medium-shot-of-a-young-woman-looking-far-away-and-a-young-man-looking-at-her-while-walking-on-the-street

Your guide to medication Citalopram

Citalopram is an SSRI antidepressant, which is commonly used to treat anxiety and depression.

Medication name: Citalopram ("sit-AL-o-pram")
Brand name: Cipramil ("SIP-ram-il")
Medication type: Selective serotonin reuptake inhibitor (SSRI)

Ways to take citalopram
Tablets: 10mg, 20mg and 40mg strengths
Oral drops*: 40mg per ml (four drops are like one 10mg tablet)

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

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

There is less research about its use and effectiveness in people under 18. Even so, specialist doctors might prescribe it 'off-label' if it is the best medicine for you.

Find out more about depression

About citalopram

How citalopram works

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

Research suggests that depression or low mood is more likely to occur when the brain doesn’t have enough serotonin.

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 and thinking.

Selective serotonin reuptake inhibitors (SSRIs) - like citalopram - are thought to work by increasing levels of serotonin in the brain. They do this by blocking the recycling of released serotonin back into the nerve endings.

Citalopram is often prescribed alongside a talking therapy.

Find out more about depression

Citalopram and everyday life

Frequently asked questions

Citalopram should start helping with depression within one to two weeks. It can take a little longer for you to feel the full effects of the medication.

For anxiety, it can take up to four weeks for the benefits to be noticed. Scientists believe that the higher level of serotonin can cause you to feel a bit more anxious or on-edge at first, before settling down.

Citalopram can cause people to lose weight when they first start talking 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 very difficult to know how citalopram will affect each person who takes it, but talk to your doctor or pharmacist if you do start to have problems with your weight while taking citalopram.

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 you feel like a zombie, and you’ve been taking it for more than a month, you should go back to the doctor and discuss other options.

Alcohol

You can continue to drink alcohol in moderation while taking citalopram.

You might find that alcohol makes you feel sleepier or you might lose your focus so, during the first few days, it might be best to stop drinking alcohol until you see how the medicine affects you.

Street drugs

Citalopram does not mix well with street drugs or legal highs.

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. For more information, have a look at our drugs and alcohol page.

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.

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 if this happens. Tell the doctor that you are taking citalopram.

Citalopram can interact with some other medicines and drugs.

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 for low mood. 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.

Always talk to your doctor if you are taking other medicines, and tell the pharmacist you are taking citalopram when you buy medicines from a pharmacy for common illnesses (like cold or flu medicine, or topical applications for your skin).

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

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

Do not drive or ride a bike just after you start taking citalopram.

Taking citalopram may affect your concentration when doing things like driving a car, riding a bike, or anything else that needs a lot of focus. It might be best to stop doing these things for the first few days, until you know how it affects you.

Don't worry - most people drive as normal while taking citalopram.

Pregnancy

If you become pregnant while you are on citalopram, you should carry on taking it and go back to your doctor as soon as possible to see if you should change or stop your medicine.

If you and your doctor agree that carrying on with citalopram has more benefits than risks, you should tell your midwife that you are taking it before you give birth.

Post-natal

If citalopram is taken in the last five months of a pregnancy, it can cause a serious condition called persistent pulmonary hypertension of the new-born (PPHN). This 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.

PPHN appears in the first 24 hours after birth. You will need help from the midwife and doctors, so it is better if they are looking out for symptoms.

There are some other symptoms that can occur in newborn babies if citalopram is taken in the last three months of pregnancy, so do look out for these and get help if they happen:

  • seizures (fits) or shaking
  • being too hot or cold
  • feeding difficulties or being sick

Breastfeeding

Breastfeeding may help offset any withdrawal symptoms.

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

Sex

Citalopram can have side effects that might affect your sex life. These include:

  • 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
  • lower sex drive

These effects should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to the doctor and see what else you could try.

The good effects of citalopram may, after a while, have a positive effect on your sex life as your mood lifts and you become interested in life and relationships again.

Fertility

Citalopram is unlikely to affect your chances of having children.

Risks with citalopram in pregnancy are low but, if you are trying to get pregnant, you should talk about it with your doctor.

Citalopram is not a banned substance in sport.

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 might be best to stop such sports for the first few days, until you know how it affects you.

Don't worry - most people play sports as normal while taking citalopram.

