Are you wondering if the prescription of Citalopram is really the best solution for your depression or anxiety? Citalopram, a selective serotonin reuptake inhibitor (SSRI), is often the first choice for treating mental health conditions like depression or anxiety disorders. However, the treatment’s effectiveness—and especially its side effects—should not be underestimated. A look into various personal experiences (more on that later) reveals: while Citalopram may offer short-term relief in some cases, at what cost?
Interestingly, current psychotherapeutic guidelines in Germany recommend a combination of medications like Citalopram and psychotherapeutic methods to treat anxiety disorders. Yet, studies suggest that cognitive behavioral therapy (CBT) alone, without medication, may be more effective in the long run. Too typically, individuals experience a resurgence of symptoms after stopping the medication. This is a sign that the underlying causes may not have been thoroughly addressed.
In this article, I’ll discuss why a critical examination of Citalopram is necessary and explore alternative treatment methods that address not only the symptoms but also the roots of mental health issues. Read on to learn about side effects, long-term risks, and real patient experiences from my practice and to understand why a shift in mental health treatment is urgently needed.
Overview of Topics
Key points in 30 seconds
- Mechanism of Action: Increases serotonin levels, which is intended to improve mood and reduce anxiety; however, the exact mechanism isn’t fully understood, which is why medication may not always be the first choice.
- Serotonin Hypothesis Questioned: New studies show that the link between serotonin and depression isn’t definitive, as many people with normal serotonin levels are also depressed (more on this later).
- Onset of Effect: Citalopram often takes two to four weeks to take full effect. However, side effects may appear at the beginning of treatment.
- Side effects: nausea, sleep issues, sexual dysfunction, and more.
- Risks: Potential long-term damage and increased suicidality in younger individuals.
- Interactions: Avoid combining alcohol with Citalopram. More on additional interactions later.
- Discontinuation: Should be done gradually under medical supervision.
- Alternative: St. John’s Wort as a natural alternative to Citalopram. Negative thought patterns regularly trigger mental disorders. Instead of just taking pills, fast “mental reprogramming” can help. For more on alternatives, see the section “Criticisms & Alternatives.”
How Citalopram Works—What’s Really Behind It?
Citalopram, a commonly prescribed selective serotonin reuptake inhibitor (SSRI), often promises quick relief for mental health issues like anxiety and depression. But can a medication that alters the brain’s serotonin balance truly address the root cause of your issues? Serotonin, typically mistakenly called the “happiness hormone,” is associated with good mood and emotional stability. There’s a widespread belief that a serotonin deficiency causes depression, and that SSRIs like Citalopram correct this imbalance by slowing the reabsorption of serotonin into nerve cells. This leaves more serotonin in circulation, which, in theory, should improve mood.
However, many doctors and therapists still follow an outdated medical model that largely serves the interests of the pharmaceutical industry, regularly overlooking the true causes and needs of patients. It’s frequently argued in other articles that an “imbalance of neurotransmitters” may cause depression and anxiety disorders. A similar claim would be that an imbalance in world politics could lead to these conditions. While both statements could have some truth to them, in the case of world politics, at least it’s sometimes clear who is responsible. By contrast, the role of neurotransmitters remains largely unclear. The old neurotransmitter hypothesis still lacks scientific proof to this day.
What is well-documented, however, are some potentially life-threatening side effects, such as serotonin syndrome, which can result from the administration of antidepressants. You can learn more about these side effects in the next section.
Also concerning: The medical guidelines for treating anxiety disorders in Germany recommend combining antidepressants with cognitive behavioral therapy (CBT). However, recent research suggests that CBT alone, without additional antidepressants, may be more effective in the long term, particularly in sustainably reducing relapses and maintaining learned strategies after the end of therapy. You’ll learn more about such a relapse in one of the upcoming personal experiences later in the text.
Nebenwirkungen von Citalopram
If you’ve been prescribed Citalopram or are considering taking it, it’s important to familiarize yourself with the possible side effects.
