual bleeding, including blood in your poo
you experience tiredness, confusion and muscle-twitching (you may have a low blood-level of sodium)
yellowing of the skin or whites of the eyes (these may be signs of hepatitis)
if fits that you have had in the past happen more often
restlessness, or difficulty sitting or standing still
dizziness, feeling sick or being sick

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking citalopram. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor or pharmacist about them.

Very common side effects when taking citalopram (affecting more than one in ten people) include:

insomnia (sleep problems) – try taking your dose first thing in the morning
dry mouth (this can increase the risk of tooth decay, so clean your teeth more often than usual and avoid drinking sugary drinks)
nausea (feeling sick) or vomiting (being sick) – try taking your citalopram with or just after food
headache
lower sex drive, difficulty reaching orgasm, problems with ejaculation, or erection problems – this can be a symptom of depression or anxiety itself

Common side effects (affecting up to one in ten people) include:

sleepiness – try taking it just before going to bed
lower appetite and loss of weight
agitation, anxiety, trembling, confusion and nervousness
diarrhoea (loose poo)
itching or prickling of the skin

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

Uncommon but important side effects to be aware of include thoughts of harming yourself, thinking about taking your own life or trying to take your own life. This may be a symptom of your illness, including depression, but may be a side effect of medication. If you experience these thoughts, contact your doctor to seek immediate support to keep you safe.

Your doctor will make sure you are monitored carefully for these side effects, and you should decide with your doctor what to do if you experience these feelings while taking citalopram. It’s a good idea to write these plans down and keep them somewhere safe.

If you are taking citalopram and have not talked about this with your doctor, go back to them and talk it through. You might also want to talk to your parents, family member or friend about it too.

Another uncommon side effect is an increase in your risk of bleeding, including intestinal (stomach or gut) bleeding. Let your doctor know if you vomit blood or develop black or blood-stained poo.

There is no routine monitoring recommended before starting or while you are taking citalopram, although your doctor may recommend specific tests, like a blood test, to help them make decisions about your medication.

Before starting citalopram, your doctor may check your heart using an electrocardiogram (ECG). If you're taking any other medicines that affect your heart, your doctor may decide to use a different medicine or check your heart on a regular basis to make sure the medication is not causing any side effects.