US Brand Name: Celexa

generic name: citalopram hydrobromide

Other Forms: Oral solution

Class: Antidepressant. Specifically a Serotonin-Selective Reuptake Inhibitor (SSRI).

1.  Other brand names & branded generic names¹

• Cipramil (Australia & UK)

2.  FDA Approved Uses of Celexa (citalopram hydrobromide)

Depression

3.  Off-Label Uses of Celexa (citalopram hydrobromide)

As you can expect for an SSRI, Celexa will be used to treat all sorts of panic/anxiety disorders.

• Panic disorders with phobias
• Combat PTSD
• Social anxiety disorder (SAnD)
• Social anxiety with depression
• OCD. Like most SSRIs, Celexa doesn’t do anything for, and can sometimes exacerbate the symmetry and hoarding forms/dimension of OCD.
• Celexa is just fabulous for compulsive shopping
• Celexa is often used to augment other meds to treat OCD. such as clomipramine.
• The data do get a bit mixed with straight-up anxiety.
  • On one hand it works well with very specific things like Late-Life Anxiety Disorders.
  • On the other hand there are several studies, in humans and critters, like this one showing how Celexa exacerbates anxiety symptoms during the early phases of treatment.
• Augmenting antipsychotics to treat psychotic depression
• Bipolar Depression
• Severe & frequent hot flashes. Particularly in post-menopausal women and women being treated for breast cancer.
• Premenstrual Dysphoric Disorder (PMDD)
• Chronic fatigue, where it’s so-so.
• Fibromyalgia. Two studies. It didn’t work in the first one, it pooped out after two months in the second one.
• Various forms of unpleasant behavior, including:
  • Reducing hostility
  • Aggression in schizophrenia
  • “Anger attacks” in bipolar depression. AKA dysphoric mania.
• A variety of eating disorders:
  • Anorexia nervosa
  • Binge eating
  • Bulimia - compares well with Prozac, which is approved to treat bulimia.
• Irritable Bowel Syndrome
  • Although this guy calls bullshit on the above study.
  • And the title of this one says it all. Citalopram is not Effective Therapy for Non-Depressed Patients with Irritable Bowel Syndrome
  • When it comes to IBS, it’s either Paxil or a TCA.
• Premature ejaculation
  • I especially like the specificity of this study: Salvage Use of Citalopram for Treatment of Fluoxetine-Resistant Premature Ejaculation in Recently Married Men
  • As well as this one: Panic attacks with spontaneous ejaculation successfully treated with citalopram and clonazepam

4.  Celexa’s (citalopram hydrobromide’s) pros and cons

4.1  Pros

• Works well on the combination of depression with OCD and/or SAnD-types of anxiety.
• Your insurance company may actually be right if they insist on your trying generic citalopram HBr for your first med. Unless your doctor has a better idea, and/or you’ve used antidepressants in the past, especially SSRIs, just by playing the numbers Celexa is more likely to work (and suck less) than any other AD on the market.
• Generic citalopram HBr is as good as Lexapro for most people.
• Basically, Celexa is the current King of all Antidepressants.

4.2  Cons

• If it does happen, the weight gain can be bad for an SSRI.
• Your insurance company might still insist you try citalopram even if you’ve failed two other SSRIs previously.
• Not all generics are created equal.

5.  Celexa’s (citalopram hydrobromide’s) Side Effects

5.1  Typical Side Effects

The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido. Most everything but the weight gain and loss of libido usually goes away within a couple of weeks.

5.2  Not So Common Side Effects

Tremor, brand new anxiety or exacerbation of existing anxiety, acne, disruption in your menstrual cycle. Given how Celexa works on PMDD and severe hot flashes those last two shouldn’t be much of a surprise if they happen.

5.3  Freaky Rare Side Effects

Rectal hemorrhage. Hiccups that won’t stop. Mouse had the unending hiccups. At the time it’s only funny when something like that happens to someone else. A year or two later it’s pretty funny no matter whom it happened to.

6.  Interesting Stuff Your Doctor Probably Won’t Tell You about Celexa (citalopram hydrobromide)

For whatever reason, Celexa is a good med to switch to if the SSRI you’re already taking stops working or sucks too much. A study with Prozac and another with Paxil correspond to the anecdotal evidence I’ve come across. So in addition to being the best first med to try - unless you have specific symptoms that indicate an SSRI isn’t a way to go in the first place - citalopram is also a good second med to try.

Like Zoloft, women tend to respond to Celexa better than men. Celexa has a slightly better chance of working for you than Zoloft regardless of your gender.

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7.  Celexa’s (citalopram hydrobromide’s) Dosage and How to Take Celexa (citalopram hydrobromide)

Initial dosage of 20mg a day that can be increased to 40mg a day after at least one week. You can go up to 60mg a day, although there is little evidence from the clinical trials to support effectiveness at that dosage. Like any SSRI I recommend starting out with 10mg and then increasing to 20mg after a week. If you don’t feel anything go up to 30mg, but stay there until you’ve given it a try for a month, otherwise it’ll just be a pain in the ass to stop it. Even at 30mg you’ll know after a month if it’s going to do something for you.

8.  How Long Celexa (citalopram hydrobromide) Takes to Work

Like all SSRIs anywhere from a couple days to over a month. If you don’t feel any positive benefit after six weeks, then you should talk to your doctor about either another SSRI or trying a med that hits another neurotransmitter.