During the initial phase of Citalopram therapy, certain side effects may occur more frequently.- Increased Sweating: excessive sweating is often observed.
- Sleep disturbances: Trouble falling or staying asleep is not uncommon.
- Diarrhea: Gastrointestinal issues, including diarrhea, can occur.
The adjustment phase to Citalopram typically lasts two to four weeks, with the full antidepressant effect often not appearing until four to six weeks. If an immediate improvement is noticed, it may be due to the placebo effect (an apparent improvement in symptoms based on the expectation of Citalopram’s effectiveness rather than the actual effect of the medication).
It is especially important for patients with suicidal thoughts to be closely monitored during the first two to four weeks of treatment. This phase is particularly critical, as Citalopram can actually increase the risk of suicide in patients under 25.
Simply switching to another antidepressant in such cases is also not a good idea, as all the following medications can also raise the risk of suicide in younger patients:
- Paroxetine
- Citalopram
- Escitalopram
- Fluoxetine
- Fluvoxamine
- Sertraline
- Venlafaxine
- Mianserin
- Mirtazapine
- Reboxetine
- Milnacipran
- Atomoxetine
- Amitriptyline
- Clomipramine
- Dibenzepin
- Doxepin
- Imipramine
- Lofepramine
- Nortriptyline
- Trimipramine
- Dosulepin
- Trazodone
- Phenelzine
- Isocarboxazid
- Tranylcypromine
- Moclobemide
- Flupenthixol
- Tryptophan
- Maprotiline
- Duloxetine
- Bupropion
- Desipramine
Side Effects During Citalopram Treatment:
- Weight Gain: Long-term treatment with Citalopram can lead to significant weight gain (more on this in the personal experiences section later).
- Emotional and Cognitive Changes: Anxiety, nervousness, and confusion have been observed in up to ten percent of patients in previous studies.
- Increased Heart Rate and Sensory Disturbances: Some patients experience increased heart rate as well as vision and hearing disturbances.
In addition to the above side effects, the following reactions are known to affect up to ten percent of patients:
- Dizziness
- Fatigue and weakness
- Muscle pain
- Tremors
- Concentration difficulties
- Vomiting
- Abdominal pain
- Attention problems
- Itching
- Decreased libido
Furthermore, more than 10 percent of patients report:
- Insomnia
- Dry mouth
- Nausea
- Headaches
- Increased sweating
- Drowsiness
Another particularly sensitive issue is sexual dysfunction, which occurs in a significant proportion of patients. In some cases, this even persists after discontinuing the medication. This problem is often underestimated because many people feel too embarrassed to discuss it. If you notice changes in your sexual function, it is advisable to speak openly with your doctor to consider appropriate treatment or adjustments to your medication.
Paying attention to these side effects becomes all the more important when we consider the risks and long-term damages that may arise from taking Citalopram. The next section of the article delves into the potential long-term consequences associated with the use of this antidepressant.
Risks and Long-Term Effects
While Citalopram can help alleviate symptoms of depression and anxiety disorders, its long-term use raises questions about potential risks and harms. One of the more serious concerns is the increased risk of self-harming tendencies, especially among young adults and teenagers. There is also the risk of serotonin syndrome—a severe reaction that can occur when too much serotonin accumulates in the body. Serotonin syndrome is a potentially life-threatening condition that includes symptoms such as increased heart rate, severe blood pressure fluctuations, fever, tremors, agitation, and, in severe cases, even hallucinations and loss of consciousness. Additionally, long-term use has been associated with prolonged QT intervals in the heart, which can lead to abnormal heart rhythms. The QT interval is a measure on an ECG; prolongation of this interval can increase the risk of serious, life-threatening heart rhythm disturbances.
