Citalopram: What you need to know!

Summary

In this video, Dr. Sil, a junior psychiatrist from Australia, explains Celexa (Citalopram), a widely used SSRI antidepressant. He covers its mechanisms, uses for various mental health disorders like depression and anxiety, and potential side effects. Dr. Sil also discusses how it affects serotonin levels, dosage recommendations, and safety concerns for different populations, including pregnant women. He emphasizes the importance of doctor-patient discussions when considering medication, managing side effects, and combining treatments. The video is an educational resource for those seeking to understand Celexa and mental health treatments.

Takeaways

• 😀 Celexa, a common antidepressant, is classified as an SSRI (Selective Serotonin Reuptake Inhibitor) that increases serotonin in the brain, helping with conditions like depression and anxiety.
• 💊 SSRIs, including Celexa, may take 2-4 weeks to show effects, with full results typically seen in 4-8 weeks. If ineffective after 8 weeks, dosage or medication changes may be needed.
• 😴 Celexa has antihistaminergic effects, meaning it can make some people feel sedated, while others may feel more energized. These varying effects guide whether it should be taken in the morning or evening.
• 🧠 The medication is used for treating various disorders like depression, anxiety, OCD, panic disorders, and premenstrual dysphoric disorder. It can also be combined with other drugs based on individual needs.
• ⚕️ Before starting Celexa, it's recommended to get blood tests, ECGs, and other health checks to rule out physical conditions that might cause anxiety or depression-like symptoms.
• 🤢 Common side effects include nausea, diarrhea, and sexual dysfunction, with the potential for less frequent effects like sedation or activation. These side effects often reduce over time.
• 💡 Celexa’s potential to cause energy boosts can increase anxiety and even suicidal thoughts in some individuals, making close monitoring essential, especially during the initial stages.
• 🧬 For long-term users, Celexa is generally safe and not habit-forming. However, stopping the medication should be done gradually to avoid SSRI discontinuation syndrome.
• 👶 Celexa is a category C drug for pregnancy, meaning the risks are uncertain, and it may affect the fetus. Decisions around use during pregnancy should balance the severity of the illness with medication risks.
• 🛑 Celexa should not be combined with MAOIs (another antidepressant class) without expert supervision due to the high risk of serotonin syndrome, a potentially dangerous condition.

Q & A

What is Celexa (Citalopram) and what type of medication is it?

Celexa, or Citalopram, is a selective serotonin reuptake inhibitor (SSRI), commonly used as an antidepressant. It works by blocking the reuptake of serotonin in the brain, theoretically increasing serotonin levels and potentially improving mood.

How does Citalopram help in treating depression?

Citalopram increases serotonin levels in the synapses between neurons, which is believed to enhance neuroplasticity and form new, less depressive circuits in the brain. This mechanism contributes to its antidepressant effects.

What conditions besides depression can Citalopram be used to treat?

Citalopram is used to treat anxiety disorders, premenstrual dysphoric disorder, obsessive-compulsive disorder (OCD), panic disorder, and specific anxiety disorders like social anxiety and agoraphobia.

How long does it take for Citalopram to start working?

Citalopram typically starts showing effects within 2 to 4 weeks. Full effects can take 4 to 8 weeks. If no improvement is seen after 8 weeks, dose adjustments or medication changes may be considered.

What are common side effects associated with Citalopram?

Common side effects include gastrointestinal issues like nausea and diarrhea, sexual dysfunction, and sedation or increased energy, depending on the individual. These side effects may improve over time.

What should be done if side effects become problematic?

If side effects are tolerable, they may diminish over time. Lowering the dose can help. However, if side effects are serious or affect quality of life, it's important to consult a doctor to consider dose adjustments or switching medications.

Is weight gain a common side effect of Citalopram?

Weight gain is considered an uncommon side effect of Citalopram compared to other SSRIs, although it can occur in some individuals.

How should Citalopram be tapered off to avoid withdrawal symptoms?

Citalopram should be tapered off slowly, ideally under medical supervision, to avoid SSRI discontinuation syndrome. A typical taper might involve reducing the dose by 50% every few days, though this process can be extended based on individual needs.

What is the risk of serotonin syndrome with Citalopram?