9.  How Likely is Celexa (citalopram hydrobromide) to Work

• As far as depression is concerned, Celexa is one of the few meds where we have some hard, real-world numbers from STAR*D on its odds of working:
  • It’s a literal 50% coin-toss that you’ll a positive response within four weeks.
  • And it’s a two-in-three chance that your depression will stay away.
  • Based on what I can find in other clinical trials & studies, books, and anecdotal evidence, you’ve got a good 60–70% chance that Celexa will work, keep working, and suck less than MDD and any other antidepressant, except Lexapro.
• The data from the clinical trials for hot flashes are pretty encouraging, but anything in stage III tends to be encouraging.
• It’s main problem with anxiety seems to be the short-term exacerbation of the problem.

10.  How to Stop Taking Celexa (citalopram hydrobromide)

Your doctor should be recommending that you reduce your dosage by by 10–20mg a day every 6–8 days if you need to stop taking it if you need to stop taking it, if not more slowly than that. Make that 10–20mg a day every week just to make things easier on everyone. Based on the 35 hour half-life.
Because Celexa’s half-life is 35 hours - Prozac is the only SSRI/SNRI with a longer half-life - severe discontinuation syndrome is less likely than most other SSRIs and all the SNRIs.

11.  Celexa’s (citalopram hydrobromide’s) Half-Life & Average Time to Clear Out of Your System

Half-life is 35 hours. So it’s out of your system within 6–8 days.

12.  Days to Reach a Steady State

About a week.

13.  How Celexa (citalopram hydrobromide) Works

Based upon the chemical imbalance theory of mental illness (or brain cooties as we often call it), Celexa effectively raises the serotonin levels in your brain by letting your synapses soak in serotonin for longer than usual by slowing (inhibiting) the mechanism of serotonin transmission deeper into the neurons (reuptake). Depending on where, and to what extent that effect on serotonin occurs, the regulation of your dopamine can be affected, which is the likely cause of various side effects, especially those involving sexual dysfunction.
This study may explain why Celexa, and probably other SSRIs, works in treating OCD. I wish there were more pretty neuroimaging pictures.
Here’s another one, looking at people with several anxiety-spectrum conditions (OCD, PTSD, & SAnD).
Your guess is as good as, if not better than, mine when it comes to how Celexa and other medications work in regards to things like PMDD.

14.  Comments

Based upon it’s efficacy and, now that it’s available as a generic practically everywhere, cost, citalopram is one of, if not the most-prescribed antidepressant on the planet. It’s certainly the most-prescribed, and usually the first-prescribed for MDD wherever it’s available. Unless your symptoms scream something else (e.g. anhedonia and the inability to figure out how to go about getting out of bed, in which case Wellbutrin would probably work better), citalopram should be the first antidepressant you’re prescribed. Unless your insurance covers Lexapro, in which case you may as well get the med that works a little faster and sucks a little less than Celexa.

Celexa is currently the only SSRI approved by the FDA for one thing, and one thing only: depression. Although that may change as it is undergoing phase III tests to treat hot flashes in women who experience them frequently long after menopause or during breast cancer therapy. In the latter it manages to do so without messing with tamoxifen, which is critical.

15.  Discussion board

Crazy Meds’ Celexa discussion board

16.  Your Comments About and Experiences with Celexa

Tell us what you think about Celexa

At age 45 I went to get counceling to work on parent issues. My therapist (not a psychiatrist) thought I might need an anti depressant while we did some of this work. She convinced me to get my GP to prescibe Celexa. I was not bipolar going into this and really was not very depressed, either. As soon as I got on Celexa, my brain kind of exploded. Do you know the video game from the lat 70′s called qix? It was a spastic little set of line segments that twisted this way and that and your job was to contain it. Somehow qix had gotten loose in my brain. I described this to my therapist and about how no thought could really happen now, but she had me on it for 30 days. Finally she sent me to a psychiatrist who took me off the Celexa. He gave me a book to read so that I could tell him what I thought I was now. Clearly I had moved from what they call cyclotropic to a full blown bipolar 2. One day I was not bipolar, and the next day I was. He put me on seraquel which really helped the ensuing mania that was left behind by the Celexa, and lamictal for the new depression that I suddenly had. This has ruined my life. I suddenly have a major mental illness, and I am tied to all the expensive drugs and debilitating issues that can not be turned off. On reading a lot I discoved fish oil. I take a high epa, low dpa one in mega high doses that I discovered by experiment. It meant I could decrease but not eliminate my meds. Fish oil made things a lot more tolerable. I am very angry not only that this happened to me but also that it is not widely known that this can happen. That means that other poor souls might suffer my same fate. I have been told that this is rare but not impossible and that Celexa can bring on manic episodes, but I am not sure people think it is permanent. It is with me. Please look into this. You have a lot of good and hard-to-find info on your page, but I did not find anything on this.

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Enter your own Comments & Experiences with Celexa here.
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17.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Celexa Full US Prescribing Information / PI Sheet

Check for drug-drug interactions

18.  Bibliography

Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press.

Primer of Drug Action 12th edition by Robert M. Julien Ph.D., Claire D. Advokat, Joseph Comaty © 2011 Published by Worth Publishers.

The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition by Stephen Stahl © 2009 Published by Cambridge University Press.

Clinical Handbook of Psychotropic Drugs 18th edition Adil S. Virani, K. Bezchlibnyk-Butler, J. Jeffries © 2009 Published by Hogrefe & Huber Publishers.

Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier. Also the 2004 edition, but only on pages that haven’t been fully updated yet.

Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton

The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.

PDR: Physicians’ Desk Reference 2010 64th edition back through to 53rd edition of 1999. Old copies of the PDR come in handy for PI sheets that are no longer available and difficult to find, as well as to track the changes in both indications and adverse effects.

Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.

¹ The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

Date created 25 Apr 2011 - 12:06 Page Creator: JerodPoore Last edited by:

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¹ While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]