Side effects
At the beginning of the therapy with citalopram the following side effects often occur: It is important to know that these side effects often improve after a longer intake. They should therefore not be a reason for a premature discontinuation. Furthermore, the intake of citalopram leads to a change in the excitation of the heart.
It leads to a prolongation of the so-called QT time. Therefore, an ECG must be written before the start of therapy to determine the QT time. In addition, citalopram should not be combined with other drugs that also lead to an extension of the QT time.
A temporary increase in depressive symptoms, sometimes with suicidal thoughts, can also be observed under antidepressant medication. In this case a close connection to the treating physician should be established in order to be able to intervene in time. A rare but life-threatening side effect is the so-called serotonin syndrome.
Here, an excess of serotonin and serotonin-like substances leads to the following symptoms: If this occurs, a doctor must be consulted immediately. Patients must be closely monitored (sometimes in an intensive care unit). The causal medication is discontinued and medication to alleviate the symptoms is given. – Dry mouth
- Nausea
- Unrest
- Nervousness
- Shaking
- Palpitations
- Sweating
- Sexual dysfunction. – Rise in pulse and blood pressure, flu-like feeling, vomiting and diarrhoea, headache, faster breathing
- Hallucinations, disturbances of consciousness, coordination disorders, restlessness, anxiety
- Tremor, muscle cramps, epileptic seizures
Dependence
Citalopram is not addictive. However, the body gets used to it, so that abrupt discontinuation can lead to circulatory problems (dizziness, nausea, palpitations, headaches, etc.). If the therapy with citalopram is to be discontinued, a slow, gradual reduction of the dose (sneaking out) is therefore recommended.
Pregnancy:There is evidence that citalopram, as well as other drugs from the group of SSRIs, can influence the development of the unborn child. It has been observed that premature birth and breathing problems of the newborn are more frequent. However, as there are no studies in pregnant women taking citalopram, the effect of the drug on the fetus remains uncertain.
Overall, an attempt should therefore be made to stop taking citalopram before pregnancy and to treat the disease by non-drug means (e.g. psychotherapy) if possible. Citalopram is a drug whose package insert already points out that the patient’s independent discontinuation of the drug can lead to severe side effects. The symptoms that can occur when the drug is taken off abruptly are known as SSRI withdrawal syndrome (e.g. sensory disturbances, fear of heights, tinnitus, sexual dysfunction or brain zaps).
Spontaneous discontinuation can lead to withdrawal symptoms in patients from one day to a week after discontinuation. These include circulatory problems such as dizziness and balance problems. These usually appear especially when the head or eyes are moved.
These are then called orthostatic disorders. In many cases they lead to nausea and discomfort. Brain zaps are sensations similar to electric shocks that radiate to the extremities.
Severe disorders can impair motor function by causing muscle twitches, muscle cramps, tremors and various tics that the patient can no longer control in everyday life. It can also lead to gastrointestinal complaints such as diarrhoea, constipation, fatigue or nausea. Mood swings can also be problematic.
Patients may complain of a stronger depressive feeling or manic phases, so that suicidal thoughts or aggressive behaviour may be observed. Withdrawal symptoms can last from weeks to months, and problems can occur even after the patient stops taking the drug. The treating doctor should therefore accompany withdrawal and allow it to take place slowly.
This is known as “sneaking out”, meaning that a patient who takes 10mg per day is initially reduced to 5mg. The dose can be further reduced if well tolerated or after a period of acclimatisation of several weeks. Although it may take several months to stop taking the drug, this has the advantage that the risk of withdrawal symptoms can be reduced.
Unfortunately, side effects cannot be completely ruled out, so a good consultation with the treating doctor is necessary. Moderate symptoms can also be treated with benzodiazepines, making withdrawal easier for the patient. If the symptoms are too severe, withdrawal should be discontinued and citalopram should be taken in its original dose. A new attempt can then be made with small steps of dose reduction.