Serotonin syndrome can occur if Citalopram is taken alongside other serotonergic medications, such as MAOIs. It results in symptoms like sweating, rapid heart rate, confusion, and autonomic instability. This combination should generally be avoided.

Is Citalopram safe to use during pregnancy or breastfeeding?

Citalopram is classified as a risk category C drug during pregnancy, meaning animal studies have shown adverse effects, but human trials are lacking. The decision to use it should weigh the risks of untreated depression against potential medication risks. Some Citalopram may be present in breast milk.

Outlines

00:00

💊 Introduction to Celexa and Mental Health

Dr. Sil introduces Celexa (Citalopram), one of the most common SSRIs, widely used in treating depression. He explains his background as a junior doctor training to become a psychiatrist and his work in treating mental health disorders like schizophrenia, bipolar disorder, and depression. He emphasizes the importance of understanding medications in psychiatry and his goal of educating people about mental health, inviting viewers to join his community.

05:01

🧠 How SSRIs Work and Citalopram's Role

Dr. Sil discusses the mechanism behind SSRIs like Celexa, explaining how they block serotonin reuptake between neurons, increasing serotonin levels, which is believed to improve mood. He delves into the theory of how increased serotonin helps with neuroplasticity, thus reducing depressive symptoms. Citalopram is commonly prescribed for depression, anxiety disorders, and conditions like OCD and PMDD. Its effects vary, with some individuals feeling sedated, while others experience increased energy.

10:02

⏳ Timeframe for Celexa's Effects

Dr. Sil explains that Celexa typically starts showing effects after 2–4 weeks, with a full impact seen by 8 weeks. If no improvement occurs after that, dosage adjustments or changes in medication may be needed. He also highlights that Celexa can be combined with other medications for treating various symptoms, such as insomnia, depressive symptoms, or bipolar disorder, under a doctor's supervision.

15:02

🩺 Health Tests and Considerations Before Taking Celexa

Before starting Celexa, Dr. Sil recommends getting general health tests like heart rate, blood pressure, blood work, and an ECG to rule out other conditions that may contribute to anxiety or depression. He emphasizes the importance of addressing potential physical causes of mental health symptoms, such as thyroid issues, electrolyte imbalances, or nutritional deficiencies, which could present as anxiety or depression.

💊 Celexa's Common Side Effects

The side effects of Celexa are similar to those of other SSRIs, with common issues including gastrointestinal discomfort like nausea and diarrhea due to serotonin activity in the gut, and sexual side effects affecting both men and women. Celexa may also cause sedation or increased energy in different individuals, influencing when the medication should be taken. Dr. Sil advises patience, as most side effects diminish over time as the body adjusts.

⚠️ Managing Serious Side Effects and Dose Adjustments

Dr. Sil outlines serious side effects of Celexa, such as increased anxiety or suicidal ideation, and stresses the importance of consulting with a doctor if these arise. He suggests that side effects can often be managed with other medications or dosage adjustments. He recommends starting at a low dose and gradually increasing it to minimize side effects, and also discusses the possibility of using medications like benzodiazepines for anxiety in the short term.

💰 Celexa Dosing Tips and Saving Money

Celexa is typically taken in doses between 20–60 mg per day. Dr. Sil provides a cost-saving tip: since the price difference between 20 mg, 40 mg, and 60 mg tablets is minimal, patients can opt for higher-dose tablets and split them to save on medication costs. He also discusses tapering off Celexa to avoid SSRI discontinuation syndrome, which can cause rebound anxiety.

🔄 Drug Interactions with Celexa

Dr. Sil emphasizes the importance of avoiding certain drug interactions when taking Celexa, particularly with Monoamine Oxidase Inhibitors (MAOIs), which can lead to serotonin syndrome—a serious and potentially life-threatening condition. He describes symptoms of serotonin syndrome, such as sweating, confusion, and autonomic instability, and stresses the need for proper medical supervision when switching antidepressants.

👶 Celexa in Special Populations

Dr. Sil discusses how Celexa dosing varies for different populations. In patients with renal or liver impairment, lower doses are recommended. Elderly patients also require careful dosing due to slowed metabolic rates. He highlights the lack of definitive safety data for Celexa in pregnancy and breastfeeding, advising patients to weigh the risks with their doctor. He emphasizes the importance of monitoring mental health during pregnancy and the postpartum period due to the high risk of developing or worsening mental illness.

