Citalopram
Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant
Citalopram is a widely prescribed selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat depression, panic disorder, and obsessive-compulsive disorder (OCD). It works by increasing serotonin levels in the brain, helping to restore emotional balance. Listed on the WHO Model List of Essential Medicines, citalopram is considered one of the most selective SSRIs available, with a well-established efficacy and safety profile supported by decades of clinical research.
Quick Facts: Citalopram
Key Takeaways
- Citalopram is a selective serotonin reuptake inhibitor (SSRI) prescribed for depression, panic disorder, and OCD, with effects typically noticeable after 2–4 weeks of treatment.
- The maximum recommended dose is 40 mg/day for adults and 20 mg/day for those over 65 or with liver impairment, due to the risk of QT prolongation at higher doses.
- It must never be combined with MAO inhibitors or drugs that prolong the QT interval, as these interactions can be life-threatening.
- Discontinuation should always be gradual under medical supervision to avoid withdrawal symptoms such as dizziness, sensory disturbances, and anxiety.
- Young adults under 25 should be closely monitored during early treatment, as there is an increased risk of suicidal thoughts during the initial weeks of SSRI therapy.
What Is Citalopram and What Is It Used For?
Citalopram belongs to a class of antidepressant medications known as selective serotonin reuptake inhibitors, or SSRIs. These medications work by selectively blocking the reuptake of the neurotransmitter serotonin (5-hydroxytryptamine, or 5-HT) at the presynaptic neuronal membrane. By preventing serotonin from being reabsorbed back into nerve cells, citalopram effectively increases the amount of serotonin available in the synaptic cleft—the space between nerve cells where chemical signaling occurs. This enhanced serotonergic transmission is believed to underlie the drug's antidepressant and anxiolytic effects.
Among the SSRIs, citalopram is considered the most pharmacologically selective. It has minimal affinity for histaminergic, cholinergic (muscarinic), and adrenergic receptors, which explains its relatively favorable side effect profile compared to older antidepressants such as tricyclics and MAO inhibitors. This selectivity was a key factor in its inclusion on the WHO Model List of Essential Medicines, which recognizes it as one of the most efficacious, safe, and cost-effective medications for priority health conditions.
Citalopram is primarily prescribed for the following conditions:
- Major Depressive Disorder (MDD): The most common indication. Multiple large-scale clinical trials and network meta-analyses, including the landmark Cipriani et al. (2018) study published in The Lancet, have confirmed citalopram's efficacy in treating moderate to severe depression.
- Panic Disorder: With or without agoraphobia. Citalopram reduces the frequency and severity of panic attacks and helps manage anticipatory anxiety.
- Obsessive-Compulsive Disorder (OCD): Citalopram is effective in reducing obsessive thoughts and compulsive behaviors, typically at doses in the higher end of the therapeutic range.
- Relapse Prevention: For patients who have responded well to initial treatment, citalopram may be continued long-term to prevent recurrence of depressive episodes. The duration of preventive treatment is individualized but often lasts at least 6 to 12 months, and in some cases several years.
It is important to understand that citalopram does not provide immediate symptom relief. Like all SSRIs, it typically takes 2 to 4 weeks before noticeable clinical improvement occurs, with full therapeutic benefits often not apparent until 6 to 8 weeks of continuous treatment. Patients should be encouraged to continue taking the medication as prescribed even if they do not feel an immediate effect, as premature discontinuation is one of the most common reasons for treatment failure.
Citalopram is available as film-coated tablets in strengths of 10 mg, 20 mg, and 40 mg. It is marketed under several brand names worldwide, including Cipramil (primarily in Europe and Australasia) and Celexa (primarily in North America), as well as numerous generic formulations from manufacturers such as Sandoz, Teva, Orion, and Viatris. All formulations contain citalopram as the hydrobromide salt.
What Should You Know Before Taking Citalopram?
Contraindications
There are several situations in which citalopram must not be used. These absolute contraindications exist because the combination of citalopram with certain conditions or medications can lead to serious, potentially life-threatening adverse events:
- You are allergic to citalopram or any of the excipients in the tablet formulation.
- You are currently taking, or have recently taken (within the past 14 days), a monoamine oxidase (MAO) inhibitor such as phenelzine, tranylcypromine, isocarboxazid, or nialamid. The antibiotic linezolid is also a MAO inhibitor.
