Main Research Findings

Citalopram is a type of selective serotonin reuptake inhibitor (SSRI) that is commonly used to treat depression and anxiety disorders. Many studies have shown that citalopram is an effective treatment, but some side effects have also been reported. 9 reports that citalopram may affect the structure, function, and metabolism of muscles. This is because citalopram can alter the electrical activity of muscles and affect muscle weight, the number of cells, and the cross-sectional area of muscle fibers. Citalopram may also affect energy metabolism, leading to changes in glycogen synthase activity, acetyl-CoA carboxylase phosphorylation, citrate synthase activity, and protein kinase B Ser phosphorylation. Furthermore, it may affect insulin signaling and glucose uptake. These changes suggest that citalopram may affect the structure, function, and metabolism of muscles, and patients taking citalopram may need to be aware of these changes. 21 investigated the association between starting citalopram treatment and public sick leave compensation in the following year. The results show that people who started taking citalopram tend to have a higher rate of receiving public sick leave compensation in the following year. This suggests that while citalopram is effective in treating mental illnesses such as depression and anxiety disorders, it can also cause side effects such as fatigue and lethargy, which may increase the likelihood of receiving public sick leave compensation. 11 compared the effects of citalopram and sertraline on chronic post-traumatic stress disorder (PTSD). The results showed that both drugs were effective in improving PTSD symptoms, but there were subtle differences in the degree of symptom improvement, physiological response, and reported side effects. Specifically, the group taking citalopram showed a significant decrease in systolic and diastolic blood pressure, while the group taking sertraline and placebo showed a significant decrease only in systolic blood pressure reactivity to individualized trauma scripts. The group taking sertraline showed significantly more improvement in avoidance/numbing symptoms than the other two groups. In terms of side effects, the group taking sertraline reported more gastrointestinal problems, and those who discontinued early reported more insomnia. Early discontinuers in the citalopram group reported more fatigue and appetite changes than other treatment groups, and those who completed the treatment reported more sexual dysfunction. These results suggest that SSRIs are effective in treating PTSD symptoms, but that there may be differences in the effects of drugs on symptom clusters, physiological parameters, and side effects, which may have clinical significance. 17 discusses methods for avoiding cardiovascular side effects of psychoactive medications. Psychoactive medications can affect the cardiovascular system and must be taken cautiously to avoid negative cardiovascular consequences. It is especially important to be careful if you have heart disease, such as atrial fibrillation, arrhythmias, or heart failure. Medications that can cause QT prolongation, such as citalopram, can be taken safely if appropriate precautions are taken. It is important to remember that fear of QT prolongation should not prevent patients from receiving necessary psychiatric treatment. For example, one large study reported substantially increased all-cause mortality/hospitalization, death/depression-hospitalization, and death/arrhythmia-hospitalization in patients who had their citalopram dosage reduced due to concerns about QT prolongation after the Food and Drug Administration Black Box Warning. In general, it is necessary to pay attention to the specific cardiac adverse effect risks of each drug, and to select and follow up on appropriate patient-related medications, to detect adverse reactions early and make adjustments accordingly. Treatment should begin with low doses, followed by careful dose titration and adjustment of the drug regimen according to clinical response. Particular care is needed to minimize negative consequences on the cardiovascular/metabolic risk profile, as this may have very detrimental long-term effects on cardiovascular health. It is crucial that fear of cardiovascular adverse effects not deprive patients of appropriate psychoactive drug therapy.

Reasons for Side Effects

Citalopram is believed to improve symptoms of depression and anxiety disorders by increasing the amount of serotonin in the brain. Serotonin is a neurotransmitter that affects mood, sleep, appetite, memory, and learning. Citalopram works by inhibiting the reuptake of serotonin in the brain, increasing the amount of serotonin in the synaptic cleft. However, increasing the amount of serotonin can have various effects on the body. This is one reason why citalopram can cause side effects.