📺 Conclusion and Call to Action

Dr. Sil concludes by encouraging viewers to leave comments about their experiences with Celexa, both positive and negative, to help others. He expresses his commitment to answering questions and invites viewers to subscribe to his channel if they find the content helpful, thanking them for watching and wishing them a good day.

Keywords

💡SSRI

Selective Serotonin Reuptake Inhibitor (SSRI) is a class of antidepressants that block the reuptake of serotonin in the brain, theoretically increasing its availability. In the video, Celexa (satal pram) is described as an SSRI, and the video explains its use in treating depression and anxiety disorders by affecting serotonin levels in the brain.

💡Serotonin

Serotonin is a neurotransmitter that plays a key role in mood regulation, among other functions. The video explains how SSRIs like Celexa increase serotonin levels between neurons, which is believed to contribute to their antidepressant effects. Serotonin also has effects in the gut, which explains some of the gastrointestinal side effects of SSRIs.

💡Neuroplasticity

Neuroplasticity refers to the brain's ability to reorganize itself by forming new neural connections. The video mentions that SSRIs may increase brain-derived neurotrophic factor (BDNF), which promotes neuroplasticity, allowing the brain to form less depressive circuits. This concept is important for understanding the long-term benefits of antidepressants like Celexa.

💡Side effects

Side effects are the unintended effects of a medication. The video outlines the potential side effects of Celexa, such as gastrointestinal issues (nausea, diarrhea), sexual dysfunction, sedation, and in some cases, increased energy. These effects vary among individuals, and the video emphasizes discussing them with a doctor to manage them properly.

💡Depression

Depression is a major mood disorder characterized by persistent feelings of sadness, lack of interest, and low energy. The video discusses Celexa’s role in treating depression by targeting serotonin reuptake, explaining how the medication can alleviate depressive symptoms over time through its effects on brain chemistry.

💡Anxiety disorders

Anxiety disorders encompass various mental health conditions that cause excessive fear, worry, or panic. The video explains that Celexa is prescribed for anxiety disorders, including panic disorder, social anxiety disorder, and agoraphobia. It highlights the importance of ruling out physical causes of anxiety before treatment.

💡Suicidal ideation

Suicidal ideation refers to thoughts of self-harm or suicide. The video cautions that SSRIs, including Celexa, may increase suicidal thoughts in some individuals due to increased energy levels before mood improves. This highlights the need for careful monitoring when starting or adjusting medications.

💡Tapering

Tapering refers to the gradual reduction of medication dosage to avoid withdrawal symptoms. The video advises tapering Celexa slowly to prevent SSRI discontinuation syndrome, which can cause rebound anxiety and other symptoms. A gradual dose reduction is recommended over an abrupt stop to ensure safe discontinuation.

💡Drug interactions

Drug interactions occur when one medication affects the activity of another. The video warns about interactions between SSRIs and monoamine oxidase inhibitors (MAOIs), which can lead to serotonin syndrome—a dangerous condition caused by excessive serotonin. The importance of managing multiple serotonin-acting drugs with medical supervision is emphasized.

💡Pregnancy and breastfeeding

Pregnancy and breastfeeding are mentioned in the context of Celexa’s potential risks. The video notes that SSRIs are categorized as risk category C in pregnancy, meaning there are potential risks to the fetus, though no conclusive human data exist. Celexa may also be found in breast milk, requiring careful consideration of treatment during these periods.

Highlights

Introduction of Celexa as a commonly used antidepressant and explanation of the speaker's role as a junior doctor specializing in psychiatry.

Explanation that Celexa is not just an antidepressant but an SSRI (Selective Serotonin Reuptake Inhibitor), focusing on its action on serotonin reuptake and neuroplasticity.

Discussion of how Celexa works: increasing serotonin in the synapse between neurons, potentially boosting neuroplasticity to reduce depressive brain circuits.

Celexa is used for a range of conditions including depression, anxiety disorders, obsessive-compulsive disorder, and premenstrual dysphoric disorder.

Variability in patient responses: some may feel sedated due to antihistaminergic effects, while others may feel more energetic.

Initial effects typically start within 2 to 4 weeks, with full effects expected by 8 weeks. If there is no effect, the dosage may need to be adjusted or the medication changed.

Combination therapy: Celexa can be combined with other medications like trazodone or bupropion, depending on the condition being treated.

Before starting Celexa, tests such as blood work and ECGs are recommended to exclude physical causes of depression or anxiety, such as thyroid issues or heart malformations.

Common side effects include gastrointestinal issues like nausea or diarrhea, as serotonin is also active in the gut.

Sexual side effects like problems with erection, ejaculation, and orgasm can occur, affecting both men and women.

Celexa is less likely to cause weight gain compared to other SSRIs, though weight gain can still happen.

The importance of starting at a low dose to mitigate side effects, which usually lessen over time as the body adjusts to the medication.

Rare but serious side effects like serotonin syndrome may occur, especially when combined with other serotonergic drugs like MAOIs.

Advice on dosing: Celexa is usually taken in one dose per day and can be broken in half to save money without affecting the medication’s effectiveness.

Considerations for special populations, such as those with renal or liver impairments, the elderly, children, and pregnant or breastfeeding women.

Recommendation to taper off Celexa slowly to avoid SSRI discontinuation syndrome, which can cause rebound anxiety.

Transcripts

satal pram brand named Celexa probably

one of the most common anti-depressants

in the world and if you want to know all

about it then you've come to the right

place hello and welcome my name is Dr

Sil I'm a junior doctor from Australia

and I'm training to become a

psychiatrist I work on Mental Health

Awards psychiatric Awards and I treat

things like schizophrenia major mood

disorders like depression bipolar

illness I also am involved in the

treatment of personality disorders I do

Psychotherapy uh so I have a very um

varied role uh which is really good um

but knowing about medications is

absolutely critical to being a good

psychiatrist and so that's why I also

make these videos cuz I'm interested in

mental health education and if that

sounds like your cup of tea you can

consider subscribing and joining the

community all right let's talk about

satala

[Music]