Try not to take citalopram for the first time just before your exams.

Taking citalopram may affect your concentration when doing things that need a lot of focus, like exams.

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 to study.

Don't worry - most people take exams as normal while taking citalopram.

medium-shot-of-a-young-woman-with-a-curly-hair-and-hands-on-her-chin-thinking-while-another-young-man-is-beside-him-looking-away
I started feeling like I could be around people and could enjoy things again.
Rachel

Your doctor should know

  • You need to talk to your doctor or pharmacist before starting treatment with citalopram if you have or have ever had any of the following:

    • liver disease
    • kidney disease
    • diabetes (you may need an adjustment of your antidiabetic therapy)
    • epilepsy or a history of seizures or fits
    • a bleeding problem, or bleeding in the stomach or gut
    • mania or bipolar disorder
    • low blood levels of sodium
    • problems with your eyes, such as glaucoma (increased pressure in the eye)
    • heart problems, or a heart attack
    • a low heart rate or long-lasting diarrhoea (loose poo), vomiting (being sick) or using diuretics (water tablets)
    • a fast or irregular heartbeat, fainting, collapsing or dizziness when you stand up.

Uses, warnings, safety and side effects

Taking citalopram

How long will I need to take citalopram for?

If you’re taking citalopram for anxiety, you may need to take it for longer than six months.

You and your doctor should talk about how long you need to take citalopram before you begin treatment with the medication.

People who have had low mood or depression more than once may need to take citalopram for a couple of years or more. This is to stop themselves experiencing depression or low mood again.

Never stop the tablets suddenly because this may make you more at risk of experiencing low mood.

Speak to your doctor if you want to stop taking citalopram.

You should only take citalopram as agreed with your doctor

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

Make sure that you know your dose. If it's not written on the label, check with your pharmacist or doctor.

You should start by taking it in the morning. This will lower the chance of it affecting your sleep.

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

If you find that it makes you sleepy, you can take it at nighttime instead.

Citalopram can be taken before or after food.

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

What if I miss a dose?

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

If you forget to take it by bedtime, just start again on the next day.

Do not take a double dose.

What will happen if I forget to take my citalopram?

If you forget to take it for a few days, you may start getting withdrawal symptoms, which feel a bit like the flu. If you get these symptoms, see your doctor as soon as possible.

If you want to stop your tablets, please speak to your doctor first as it is better if they are stopped slowly over a few weeks rather than suddenly.

Stopping the use of citalopram

Stopping the medication causes the balance of chemicals in the brain to change.

When you start taking an SSRI, the brain adjusts to having a higher level of serotonin around. If you stop taking the SSRI suddenly, the levels of serotonin start to drop, and your brain can take a while to adapt to this change. You could get some symptoms from the change, which are called withdrawal symptoms.

This does not mean you are addicted to the medicine - just that your brain has become used to citalopram to control the serotonin levels.

Withdrawal symptoms usually start a few days after stopping the medicine and might include:

  • dizziness or headaches
  • numbness or tingling in hands or feet
  • sleep disturbances (vivid dreams, nightmares, not being able to sleep)
  • ‘electric shock’ feelings in the head, neck and spine (back)
  • feeling anxious, confused or disorientated
  • feeling or being sick or having diarrhoea (loose poo)
  • sweating or shaking
  • feeling restless or agitated or feeling emotional or irritable
  • flu-like symptoms
  • tinnitus (ringing in your ears)
  • problems with your eyes, or fluttering/pounding heartbeat (palpitations) can happen, but not as often as the others symptoms listed above

You can stop taking citalopram safely with your doctor's help, who will show you how to reduce your dosage gradually.

Warnings and safety

Safety headlines

If you have taken more citalopram than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.

As part of depression some people think about hurting themselves or taking their own lives. Taking an antidepressant may not stop this. You must get some urgent help if you are having these sorts of thoughts. Speak to someone who is looking after you or go straight to hospital with your tablets.

Citalopram can sometimes also cause other serious side effects, including: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), and other serious symptoms that you can find here. Go to a hospital if you get any of these symptoms, taking your medicine with you.

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.

Stopping citalopram suddenly can cause unpleasant withdrawal effects. Go to your doctor if you are thinking of stopping.