Another significant long-term effect that can arise from regular use of Citalopram is the development of dependence. This becomes particularly evident when attempting to discontinue the medication. Many people experience challenges when trying to stop taking Citalopram, leading to what is known as a withdrawal syndrome. This syndrome can be very distressing for those affected and manifests in symptoms such as dizziness, restlessness, sleep disturbances, and mood swings. Tips on how to minimize the likelihood of withdrawal syndrome are provided later in the article under “Guidelines for Discontinuing Citalopram.”
People with an allergy to Citalopram should, of course, avoid the medication. It is recommended for pregnant women only when absolutely necessary, as it may cause symptoms in newborns such as breathing difficulties, seizures, and unstable body temperature.
Breastfeeding mothers should be aware that Citalopram passes into breast milk, and the long-term effects on the child have not been sufficiently studied. Therefore, it is advisable not to take Citalopram while breastfeeding.
Life with Citalopram: Patient Experiences
In my daily work, I encounter many people struggling with the side effects of antidepressants like Citalopram. The following stories are based on real examples from my practice, with the names of those involved changed to protect their privacy. These stories not only highlight the severe side effects of Citalopram but also the successful transition to alternative healing methods through my support and the use of the Bernhardt Method.
Case Study 1: Thomas (52 years): Difficulties with Discontinuation and Emotional Turmoil
“The years I spent on Citalopram for my depression were a constant emotional rollercoaster. Although the medication initially alleviated my symptoms somewhat after a few weeks, the extreme mood swings severely affected my social life and work capability. When I decided to stop taking the medication, I went through a severe withdrawal syndrome that almost drove me to despair. It truly felt as though I was dependent on the medication and couldn’t function without it. This happened while I was undergoing cognitive behavioral therapy, and the relapse made it feel as though all my therapeutic progress was undone. I had to start over despite therapy. With medical supervision, I was finally able to taper off the medication gradually. Through regular sessions afterward and learning the Bernhardt Method, I was able to work through my inner conflicts and regain control over my emotions. Today, I am not only medication-free but also emotionally more stable than ever before.”
Case Study 2: Anna (39 years): Weight Gain and Loss of Identity
“The weight gain I experienced while taking Citalopram was devastating for me. Although my depressive symptoms improved somewhat after a few weeks, my body changed so much within a few months that I hardly recognized myself in the mirror. This physical transformation led to a deep self-esteem crisis, worsening my depression again. On a recommendation, I reached out to Klaus Bernhardt, who helped me recognize the psychological causes of my depression and low self-esteem. Through a combination of individual counseling and the Bernhardt Method, which is completely medication-free, I reconnected with my true self and was finally able to stop the weight gain.”
Case Study 3: Julia (28 years)—Sexual Dysfunction
“The sexual dysfunction I experienced from Citalopram severely strained my relationship with my partner and led to deep isolation and sadness. I felt numb, had no sexual desire, and didn’t realize for a long time that this was just a side effect of the medication. In my desperation, I came across Klaus Bernhardt’s online therapy, which offered me new perspectives and methods without medication. Thanks to the course’s guidance, I was able to address the deeper psychological causes of my anxiety disorder and gradually discontinue the medication. After a few weeks, my desire for my partner returned, which literally saved my relationship at the last minute. I am incredibly grateful for the strategies and understanding I gained through Klaus Bernhardt’s online therapy, and today I feel almost like a new person.”
Interactions
Now that you know more about the potential side effects and long-term risks of Citalopram, it’s also important to understand the drug’s interactions.
The combination of Citalopram and alcohol can be particularly problematic. Alcohol can amplify many of Citalopram’s side effects, especially those like drowsiness and slowed reaction time. Since both Citalopram and alcohol affect the central nervous system, taking them together can lead to increased sedation, which not only impairs overall motor coordination and judgment but also poses serious risks to respiratory function and the cardiovascular system. Additionally, alcohol may worsen the depressive symptoms that Citalopram is intended to treat.
Additional Interactions of Citalopram:
Medications that affect serotonin levels:
- Avoid triptans and opioid pain relievers like tramadol and fentanyl.
- Use caution when taking tryptophan and 5-HTP.