- You have a known history of QT prolongation or congenital long QT syndrome, as confirmed by electrocardiogram (ECG).
- You are taking other medications that are known to prolong the QT interval (see Drug Interactions section).
If you have been taking a non-selective MAO inhibitor, you must wait at least 14 days after stopping it before starting citalopram. For the reversible MAO-A inhibitor moclobemide, a minimum of 1 day must elapse. Conversely, after discontinuing citalopram, you should wait at least 7 days before starting any MAO inhibitor.
Warnings and Precautions
Before starting citalopram, discuss the following conditions with your prescribing physician, as they may require dose adjustment, additional monitoring, or special precautions:
- Suicidal ideation and behavior: Antidepressants, including citalopram, may increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults (under 25 years). This risk is highest during the first weeks of treatment or when the dose is changed. Close monitoring is essential during this period. Patients and caregivers should be alert to any worsening of depression, emergence of suicidal thoughts, or unusual changes in behavior, and should seek immediate medical attention if these occur.
- Manic episodes: Patients with bipolar disorder may switch into a manic phase during citalopram treatment. Symptoms include racing thoughts, exaggerated feelings of well-being, and excessive physical activity. If these occur, citalopram should be discontinued and your doctor consulted immediately.
- Liver or kidney impairment: Patients with reduced liver function should not exceed 20 mg daily. Kidney function should also be assessed, and dose adjustments may be necessary.
- Diabetes: Citalopram may affect blood glucose control. Insulin or oral hypoglycemic drug doses may need adjustment. Regular blood glucose monitoring is recommended, especially when starting or stopping treatment.
- Epilepsy or seizure history: If seizures occur or increase in frequency, citalopram should be discontinued.
- Bleeding disorders: SSRIs may impair platelet aggregation, increasing bleeding risk. This is particularly relevant for patients taking anticoagulants, NSAIDs, or aspirin concurrently.
- Hyponatremia: Low blood sodium levels can occur, especially in elderly patients and those taking diuretics. Symptoms include confusion, fatigue, and muscle cramps.
- Heart conditions: Patients with pre-existing cardiac disease, recent heart attack, slow resting heart rate, or electrolyte imbalances (low potassium or magnesium) should have an ECG before starting treatment and should be monitored for cardiac symptoms.
- Glaucoma: Citalopram may increase intraocular pressure, which is a concern for patients with certain types of glaucoma (particularly angle-closure glaucoma).
- Electroconvulsive therapy (ECT): Caution is advised when combining citalopram with ECT due to limited clinical experience.
Some patients may experience restlessness, agitation, or an inability to sit or stand still during the first weeks of treatment. This condition is known as akathisia and can be distressing. If you experience these symptoms, contact your doctor immediately—do not increase the dose, as this may worsen the symptoms.
Children and Adolescents
Citalopram is generally not recommended for children and adolescents under 18 years of age. Clinical studies in this age group have shown an increased risk of suicidal behavior (suicide attempts and suicidal thoughts) and hostility (primarily aggression, oppositional behavior, and anger) compared to placebo. However, if a physician determines that the benefits outweigh the risks, it may still be prescribed in exceptional circumstances under close medical supervision. The long-term effects on growth, maturation, and cognitive and behavioral development in this age group have not been fully established.
Pregnancy and Breastfeeding
The decision to use citalopram during pregnancy must be made carefully, weighing the risks of untreated maternal depression against the potential effects on the developing fetus. Abrupt discontinuation of citalopram during pregnancy is not recommended, as this may precipitate a relapse of depression.
If citalopram is used during the third trimester, the newborn may experience transient symptoms including breathing difficulties, bluish skin discoloration, seizures, temperature instability, feeding difficulties, vomiting, low blood sugar, muscle tone abnormalities, tremor, jitteriness, irritability, and excessive crying. These neonatal adaptation symptoms are usually self-limiting but should be reported to a healthcare professional immediately.
There is also a small but documented risk of persistent pulmonary hypertension of the newborn (PPHN) when SSRIs are used during late pregnancy. Additionally, citalopram use near delivery may increase the risk of postpartum hemorrhage.
Citalopram passes into breast milk. While concentrations are generally low, there is a theoretical risk of effects on the nursing infant. The decision to breastfeed while taking citalopram should be made in consultation with your doctor, considering the benefits of breastfeeding, the mother's need for treatment, and any potential adverse effects on the infant.
