Listlessness, low mood, and no friends in everyday activities are typical of inhibited apathetic depression. The antidepressant citalopram can help brighten mood and restore drive. It has been prescribed since the mid-1980s and has been among the most widely used antidepressants since 1990.
SSRIs and citalopram
According to current research, a lack of certain neurotransmitters in the brain is primarily responsible for upset as well as joylessness experienced during depression. There is a lack of both norepinephrine, an activating neurotransmitter, and serotonin, which is primarily thought to be responsible for mood. Citalopram intervenes at this point. Citalopram belongs to the group of selective serotonin reuptake inhibitors (SSRIs). A characteristic feature of SSRIs is their activating and mood-lifting effect. This is in contrast to other antidepressants such as mirtazapine, which have a more depressant as well as sedative effect. The increase in drive is desirable, but there is a risk that this may result in inner restlessness. Therefore, patients or relatives must be very vigilant, especially when starting therapy, and go to the doctor immediately as soon as they notice a worsening of depression while taking the new medication.
Increase in drive and elevation of mood
However, the drive enhancement of citalopram, and specifically of this entire group of medications, also carries another side effect as a danger. The increased drive occurs shortly after starting the drug, whereas the mood elevation and thus the antidepressant effect do not take full effect until three to four weeks later. Because of this delay, citalopram, as well as the other SSRIs, can increase the risk of suicide during the first few weeks. The other drugs in the SSRI class-fluoxetine, fluvoxamine, paroxetine, sertraline-act very similarly to citalopram. The advantage of citalopram over other SSRIs is that when it is broken down, a special liver enzyme (cytochrome P450) is less blocked. These enzymes are important because they break down not only antidepressants but also many other drugs. If they are blocked by SSRIs, this can lead to delayed breakdown of other drugs. This can, in the worst case, result in drug toxicity as a side effect.
Effect of citalopram
SSRIs selectively block the transporter for the reuptake of serotonin into nerve cells. As a result, citalopram increases the concentration and action of serotonin at the special serotonin receptors on the nerves in the brain, leading to improved mood. Unlike other antidepressants, such as the tricyclic antidepressants, citalopram has little effect at receptors in the brain and nervous system. Therefore, citalopram has a narrower range of side effects.
Citalopram side effects
The most significant side effects of citalopram, and the SSRIs in general, are nausea and vomiting in particular. Relatively common side effects of citalopram also include insomnia and headache. Rarely, manic reactions, dizziness, and inner restlessness occur as side effects. Delayed ejaculation has also been reported in some cases. The side effects of SSRIs are generally less than those of tricyclic antidepressants, thanks to their specific target at the serotonin receptor. Because they bind less to histamine receptors, weight gain is less likely to occur. Like weight gain, side effects such as dry mouth, palpitations, low blood pressure, visual disturbances, and glaucoma attacks should also be unlikely to occur, unlike with tricyclic antidepressant therapy.
Drug Interactions with Citalopram
Taking citalopram concomitantly with other psychotropic drugs usually results in a slower breakdown of these drugs in the body. Therefore, dose adjustment of each medication may be necessary. Substances that remain in the body more in combination with citalopram include tricyclic antidepressants, haloperidol, phenytoin, carbamazepine, diazepam, and lithium salts. Combining citalopram and other SSRIs with monoamine oxidase (MAO) inhibitors is even contraindicated. Simultaneous use of both antidepressants can lead to mutual effect enhancement. This would lead to an excessively increased and difficult to control serotonin level in the brain.This is accompanied by the risk of seizures and poisoning, which can ultimately lead to serotonin syndrome. This poisoning results in nausea, vomiting, flushing, confusion, involuntary tremors and convulsions.
Notes on the drug citalopram
- Effective antidepressant
- Use and dosage in all cases consult with a psychiatrist.
- When improvement of isolated symptoms do not discontinue independently
- Fewer side effects than other antidepressants
- Contraindication is concomitant use of MAO inhibitors, another class of antidepressants.
- Relative contraindication is concomitant lithium therapy.
- Not suitable for pregnant or lactating women