Risk with QT Interval Prolongation:
- Medications that prolong the QT interval can increase the risk of serious heart rhythm disturbances. Therefore, it’s essential to avoid combining Citalopram with other medications that also lead to QT interval prolongation to minimize the risk of such heart issues.
- Do not combine Citalopram with medications that also prolong the QT interval.
Examples of Medicines with QT Interval Prolongation:
- Certain antibiotics: Azithromycin, Erythromycin
- Asthma medications: Salbutamol, Terbutaline
- Antifungal agents: fluconazole, ketoconazole
- Cold medications: Ephedrine, pseudoephedrine
Guidelines for Discontinuing Citalopram
Gradually reducing the dose, known as “tapering,” is necessary when deciding to end treatment with Citalopram.
This process helps prevent withdrawal symptoms that can occur if the medication is stopped abruptly. These withdrawal symptoms can vary and include digestive issues, headaches, flu-like symptoms, and sensory disturbances (more on this under “Risks and Long-Term Effects”).
Important:
If you are currently taking Citalopram, please avoid discontinuing the medication on your own.
This process should always be done in consultation with your doctor and under their supervision to ensure a safe and successful withdrawal.
Further Articles on Depression and Antidepressants
Criticisms & Alternatives to Citalopram
The serotonin hypothesis—the idea that a lack of serotonin causes depression—has long been central to antidepressant research. Recently, this theory has been questioned. Current research shows that the direct link between serotonin levels and depression is not as clear as once thought. Evidence suggests that many people with depression have normal serotonin levels, and that reducing serotonin in healthy individuals does not necessarily lead to depression.
This insight raises questions about the effectiveness of antidepressants like Citalopram. Studies indicate that these medications often perform no better than a placebo for mild to moderate depression, meaning they do not bring greater improvement than a Sham treatment in these cases. Only in cases of very severe depression do they appear to have a noticeable effect, as they can provide enough energy for patients to begin psychotherapeutic treatment. However, it is recommended that they be discontinued as soon as possible afterward. Further research, including a large metastudy from Denmark, confirms that antidepressants do not deliver the hoped-for effects and often do not differ significantly from placebos.
This puts Citalopram, one of the most widely prescribed antidepressants worldwide, in a critical light. The decision to take it should consider not only the potential benefits but also the possible risks and side effects. When the effectiveness is at best marginal, the potential unwanted side effects deserve even more attention.
It is a common belief that depression and anxiety disorders can simply be traced to disruptions in brain chemistry. However, the reality is more complex, as these conditions can be triggered by a variety of physical and psychological factors. It is therefore not surprising that antidepressants only lead to improvement in about 14% of those affected.
A natural alternative to Citalopram is St. John’s Wort. St. John’s Wort has been shown to be similarly effective for mild to moderate depression as Citalopram, but with significantly fewer side effects. You can learn more about this in a separate article. It’s important to know that St. John’s Wort supplements can interfere with the effects of some antidepressants and should not be taken simultaneously with Citalopram. However, there is also a risk of serotonin syndrome with St. John’s Wort. Taking pills alone, even herbal alternatives, will never address the true causes of mental health issues.
Effective treatment of depression and anxiety disorders requires understanding and addressing the individual causes in detail. In my book, How to calm Anxiety, I delve comprehensively into the most common triggers of depression. Although many people can hardly imagine it, negative thinking is by far the most common trigger of anxiety disorders, depression, and obsessive-compulsive disorders. However, this is definitely not something that can be eliminated by taking pills. What does help—and surprisingly quickly—is “mental reprogramming.” How exactly this works is explained in the first episode of our online therapy, How to Calm Anxiety, which you can watch here for free.
Even though the title of the online therapy primarily targets anxiety disorders, the method presented is also highly effective for depression and obsessive-compulsive disorders.
From my many years of experience as a therapist, I can assure you: You are not alone, and it is possible to overcome your depression completely medication-free!
Troy A.
Tampa, Florida