Driving and Operating Machinery
Citalopram may impair reaction time and concentration in some individuals. Patients should assess their own response to the medication before driving, operating heavy machinery, or engaging in activities that require mental alertness. Drowsiness and dizziness are common side effects, particularly during the initial weeks of treatment.
Alcohol
Although citalopram is not expected to interact pharmacokinetically with alcohol, concurrent use is not recommended. Alcohol is a central nervous system depressant that can exacerbate symptoms of depression and anxiety, and may potentiate the sedative effects of citalopram.
How Does Citalopram Interact with Other Drugs?
Drug interactions with citalopram can range from clinically insignificant to life-threatening. Understanding these interactions is critical for safe use. The following table summarizes the most important known interactions, categorized by severity.
Major Interactions (Avoid Combination)
| Interacting Drug | Risk | Recommendation |
|---|---|---|
| MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) | Serotonin syndrome (potentially fatal) | Contraindicated. Wait 14 days after stopping MAOIs before starting citalopram. |
| Linezolid (antibiotic) | Serotonin syndrome (MAO inhibitor activity) | Contraindicated. Do not use concurrently. |
| Pimozide, haloperidol (antipsychotics) | QT prolongation, cardiac arrhythmias | Contraindicated. Do not combine with QT-prolonging drugs. |
| Class IA/III antiarrhythmics | QT prolongation, risk of Torsade de Pointes | Contraindicated. Use alternative treatments. |
| Erythromycin IV, moxifloxacin | QT prolongation | Contraindicated. Choose a non-QT-prolonging antibiotic. |
Moderate Interactions (Use with Caution)
| Interacting Drug | Risk | Recommendation |
|---|---|---|
| Lithium, tryptophan | Increased serotonergic effects; serotonin syndrome risk | Monitor closely. Reduce dose if necessary. |
| Sumatriptan and other triptans | Serotonin syndrome risk | Use with caution. Monitor for symptoms. |
| Tramadol and other opioids | Serotonin syndrome risk; seizure threshold lowered | Use with caution. Monitor closely. |
| St. John's Wort (Hypericum perforatum) | Increased serotonergic side effects | Avoid concurrent use. |
| Warfarin, NSAIDs, aspirin | Increased bleeding risk | Monitor for signs of bleeding. Consider gastroprotection. |
| Imipramine, desipramine (tricyclics) | Increased tricyclic plasma levels; serotonin syndrome | Monitor levels. Dose adjustment may be needed. |
| Metoprolol | Increased metoprolol plasma levels | Monitor heart rate and blood pressure. Citalopram dose may need adjustment. |
| Mefloquine, bupropion | Lowered seizure threshold | Use with caution in patients with seizure history. |
Minor Interactions
The following drugs may increase citalopram plasma levels through inhibition of hepatic metabolism, but these interactions are generally manageable with monitoring:
- Cimetidine, omeprazole, lansoprazole (proton pump inhibitors and H2 blockers): May increase citalopram levels by inhibiting CYP2C19 enzyme. Monitor for side effects.
- Fluconazole (antifungal): CYP2C19 inhibitor. Consider citalopram dose reduction.
- Fluvoxamine (antidepressant): CYP2C19 and CYP1A2 inhibitor. Not typically used concurrently, but may increase citalopram levels.
Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the central nervous system. Symptoms include high fever, agitation, confusion, tremor, rapid muscle contractions (myoclonus), diarrhea, rapid heart rate, and fluctuating blood pressure. In severe cases, it can lead to seizures, organ failure, and death. If you experience these symptoms, stop the medication and seek emergency medical care immediately.
What Is the Correct Dosage of Citalopram?
Citalopram dosing should always be individualized based on the clinical response and tolerability of the patient. The following dosage guidelines are based on international prescribing information and clinical practice guidelines. Never adjust your dose without consulting your doctor or pharmacist.
Adults
Depression
The recommended starting dose is 20 mg once daily. Depending on individual response, the dose may be increased in increments of 10 mg at intervals of at least one week, up to a maximum of 40 mg per day. In 2011, the FDA issued a safety communication recommending that doses above 40 mg/day should not be used due to the dose-dependent risk of QT prolongation.
Panic Disorder
The recommended starting dose is 10 mg once daily during the first week, followed by an increase to 20–30 mg per day. The dose may be further increased to a maximum of 40 mg per day based on clinical response. The lower starting dose helps minimize the initial worsening of anxiety symptoms that can occur when starting SSRI treatment for panic disorder.
Obsessive-Compulsive Disorder (OCD)
The recommended starting dose is 20 mg once daily. The dose may be increased to a maximum of 40 mg per day. Improvement is typically observed within 2–4 weeks, with further benefits seen during continued treatment. OCD often requires treatment at higher doses and for longer durations than depression.
Elderly Patients (Over 65 Years)
Elderly (65+ years)
The starting dose should be half the usual adult dose, typically 10–20 mg daily. Elderly patients should generally not exceed 20 mg per day due to increased sensitivity to the drug and a higher risk of QT prolongation. The dose should be titrated slowly, with regular monitoring of cardiac function.
Patients with Liver Impairment
Patients with hepatic impairment should not exceed a dose of 20 mg per day. Citalopram is extensively metabolized by the liver, and reduced hepatic function leads to slower drug clearance and higher plasma concentrations.
Children and Adolescents (Under 18 Years)
Citalopram is not recommended for use in children and adolescents under 18 years of age (see Warnings and Precautions section). If prescribed by a specialist in exceptional circumstances, the dose should be carefully individualized and the patient closely monitored.
How to Take Citalopram
Citalopram is taken once daily, at any time of the day, with or without food. The tablet should be swallowed with water. Taking it at the same time each day helps maintain consistent blood levels and improves adherence.
It is important to continue taking citalopram as prescribed for the full duration recommended by your doctor, even after you start feeling better. Premature discontinuation is a common cause of treatment failure and relapse. For depression, at least 6 months of treatment after symptom resolution is generally recommended to reduce the risk of recurrence. Patients with recurrent depression may need treatment for several years.
Missed Dose
If you forget to take a dose, take it as soon as you remember—unless it is close to the time for your next dose. In that case, skip the missed dose and continue with your regular schedule. Never take a double dose to make up for a forgotten one.
Overdose
If you suspect a citalopram overdose, contact your local emergency services or poison control center immediately. Bring the medication packaging with you. Signs of overdose may include:
- Potentially life-threatening cardiac arrhythmias (QT prolongation, Torsade de Pointes)
- Seizures and tremor
- Serotonin syndrome (agitation, confusion, rapid muscle contractions)
- Drowsiness progressing to coma
- Nausea, vomiting, and sweating
- Low or high blood pressure
- Dilated pupils and cyanosis (bluish skin)
What Are the Side Effects of Citalopram?
Like all medications, citalopram can cause side effects, although not everyone experiences them. Many of the most common side effects are mild and tend to diminish or resolve entirely as your body adjusts to the medication, typically within the first 1–2 weeks of treatment. It is also important to note that some symptoms you may experience could be related to the underlying condition (depression, anxiety) rather than the medication itself.
The side effects are listed below according to their frequency of occurrence, based on data from clinical trials and post-marketing surveillance.
Very Common
Affects more than 1 in 10 people
- Nausea
- Dry mouth (increased risk of dental caries—brush teeth more frequently)
- Drowsiness (somnolence)
- Insomnia (difficulty sleeping)
- Increased sweating (hyperhidrosis)
- Headache
Common
Affects 1 in 10 to 1 in 100 people
- Decreased appetite
- Agitation, nervousness, anxiety
- Decreased libido (reduced sexual desire)
- Confusion, abnormal dreams
- Tremor, tingling or numbness (paresthesia)
- Dizziness, impaired concentration
- Tinnitus (ringing in the ears)
- Yawning
- Diarrhea, constipation, vomiting
- Itching (pruritus)
- Joint and muscle pain (arthralgia, myalgia)
- Sexual dysfunction (ejaculation/erection problems in men; difficulty achieving orgasm in women)
- Fatigue
- Weight loss
Uncommon
Affects 1 in 100 to 1 in 1,000 people
- Easy bruising (ecchymosis)
- Increased appetite
- Aggression, depersonalization, hallucinations
- Mania (elevated mood, racing thoughts)
- Fainting (syncope)
- Dilated pupils (mydriasis)
- Palpitations, slow heart rate (bradycardia)
- Urticaria (hives), hair loss, rash, photosensitivity
- Difficulty urinating
- Menstrual irregularities, heavy periods
- Peripheral edema (swollen limbs)
- Weight gain
Rare
Affects 1 in 1,000 to 1 in 10,000 people
- Seizures (convulsions)
- Involuntary movements (dyskinesia)
- Taste disturbance (dysgeusia)
- Hemorrhage (bleeding)
- Hepatitis (liver inflammation)
- Fever
- Hyponatremia (low sodium—causing fatigue, confusion, muscle cramps)
Frequency Not Known
Reported from post-marketing surveillance
- Suicidal ideation and behavior (see Warnings section)
- Serotonin syndrome (fever, agitation, confusion, tremor, muscle rigidity)
- QT prolongation, Torsade de Pointes (potentially life-threatening cardiac arrhythmia)
- Angioedema (swelling of face, tongue, lips, or throat)
- Gastrointestinal bleeding
- Thrombocytopenia (low platelet count)
- Hypokalemia (low potassium)
- Akathisia (restless inability to sit still)
- Visual disturbances
- Priapism (painful prolonged erection)
- Galactorrhea (milk secretion in non-nursing individuals)
- Elevated prolactin levels
- Abnormal liver function tests
- Increased bone fracture risk
- Postpartum hemorrhage
- Bruxism (teeth grinding)
- Panic attacks, nosebleeds
SSRIs including citalopram can cause sexual side effects such as decreased libido, difficulty achieving orgasm, and erectile dysfunction. In most cases, these symptoms resolve after discontinuation of the medication. However, in rare cases, sexual dysfunction may persist after treatment has been stopped (a condition sometimes referred to as Post-SSRI Sexual Dysfunction or PSSD). If sexual side effects are troublesome, discuss alternative treatments or management strategies with your doctor.
How Should You Stop Taking Citalopram?
When it is time to stop treatment with citalopram, it is essential that the dose is reduced gradually under medical supervision. Abrupt discontinuation—especially after prolonged use or at higher doses—can trigger a range of unpleasant symptoms known as discontinuation syndrome (sometimes called withdrawal symptoms).
Your doctor will typically recommend reducing your dose in small steps over a period of several weeks to months, depending on how long you have been taking the medication and at what dose. If you experience severe discontinuation symptoms despite gradual tapering, your doctor may suggest returning to the previous dose and reducing more slowly.
Common Discontinuation Symptoms
- Dizziness (feeling unsteady or off-balance)
- Sensory disturbances (tingling, burning, and less commonly, electric shock-like sensations, including in the head—often called "brain zaps")
- Sleep disturbances (vivid dreams, nightmares, insomnia)
- Gastrointestinal symptoms (nausea, diarrhea)
- Emotional instability (anxiety, irritability, confusion, disorientation)
- Physical symptoms (headache, tremor, sweating, palpitations)
For most people, these symptoms are mild to moderate and resolve within 1 to 2 weeks. However, in some cases they may be more prolonged. It is important to understand that experiencing discontinuation symptoms does not mean you are addicted to citalopram—it is a physiological response to the change in serotonin levels in the brain.
How Should You Store Citalopram?
Proper storage of medication ensures it remains effective and safe to use throughout its shelf life. Citalopram tablets should be stored at temperatures not exceeding 25°C (77°F). Keep the tablets in their original packaging to protect them from moisture and light.
Always store medications out of sight and reach of children. Do not use citalopram after the expiration date shown on the packaging (the expiration date refers to the last day of that month). Do not dispose of medications in household waste or by flushing them down the toilet. Return unused or expired medications to your pharmacist for safe disposal to help protect the environment.
What Does Citalopram Contain?
The active substance in each tablet is citalopram, present as citalopram hydrobromide. The actual amount of citalopram hydrobromide in each tablet is slightly higher than the stated citalopram content, because the hydrobromide salt form has a higher molecular weight than the base compound.
Inactive Ingredients (Excipients)
The following inactive ingredients are typically found in citalopram film-coated tablets (exact composition may vary between manufacturers):
- Tablet core: Maize starch, lactose monohydrate, microcrystalline cellulose, copovidone, glycerol 85%, croscarmellose sodium, magnesium stearate
- Film coating: Hypromellose 5, macrogol 400, titanium dioxide (E171)
Citalopram tablets contain lactose monohydrate. If you have been told by your doctor that you have an intolerance to certain sugars, contact your doctor before taking this medicine. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption should not take this medicine.
Tablet Appearance
Tablet appearance may vary between manufacturers. Common forms include:
- 10 mg: Round, white, film-coated tablets (e.g., marked "CL" on one side for Cipramil brand)
- 20 mg: Oval, white, scored, film-coated tablets (e.g., marked "C" and "N" on either side of the score line for Cipramil brand)
- 40 mg: Oval, white, scored, film-coated tablets (appearance varies by manufacturer)
Frequently Asked Questions About Citalopram
Citalopram typically begins to produce noticeable improvement in mood and anxiety symptoms within 2 to 4 weeks of starting treatment, although some effects such as improved sleep and reduced anxiety may be noticed sooner. Full therapeutic benefits are usually achieved after 6 to 8 weeks of continuous treatment at an adequate dose. It is crucial to continue taking the medication as prescribed during this period, even if you do not feel an immediate effect. If you see no improvement after 6–8 weeks, consult your doctor about adjusting the dose or considering alternative treatments.
Although citalopram does not have a significant pharmacological interaction with alcohol, drinking while on this medication is generally not recommended. Alcohol is a central nervous system depressant that can worsen symptoms of depression and anxiety. It may also increase the sedative effects of citalopram, impairing judgment, coordination, and reaction time. If you choose to drink, do so in moderation and discuss safe limits with your healthcare provider.
Abruptly stopping citalopram can cause discontinuation syndrome, characterized by dizziness, sensory disturbances (tingling, electric shock-like sensations or "brain zaps"), sleep problems (vivid dreams, insomnia), nausea, headache, anxiety, irritability, and tremor. These symptoms are typically mild to moderate and resolve within 1–2 weeks, but they can be very distressing. To minimize the risk, your doctor will recommend gradually tapering the dose over several weeks. Never stop citalopram without consulting your doctor first.
Weight changes with citalopram vary between individuals. Weight loss is actually listed as a common side effect during the first weeks of treatment, while weight gain is listed as an uncommon side effect. Over the longer term, some patients may experience modest weight gain. Overall, citalopram is considered relatively weight-neutral compared to other antidepressants like mirtazapine or paroxetine, which are more commonly associated with weight gain. If weight changes concern you, discuss monitoring strategies and lifestyle modifications with your healthcare provider.
The safety of citalopram during pregnancy requires careful consideration with your doctor. Untreated depression during pregnancy carries its own risks for both mother and baby, so the decision involves balancing potential medication effects against the risks of untreated illness. SSRI use during the third trimester may cause transient neonatal symptoms (breathing difficulties, tremor, feeding problems) and a small increased risk of persistent pulmonary hypertension (PPHN). Abrupt discontinuation during pregnancy is not recommended. Your obstetrician and psychiatrist should collaborate on the safest treatment plan for your individual situation.
The maximum recommended dose of citalopram is 40 mg per day for adults under 65 years of age. For patients over 65 years or those with liver impairment, the maximum dose is 20 mg per day. These limits exist because citalopram can cause dose-dependent QT prolongation (a cardiac conduction abnormality detectable on ECG), which increases the risk of serious heart rhythm disturbances. The FDA issued a safety communication in 2011 specifically warning against doses exceeding 40 mg per day.
References and Sources
All medical information on this page is based on peer-reviewed research, international clinical practice guidelines, and official regulatory agency publications. The following sources were consulted:
- Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet. 2018;391(10128):1357–1366. doi:10.1016/S0140-6736(17)32802-7
- National Institute for Health and Care Excellence (NICE). Depression in adults: recognition and management. Clinical guideline CG90. Updated 2022.
- American Psychiatric Association (APA). Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 3rd ed. 2023.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. 2023.
- U.S. Food and Drug Administration (FDA). FDA Drug Safety Communication: Revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses. 2012.
- European Medicines Agency (EMA). Citalopram – Summary of Product Characteristics. Updated 2024.
- British National Formulary (BNF). Citalopram. NICE Evidence Services. Accessed January 2026.
- Stahl SM. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 5th ed. Cambridge University Press; 2021.
Editorial Team and Medical Review
This article was written by the iMedic Medical Editorial Team and reviewed by board-certified specialists in clinical pharmacology and psychiatry. Our editorial process follows the GRADE evidence framework and adheres to the principles of evidence-based medicine.
iMedic Medical Editorial Team — specialists in clinical pharmacology and psychopharmacology with documented academic credentials and clinical experience.
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