I have never suffered from anxiety attacks but they must be pretty bad to risk the adverse effects listed below.
Adverse effects
Sexual dysfunction is often a side effect with
SSRIs. Specifically, common side effects include difficulty becoming aroused, lack of interest in sex, and
anorgasmia (trouble achieving orgasm).Genital anesthesia,
[15][16] loss of or decreased response to sexual stimuli, and ejaculatory
anhedonia are also possible. Although usually reversible, in some people these sexual side effectsbecome permanent after the drug has been completely withdrawn.
[17] This is known as
post-SSRI sexual dysfunction.
Citalopram theoretically causes side effects by increasing the concentration of
serotonin in other parts of the body (e.g., the intestines). Other side effects, such as increased apathy and emotional flattening, may be caused by the decrease in
dopamine release that is associated with increased serotonin. Citalopram is also a mild
antihistamine, which may be responsible for some of its sedating properties.
[10]:104
Common side effects of citalopram include
drowsiness,
insomnia,
nausea, weight changes, vivid dreaming, frequent urination, decreased sex drive,
anorgasmia,
dry mouth,
[1] increased
sweating,
trembling,
diarrhea, excessive yawning, and
fatigue. Less common side effects include
bruxism,
vomiting,
cardiac arrhythmia,
blood pressure changes, dilated pupils,
anxiety,
mood swings,
headache, and
dizziness. Rare side effects include
convulsions,
hallucinations, and severe
allergic reactions.
[1] If sedation occurs, the dose may be taken at bedtime rather than in the morning.
Citalopram and other
SSRIs can induce a
mixed state, especially in those with undiagnosed
bipolar disorder.
[10]:105
Citalopram should not be taken with
St John's wort,
tryptophan or
5-HTP as the resulting drug interaction could lead to
serotonin syndrome.
[18] With St John's wort, this may be caused by compounds in the plant extract reducing the efficacy of the
hepatic cytochrome P450 enzymes that process citalopram.
[19] It has also been suggested that such compounds, including
hypericin,
hyperforin and
flavonoids, could have SSRI-mimetic effects on the nervous system, although this is still subject to debate.
[20] One study found that
Hypericum extracts had similar effects in treating moderate depression as citalopram, with fewer side effects.
[21] Tryptophan and 5-HTP are precursors to serotonin and can cause a rise in serotonin. When taken with an SSRI, such as citalopram, this can lead to levels of serotonin that can be lethal.
In the US, Federal health regulators are warning doctors not to prescribe high doses of Citalopram because of the risk of fatal heart complications. The Food and Drug Administration (FDA) said the drug could interfere with the heart’s electrical activity at doses above 40 milligrams and lead to sudden death. In addition, 20 mg per day is the maximum dose recommended by the FDA for patients with hepatic impairment, who are greater than 60 years of age, who are CYP 2C19 poor metabolizers, or who are taking concomitant cimetidine (brand name: Tagamet), because these factors lead to increased blood levels of citalopram, increasing the risk of QT interval prolongation and Torsade de Pointes.
SSRIs, including citalopram, can increase the risk of bleeding, especially when coupled with
aspirin,
NSAIDs,
warfarin, or other
anticoagulants.
[1] Citalopram is
contraindicated in individuals taking
MAOIs, owing to a potential for
serotonin syndrome.
When taken with
Prilosec, the clearance of citalopram may be reduced, leading to higher blood levels of citalopram.
Prilosec inhibits the CYP450 2C19 enzyme, one of the two primary enzymes responsible for the metabolism of citalopram. Dosage adjustments may be needed to counter this effect.[
citation needed]
SSRI discontinuation syndrome has been reported when treatment is stopped. Tapering off citalopram therapy, as opposed to abrupt discontinuation, is recommended in order to diminish the occurrence and severity of discontinuation symptoms. Some doctors may choose to switch a patient to Prozac (Fluoxetine) when discontinuing Citalopram as Prozac has a much longer half-life (i.e. stays in the body longer compared to Citalopram). This may avoid many of the severe withdrawal symptoms associated with Citalopram discontinuation. This can be done either by administering a single 20 mg dose of Prozac or by beginning on a low dosage of Prozac and slowly tapering down. Either of these prescriptions may be written in liquid form to allow a very slow and gradual tapering down in dosage. Alternatively, a patient wishing to stop taking Citalopram may visit a compounding pharmacy where his or her prescription may be re-arranged into progressively smaller dosages.
According to the FDA, Celexa "can cause abnormal changes to the electrical activity of the heart." and can lead to fatal changes in the heart's rhythm. The higher the dose, the greater the risk to the heart.
[22]
Suicidality
In the United States, citalopram, like other antidepressants, carries a
black box warning stating that it may increase suicidal thinking and behavior in those under age 24.
[1]
Abnormal heart rhythm
The U.S. Food and Drug Administration (FDA) is informing healthcare professionals and patients that the antidepressant Celexa (citalopram hydrobromide; also marketed as generics) should no longer be used at doses greater than 40 mg per day because it can cause abnormal changes in the electrical activity of the heart that are extremely rare but potentially serious. Previously, the citalopram drug label stated that certain patients may require a dose of 60 mg per day. Patients at particular risk for developing prolongation of the QT interval include those with underlying heart conditions and those who are predisposed to low levels of potassium and magnesium in the blood. The FDA advised that if you are currently taking more than 40 mg of Celexa a day, to contact your health care professional.
[23]