pram so I think we're only a minute or

two into the video and I've already made

uh a mistake I think we call satell

pramin anti-depressant and we call a lot

of things anti-depressant but really the

more accurate term for it is an SSRI

selective serotonin reuptake inhibitor

and that's because when we run studies

to see how these medications work it

looks like they block the reuptake pump

of Serotonin at those spaces between

neurons theoretically increasing the

amount of serotonin in that syapse

between neurons and thereby having an

effect that is anti-depressive and the

theory here is that it increases a

chemical called BNF brain derived

neurotrophic factor and that makes um

neuroplasticity more available to

forming less depressive circuits in the

brain we don't have to get into the all

the nitty-gritty of all the

neurochemistry and the biology of how

these things work because it's

incompletely understood but there's

still plenty that we do understand about

this medication and so that's what I

want to talk about so yeah let's talk

about why it's used the indications for

calram include depression anxiety

disorders premenstrual dysphoric

disorder obsessive compulsive disorder

panic disorder and more specific anxiety

disorders would include things like

panic disorder or agoraphobia or social

anxiety disorder as well now we spoke

about already how it works on that re

serotonin reuptake uh protein on the

neuronal membrane but it's also probably

got some antihistaminergic effects as

well which put simply means it can make

some people sedated but strangely other

people don't get sleepy at all they

actually get kind of energetic off of it

and it's hard to predict who's going to

have which response but it's important

to remember that people can have both

responses cuz it'll inform when you

should take the medication and we'll

talk about that later now how long until

it works well generally with ssris you

want to try them for at least 2 weeks

and you start at a low dose and then you

can try increasing the dose uh generally

between 2 and 4 weeks you'll start

seeing the start of its effect and

between 4 and 8 weeks you'll have its

effect if there is no effect after 8

weeks you need to consider a dose change

or a change of medications and these

decisions should be made in discussion

with your doctor now ESAT alpram can be

used in combination with other

medications depending on what the

illness is being treated some people

with insomnia might consider a Trazodone

and um and calop pram combination

sometimes it's used with metazine or

bupropion in terms of treating for

depressive symptoms sometimes it's used

in combination with mood stabilizers if

treating is suspected bipolar illness

all these things need to be decided uh

between you and your doctor and

considering the pros and cons for your

individual circumstances now tests

required prior to starting if you are a

healthy individual otherwise you don't

need to have other blood test before

trying calam I suggest everyone with the

firstep s of depression should get a

series of tests anxiety as well because

there are organic or physical health

contributions or causes for these things

so getting a set of observations with

your your your GP looking for things

like heart rate and blood pressure at

Baseline getting things like blood tests

done and an ECG these are all really

helpful things to exclude other things

that could be generating anxiety if you

have a congenital heart malformation

that causes palpitation

and you know that could theoretically

present as anxiety first time if you

have high levels of thyroid hormone

because of a uh you know hyperactive GOA

that you don't know about in your

thyroid glands well that can present as

anxiety as a first presentation so there

are physical health things that present

as anxiety electrolyte abnormalities um

you know nutritional deficits iron

folate probably vitamin B12 and vitamin

D all sorts of things can at least

contribute to anxiety and it's and and

you want to optimize your General Health

especially if there's any kind of mental

um health problem in terms of side

effects it's similar with calop pram as

it is to the other ssris selective

serotonin reuptake Inhibitors so there's

the gastrointestinal or the gut side

effects things like nausea diarrhea and

this is because serotonin the chemical

is very active in the bowel and in the

gut there are serotonin receptors

throughout and so you can get a nauseous

um response some people may even vomit

uh so that's one domain of side effects

there's also sexual side effects so

problems with erection ejaculation

orgasm uh in both men and women uh can

be seen with SSR eyes and as we said

before there's there's probably an

anti-histamine effect um and so

depending on where your antihistamine

receptors are some people might get a

sedative response to satal pram and that

will guide if you should take it in the

morning or at night so some people get

sedated uh other people people don't get

sedated at all and they'll feel super

activated and get more energy than

they've had in a long time and want to

go and do things if that's the case you

shouldn't take this medication at night

there are some more rare side effects um

that may be more common in people who

are have abnormal metabolism or you know

renal failure liver failure elderly

people um there's something called uh

well anyway we don't have to go into

syndrome of inappropriate antidiuretic

hormone but it's it's essentially a side

effect where your sodium levels can get

affected by the medication

and that can be diagnosed in a blood

test and a urine test in terms of weight

gain this is actually considered a

relatively unom common side effect from

satal pram uh ssris can have Associated

weight gain as a side effect it can be

seen uh but satal pram is considered one

of the less associated with weight gain

now if you're getting side effects what

to do well first you know start at a low

dose lower the starting dose if needed

but try to if it's not a serious side

effect and it's not causing significant

functional or quality of life issues try

to tolerate it wait they they usually

aate most side effects will get less

intense and even sometimes disappear as

your body gets used to the medication I

guess it can be considered a side effect

but uh as I was saying it can be kind of

activating and people can get energetic

and um uh kind of more Restless that can

manifest as anxiety and actually uh if

there's suicidal thinking it can worsen

suicidal ideation as there's an increase

in energy and so if that's the case um

that can be well first of all you need

to talk to your doctor about all the

side effects you're experiencing these

different side effects can be managed

with different strategies there are some

medication options for some side effects

so if there's um uh you know anxiety

