Citalopram in clinical practice Review article
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Published:
Mar 31, 2025
Keywords:
citalopram, SSRI, depression, anxiety
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Abstract
Citalopram is one of selective serotonin reuptake inhibitors, with well-documented efficacy in the treatment of major depressive disorder, as well as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, premenstrual disorders and agitation in patients with dementia. The effect of citalopram was also assessed in patients with schizophrenia or alcohol use disorder. The aim of this work is to summarize the currently available data on the pharmacokinetics, pharmacodynamics, efficacy and safety as well positioning the role of citalopram in every day psychiatric clinical practice.
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How to Cite
Krupa, A. J., & Siwek, M. (2025). Citalopram in clinical practice. Medycyna Faktow (J EBM), 18(1(66), 104-111. https://doi.org/10.24292/01.MF.0125.16
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References
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10. Assimon MM, Pun PH, Al-Khatib SM et al. Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis. Pharmacoepidemiol Drug Saf. 2022; 31(6): 670-9. https://doi.org/10.1002/pds.5428.
11. Montgomery S, Hansen T, Kasper S. Efficacy of escitalopram compared to citalopram: a meta-analysis. Int J Neuropsychopharmacol. 2011; 14(2): 261-8. https://doi.org/10.1017/S146114571000115X .
12. Fagan HA, Baldwin DS. Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions. Expert Rev Neurother. 2023; 23(6): 535-48. https://doi.org/10.1080/14737175.2023.2211767.
13. Lenze EJ, Mulsant BH, Shear MK et al. Efficacy and tolerability of citalopram in the treatment of late-life anxiety disorders: results from an 8-week randomized, placebo-controlled trial. Am J Psychiatry. 2005; 162(1): 146-50. https://doi.org/10.1176/appi.ajp.162.1.146.
14. Montgomery S, Chatamra K, Pauer L et al. Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder. Br J Psychiatry. 2008; 193(5): 389-94. https://doi.org/10.1192/bjp.bp.107.037788.
15. Mezhebovsky I, Mägi K, She F et al. Double-blind, randomized study of extended release quetiapine fumarate (quetiapine XR) monotherapy in older patients with generalized anxiety disorder. Int J Geriatr Psychiatry. 2013; 28(6): 615-25. https://doi.org/10.1002/gps.3867.
16. Guaiana G, Meader N, Barbui C et al. Pharmacological treatments in panic disorder in adults: a network meta-analysis. Cochrane Database Syst Rev. 2023; 11(11): CD012729. https://doi.org/10.1002/14651858.CD012729.pub3.
17. Uguz F. Citalopram in Treatment of Pregnant Women With Panic Disorder: A Retrospective Study. J Clin Psychopharmacol. 2020; 40(6): 615-7. https://doi.org/10.1097/JCP.0000000000001279.
18. Stein DJ, Andersen EW, Overo KF. Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo. Braz J Psychiatry. 2007; 29(4): 303-7. https://doi.org/10.1590/s1516-44462007000400003.
19. Stein DJ, Montgomery SA et al. Predictors of response to pharmacotherapy with citalopram in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2001; 16(6): 357-61. https://doi.org/10.1097/00004850-200111000-00007.
20. Marazziti D, Golia F, Consoli G et al. Effectiveness of long-term augmentation with citalopram to clomipramine in treatment-resistant OCD patients. CNS Spectr. 2008; 13(11): 971-6. https://doi.org/10.1017/s1092852900014024.
21. Jespersen C, Lauritsen MP, Frokjaer VG et al. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database Syst Rev. 2024; 8(8): CD001396. https://doi.org/10.1002/14651858.CD001396.pub4.
22. Wikander I, Sundblad C, Andersch B et al. Citalopram in premenstrual dysphoria: is intermittent treatment during luteal phases more effective than continuous medication throughout the menstrual cycle? J Clin Psychopharmacol. 1998; 18(5): 390-8. https://doi.org/10.1097/00004714-199810000-00007.
23. Parnowski T, Borzym A, Broczek K et al. Rekomendacje leczenia pobudzenia u chorych z otępieniem dla lekarzy POZ. Lekarz POZ. 2018; 4(4): 239-62.
24. Chen K, Li H, Yang L et al. Comparative efficacy and safety of antidepressant therapy for the agitation of dementia: A systematic review and network meta-analysis. Front Aging Neurosci. 2023; 15: 1103039. https://doi.org/10.3389/fnagi.2023.1103039.
25. Porsteinsson AP, Drye LT, Pollock BG et al.; CitAD Research Group. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA. 2014; 311(7): 682-91. https://doi.org/10.1001/jama.2014.93.
26. Viscogliosi G, Chiriac IM, Ettorre E. Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in Nursing Home Residents With Alzheimer Dementia. J Am Med Dir Assoc. 2017; 18(9): 799-802. https://doi.org/10.1016/j.jamda.2017.06.010.
27. Aga VM. When and How to Treat Agitation in Alzheimer’s Disease Dementia With Citalopram and Escitalopram. Am J Geriatr Psychiatry. 2019; 27(10): 1099-107. https://doi.org/10.1016/j.jagp.2019.04.016.
28. Ehrhardt S, Porsteinsson AP, Munro CA et al.; S-CitAD Research Group. Escitalopram for agitation in Alzheimer’s disease (S-CitAD): Methods and design of an investigator-initiated, randomized, controlled, multicenter clinical trial. Alzheimers Dement. 2019; 15(11): 1427-36. https://doi.org/10.1016/j.jalz.2019.06.4946.
29. Hughes LE, Rittman T, Regenthal R et al. Improving response inhibition systems in frontotemporal dementia with citalopram. Brain. 2015; 138(Pt 7): 1961-75. https://doi.org/10.1093/brain/awv133.
30. Goff DC, Freudenreich O, Cather C et al. Citalopram in first episode schizophrenia: The DECIFER trial. Schizophr Res. 2019; 208: 331-7. https://doi.org/10.1016/j.schres.2019.01.028.
31. de Bardeci M, Greil W, Stassen H et al. Dear Doctor Letters regarding citalopram and escitalopram: guidelines vs real-world data. Eur Arch Psychiatry Clin Neurosci. 2023; 273(1): 65-74. https://doi.org/10.1007/s00406-022-01392-x.
32. Krupa AJ, Siwek M. Zaburzenia rytmu serca w przebiegu psychofarmakoterapii. In: Działania niepożądane i powikłania leczenia psychotropowego. Warszawa 2024: 315-28.
33. Aakjaer M, Werther SK, De Bruin ML et al. Serious arrhythmia in initiators of citalopram, escitalopram, and other selective serotonin reuptake inhibitors: A population-based cohort study in older adults. Clin Transl Sci. 2022; 15(9): 2105-15. https://doi.org/10.1111/cts.13319.
34. Hayes BD, