Lack of drive, bad mood and no friends in everyday activities are typical of an inhibited apathetic depression. The antidepressant citalopram can help to lighten the mood and to find new impulses again. It has been prescribed since the mid-1980s and has been one of the most widely used antidepressants since 1990.
SSRI and citalopram
According to the current state of research, a lack of certain messenger substances in the brain is responsible for the moodiness and joylessness one experiences during depression. It lacks both noradrenaline, an activating messenger substance, as well as serotonin, which is mainly responsible for the mood. Citalopram intervenes at this point.
Citalopram belongs to the group of selective serotonin reuptake inhibitors, the SSRI (selective serotonin reuptake inhibitors). Characteristic of the SSRI is its activating and mood-enhancing effect. This is in contrast to other antidepressants such as mirtazapine, which are more depressant and sedative. The increase in drive is desired, but there is a danger that this results in an inner restlessness. Therefore, especially at the beginning of therapy, patients or relatives must be very vigilant and go to the doctor immediately as soon as they notice an aggravation of the depression while taking the new medication.
Drive increase and mood enhancement
The increase in the drive of citalopram and especially of this entire group of medicines also harbors another side effect as a danger. The increased impulse occurs shortly after the onset of intake, while the mood lightening and thus the antidepressant effect only after three to four weeks in full effect. Due to this delay, citalopram, but also the other SSRIs, can increase suicidal behavior in the first few weeks.
The other drugs of the SSRI class - fluoxetine, fluvoxamine, paroxetine, sertraline - are very similar to citalopram. The advantage of citalopram over other SSRIs is that its degradation lessens a specific liver enzyme (cytochrome P450). These enzymes are important because they not only break down antidepressants, but also many other medicines. If they are blocked by SSRI, there may be a delay in the breakdown of other medicines. This can at worst be accompanied by drug poisoning as a side effect.
Effect of citalopram
SSRIs selectively block the transporter for the reuptake of serotonin into the nerve cells. Thus, citalopram increases the concentration and effect of serotonin on the special serotonin receptors of the nerves in the brain and thus leads to improved mood. Unlike other antidepressants, such as the tricyclic antidepressants, citalopram hardly affects receptors in the brain and nervous system. That's why citalopram has a lower range of side effects.
Citalopram side effects
The most significant side effects of citalopram and the SSRI in general, in particular, are nausea and vomiting. Citalopram is also relatively often associated with insomnia and headache as side effects. Rarely, manic reactions, dizziness and inner agitation occur as side effects. In some cases delayed ejaculation has also been reported.
The side effects of SSRIs are generally lower than those of tricyclic antidepressants due to their specific target of serotonin receptor. Since they bind less to histamine receptors, weight gain is less likely. Like weight gain, side effects such as dry mouth, palpitations, low blood pressure, blurred vision, and seizures are unlikely to occur in contrast to tricyclic antidepressants.
Interactions with citalopram
The concomitant use of citalopram with other psychotropic drugs usually leads to a slower degradation of these drugs in the body. Therefore, a dose adjustment of the individual drugs may be necessary. Substances that are more likely to remain in the body in combination with citalopram include tricyclic antidepressants, haloperidol, phenytoin, carbamazepine, diazepam, and lithium salts.
A combination of citalopram and other SSRIs with monoamine oxidase inhibitors (MAO inhibitors) is even contraindicated. The simultaneous use of both antidepressants can lead to a mutual increase in the effect. This would lead to an excessive and difficult to control serotonin level in the brain. This is accompanied by the risk of seizures and poisoning, which can ultimately lead to serotonin syndrome. This poisoning causes nausea, vomiting, flushing, confusion, involuntary tremor and convulsions.