If you take citalopram while you are pregnant, it may affect the developing baby’s heart. Use good contraception while you are taking citalopram. It can also cause symptoms in newborn babies if you take it at the end of pregnancy. Talk to your doctor or midwife about this.

When to go to the hospital

If you have taken more citalopram than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different. Go to A&E, taking your medicine with you, and tell doctors how much medication you have taken. Get a friend or family member to go with you in case you feel ill on the way.

You might get any of the following signs:

  • changes in your heartbeat, going fast or unevenly
  • nausea (feeling sick) or being sick
  • having a seizure (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 take too much citalopram, you may be at risk of developing serotonin syndrome. Symptoms include a high fever, agitation, confusion, trembling, or weird movements of your muscles. This is rare, but you should watch out for it. Go straight to A&E if you experience these side effects.

While taking citalopram some people may think about hurting themselves or taking their own lives. This can happen to anyone, including people who are under 18.

These thoughts may happen or get worse in the first few weeks of taking the tablets until the level of serotonin in the brain becomes stable.

You must go straight to hospital if you have these thoughts, taking your tablets with you. Ask a friend or family member to go with you to keep you safe on the way.

When to see your doctor

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

  • difficulty breathing
  • swelling of your face, lips, tongue or throat so that you cannot swallow or breathe
  • 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

Go to your doctor or the hospital straight away, but don't stop taking citalopram, if you get any of the following symptoms:

  • you start having seizures (fits) for the first time, or if fits that you have had in the past happen more often
  • your behaviour changes because you feel very happy or over-excited
  • you experience tiredness, confusion and muscle-twitching - you may have a low blood-level of sodium

Side effects

Side effects

People under 18 who take citalopram can get serious side effects and have an increased risk of thinking about taking their own lives, trying to take their own lives, and hostility (mostly aggression, oppositional behaviour and anger). Therefore, it is not licensed for people under 18 years old.

If you are under 18, you and your doctor may decide that the benefits of taking citalopram outweigh the risks for you.

You should decide with your doctor what to do if you experience any side effects 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 or carers about it.

SSRIs can, but not very often, increase 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.

Do not stop taking the tablets until you talk to your doctor, or you may get withdrawal symptoms as well.

If you do get a side effect, please think about reporting it via the 'Yellow Card' scheme.

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 - try taking your citalopram with or just after food. This tends to wear off after a few days
  • headache
  • lower sex drive, difficulty reaching orgasm, problems with ejaculation, or erection problems - talk to your doctor or pharmacist if you get this. This can be a symptom of depression itself

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

  • sleepiness - try taking 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

Citalopram can affect the way your heart works and should be used carefully with certain medications.

Citalopram and escitalopram (a very similar medicine) can change the way electricity goes through the heart (called the QT length). Escitalopram has less of this effect on the heart.

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.

Taking citalopram

How long will I need to take citalopram for?

If you’re taking citalopram for anxiety, you may need to take it for longer than six months.

You and your doctor should talk about how long you need to take citalopram before you begin treatment with the medication.

People who have had low mood or depression more than once may need to take citalopram for a couple of years or more. This is to stop themselves experiencing depression or low mood again.

Never stop the tablets suddenly because this may make you more at risk of experiencing low mood.

Speak to your doctor if you want to stop taking citalopram.

You should only take citalopram as agreed with your doctor

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

Make sure that you know your dose. If it's not written on the label, check with your pharmacist or doctor.

You should start by taking it in the morning. This will lower the chance of it affecting your sleep.

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

If you find that it makes you sleepy, you can take it at nighttime instead.

Citalopram can be taken before or after food.

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

What if I miss a dose?

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

If you forget to take it by bedtime, just start again on the next day.

Do not take a double dose.

What will happen if I forget to take my citalopram?

If you forget to take it for a few days, you may start getting withdrawal symptoms, which feel a bit like the flu. If you get these symptoms, see your doctor as soon as possible.

If you want to stop your tablets, please speak to your doctor first as it is better if they are stopped slowly over a few weeks rather than suddenly.

Stopping the use of citalopram

Stopping the medication causes the balance of chemicals in the brain to change.

When you start taking an SSRI, the brain adjusts to having a higher level of serotonin around. If you stop taking the SSRI suddenly, the levels of serotonin start to drop, and your brain can take a while to adapt to this change. You could get some symptoms from the change, which are called withdrawal symptoms.