associated with starting the the SSRI

you can consider a short-term use of

benzo Pines that needs to be discussed

with your doctor to see if you're an

appropriate candidate uh then there's

also things like sexual side effects can

be um treated with sanl or Viagra that's

uh done sometimes if there's insomnia

sometimes a low dose of metazine can

help which is another uh anti-depressant

but it works differently to an SSRI and

can have an additive uh anti-depressant

effect as well but it's important to

remember that side effects are generally

dose dependent so starting at a lower

dose and slowly increasing the dose can

often help with the side effects all

right right now talking about dosing so

uh the range is usually between 20 and

60 mg a day it's usually taken in one

dose and it can be either in the morning

or at night depending on if it has a

sedating effect on you or no effect on

you or an activating effect on you but

here's the hot tip uh to save money

usually the tablets come with a scored

uh tablet so you can break them in half

and the the cost difference between uh a

20 mg tablet or 40 Mig tablet and a 60

mg tablet is generally not much at all

they're usually roughly priced the exact

same so if you are on 10 mg I suggest

getting a script for 20 milligrams and

breaking them in half and you get twice

the medication for the same price and go

the same goes for um 60 Mig tablet if

you want to break it in half and have 30

Mig uh so just think about that with

your doctor and it can hopefully save

you a bit of cash now in terms of

long-term use it's considered safe in

terms of uh like habit forming or

dependency or tolerance uh it's

considered safe uh if you do want to

stop I always suggest a taper and a slow

taper at that uh just to avoid SSRI

discontinuation syndrome which is this

rebound anxiety that can happen with

people who stop um serotonergic

medications and uh you know this

textbook that I'm using to reference

this talk suggests 3 days at 50% of the

original dose and then another 3 days at

50% of that dose I would slow that even

down further talk to your doctor about

what works for you uh but but I wouldn't

I wouldn't rush it now in terms of drug

interactions there are significant and

important drug interactions to know

about um the main one is with uh

monoamine oxidase Inhibitors which is a

class of medication also used in

depression management uh things like

mide mobom and

phenoline uh the these medications are

pretty strong anti-depressants so you

and you will probably have been told

about the side effects and the risks of

changing anti-depressants if you've

started on these drugs uh but the

important thing is to make sure there's

3 weeks Gap after stopping a monoamine

oxidase inhibitor and MAOI before

starting an

SSRI uh so taking an M MAOI and an SSRI

at the same time is essentially never

well very very rarely only done by

people with significant expertise in the

area with very close monitoring uh so if

that's happening you know I'm sure

you're talking to your doctor about it

very frequently but otherwise I would I

wouldn't risk it and the reason is

because the MAOI blocks the the protein

enzyme that breaks down serotonin so if

you block the breakdown of Serotonin

plus you block the reuptake of Serotonin

using the SSRI and the MAOI then MAOI

then you've just got this huge surplus

of serotonia bathed in it and what can

happen is something called a serotonin

syndrome which makes people look I've

seen serotonin syndrome and it's very

scary you know people look sweaty they

um they have autonomic instability so

the their heart rate's through the roof

and the blood pressure going up and down

and they're sweating and the pupils are

dilated you get confusion uh and it's a

really horrible people feel extremely

nauseous uh so it's all the side effects

of Serotonin put on a thousand times uh

worse so you know it needs to be avoided

and talk to your doctor if there's

multiple serotonin acting medications

now in terms of special populations so

for people who have renal impairment or

poor kidney function uh it's usually

doesn't require a significant dose

change if it's mild or moderate if it's

severe renal impairment then you might

have to try a lower dose uh with a liver

impairment the dose will usually be

around 20 Mig and sometimes up to 40 but

rarely would it ever go up to 60 so it's

usually a lower dose range in the

elderly as well it's used at a lower

dose range just because the metabolic

rate is slowed and with children um I

won't even comment on dose ranges it has

to be done with a specialist uh

especially under the age of 12 ssris

need to be done with a with a consultant

um specialist yeah and in pregnancy it's

a risk category C which means there are

some uh animal studies that show adverse

effects but no human trials which you

know this is so frustrating but part of

the complexity of healthcare that we

just don't have the data to suggest

whether it's safe or not in pregnancy

which is really important but it's just

there's no ethical way to collect that

data so uh you have to basically weigh

up the risks uh of the medication versus

the risks of not taking any medication

and so the severity of the illness needs

to be taken into account so someone who

stops eating when they're depressed um

and becomes bedridden and suicidal

that's obviously extremely high risk and

and needs treatment um and so you have

to weigh the risks of a depressive

relapse or whatever the indication

you're taking it for the the risks of a

relapse of mental illness um versus uh

the side effects of the medication but

there have been some studies that are

not very strong studies you know that

they these are suggested that ssris can

cause some um heart defects in in

fetuses that it can affect the

circulation around the lungs and um also

in breastfeeding so some of the drug is

found in the mother's breast milk it's

really important to remember that um

pregnancy and the postpartum period

after pregnancy is a super high risk for

um mothers for developing mental illness

so the treatment you know is is really

important so I just really encourage you

guys to talk to your doctors and have

strong monitoring if if you're in that

population group all right so T pram

that's it we've done it there's nothing

else I really wanted to talk about um if

you have any questions leave them in the

comments below and I'll try and answer

as many as I can uh and if you've had an

experience on satal pram comment down

below what your experience was like

positive and negative uh it's all useful

reading for people and uh and yeah I'll

see you all in the next video but if you

find this stuff helpful and you want to

support my my Channel please consider

subscribing and liking the video other

than that sorry about that other than

that I wish you all a beautiful day and

I'll see you all in the next video bye

for now