Common Side Effects

Gastrointestinal

Citalopram may affect the gastrointestinal system, causing symptoms such as nausea, vomiting, diarrhea, constipation, and abdominal pain. This is thought to be due to citalopram slowing down gastrointestinal motility or increasing stomach acid secretion. 15 reports that about 30% of patients taking citalopram experienced gastrointestinal side effects. Gastrointestinal side effects are more common when you first start taking citalopram, but they may lessen as you continue taking it. If you are concerned about gastrointestinal side effects, talk to your doctor.

Nervous System

Citalopram may affect the nervous system, causing symptoms such as headache, dizziness, drowsiness, anxiety, tremors, and sweating. This is thought to be caused by citalopram altering the activity of nerve cells in the brain by increasing the amount of serotonin. 8 reports that taking citalopram may affect gamma wave activity in the brain. Gamma waves play an important role in brain activity. Citalopram may cause nervous system side effects by altering gamma wave activity. If you are concerned about nervous system side effects, talk to your doctor.

Sexual Function

Citalopram may affect sexual function, causing symptoms such as decreased libido, erectile dysfunction, and delayed ejaculation. This is thought to be caused by citalopram inhibiting sexual arousal by increasing the amount of serotonin in the brain. 16 reports that citalopram may be effective in treating premature ejaculation, but may also cause sexual side effects. Sexual side effects are reported in many patients taking citalopram. If you are concerned about sexual side effects, talk to your doctor.

Others

Citalopram can also cause other side effects such as weight gain, dry mouth, and visual disturbances. These side effects are thought to be caused by citalopram affecting various organs of the body. If you are concerned about these side effects, talk to your doctor.

Side Effect Management

Gastrointestinal

To reduce gastrointestinal side effects, try dietary changes and lifestyle improvements. For example, eating small meals, eating easily digestible foods, and chewing food thoroughly can be effective. It is also important to stay well-hydrated. If these measures do not improve the situation, consult your doctor.

Nervous System

To reduce nervous system side effects, make sure you get enough rest. It is also important to avoid strenuous exercise and alcohol. If these measures do not improve the situation, consult your doctor.

Sexual Function

To reduce sexual side effects, talk to your doctor about adjusting your citalopram dosage or changing to a different medication. Sexual side effects are reported in many patients taking citalopram, so consult your doctor for appropriate management.

Others

For other side effects, consult your doctor for appropriate management.

Research Comparisons

Research Similarities

Many studies have reported that citalopram is an effective treatment, but some side effects have been observed. A common finding across studies is that citalopram is an effective medication for treating mental illnesses such as depression and anxiety disorders, but it can also cause side effects affecting the gastrointestinal, nervous, and sexual systems. These side effects can affect patients' quality of life and lead to discontinuation of treatment.

Research Differences

Studies vary in the types and severity of side effects caused by citalopram. For example, 11 reports that citalopram has a stronger blood pressure lowering effect than sertraline. 9 reports that citalopram may affect muscle structure, function, and metabolism. These findings suggest that citalopram may have different side effects depending on the individual.

Notes on Real-Life Applications

Citalopram is an effective treatment, but it can cause side effects, so it is important to take precautions when taking it. In particular, pregnant or breastfeeding women, people with heart or liver disease, and those taking other medications should consult their doctor before taking citalopram. Also, if you experience any concerning symptoms while taking citalopram, consult your doctor immediately.

Limitations of Current Research

Research on the side effects of citalopram is still insufficient. In particular, there are still many unknowns about the long-term effects. Also, citalopram side effects can vary from person to person. Therefore, it is difficult to accurately predict citalopram side effects.

Future Research Directions

Further research on the side effects of citalopram is needed. In particular, research on long-term effects and individual differences is necessary. These studies will help us to better understand citalopram side effects and develop safer treatments.

Conclusion

Citalopram is an effective medication for treating mental illnesses such as depression and anxiety disorders, but it can cause side effects affecting the gastrointestinal, nervous, and sexual systems. These side effects can affect patients' quality of life and lead to discontinuation of treatment. When taking citalopram, it is important to be aware of the side effects and consult your doctor immediately if you experience any concerning symptoms.