This does not mean you are addicted to the medicine - just that your brain has become used to citalopram to control the serotonin levels.

Withdrawal symptoms usually start a few days after stopping the medicine and might include:

  • dizziness or headaches
  • numbness or tingling in hands or feet
  • sleep disturbances (vivid dreams, nightmares, not being able to sleep)
  • ‘electric shock’ feelings in the head, neck and spine (back)
  • feeling anxious, confused or disorientated
  • feeling or being sick or having diarrhoea (loose poo)
  • sweating or shaking
  • feeling restless or agitated or feeling emotional or irritable
  • flu-like symptoms
  • tinnitus (ringing in your ears)
  • problems with your eyes, or fluttering/pounding heartbeat (palpitations) can happen, but not as often as the others symptoms listed above

You can stop taking citalopram safely with your doctor's help, who will show you how to reduce your dosage gradually.

Warnings and safety

Safety headlines

If you have taken more citalopram than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.

As part of depression some people think about hurting themselves or taking their own lives. Taking an antidepressant may not stop this. You must get some urgent help if you are having these sorts of thoughts. Speak to someone who is looking after you or go straight to hospital with your tablets.

Citalopram can sometimes also cause other serious side effects, including: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), and other serious symptoms that you can find here. Go to a hospital if you get any of these symptoms, taking your medicine with you.

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.

Stopping citalopram suddenly can cause unpleasant withdrawal effects. Go to your doctor if you are thinking of stopping.

If you take citalopram while you are pregnant, it may affect the developing baby’s heart. Use good contraception while you are taking citalopram. It can also cause symptoms in newborn babies if you take it at the end of pregnancy. Talk to your doctor or midwife about this.

When to go to the hospital

If you have taken more citalopram than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different. Go to A&E, taking your medicine with you, and tell doctors how much medication you have taken. Get a friend or family member to go with you in case you feel ill on the way.

You might get any of the following signs:

  • changes in your heartbeat, going fast or unevenly
  • nausea (feeling sick) or being sick
  • having a seizure (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 take too much citalopram, you may be at risk of developing serotonin syndrome. Symptoms include a high fever, agitation, confusion, trembling, or weird movements of your muscles. This is rare, but you should watch out for it. Go straight to A&E if you experience these side effects.

While taking citalopram some people may think about hurting themselves or taking their own lives. This can happen to anyone, including people who are under 18.

These thoughts may happen or get worse in the first few weeks of taking the tablets until the level of serotonin in the brain becomes stable.

You must go straight to hospital if you have these thoughts, taking your tablets with you. Ask a friend or family member to go with you to keep you safe on the way.

When to see your doctor

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

  • difficulty breathing
  • swelling of your face, lips, tongue or throat so that you cannot swallow or breathe
  • 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

Go to your doctor or the hospital straight away, but don't stop taking citalopram, if you get any of the following symptoms:

  • you start having seizures (fits) for the first time, or if fits that you have had in the past happen more often
  • your behaviour changes because you feel very happy or over-excited
  • you experience tiredness, confusion and muscle-twitching - you may have a low blood-level of sodium

Side effects

Side effects

People under 18 who take citalopram can get serious side effects and have an increased risk of thinking about taking their own lives, trying to take their own lives, and hostility (mostly aggression, oppositional behaviour and anger). Therefore, it is not licensed for people under 18 years old.

If you are under 18, you and your doctor may decide that the benefits of taking citalopram outweigh the risks for you.

You should decide with your doctor what to do if you experience any side effects 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 or carers about it.

SSRIs can, but not very often, increase 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.

Do not stop taking the tablets until you talk to your doctor, or you may get withdrawal symptoms as well.

If you do get a side effect, please think about reporting it via the 'Yellow Card' scheme.

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 - try taking your citalopram with or just after food. This tends to wear off after a few days
  • headache
  • lower sex drive, difficulty reaching orgasm, problems with ejaculation, or erection problems - talk to your doctor or pharmacist if you get this. This can be a symptom of depression itself

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

  • sleepiness - try taking 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

Citalopram can affect the way your heart works and should be used carefully with certain medications.

Citalopram and escitalopram (a very similar medicine) can change the way electricity goes through the heart (called the QT length). Escitalopram has less of this effect on the heart.

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.

About this information

The information on this page was reviewed by the College of Mental Health Pharmacy in March 2020.

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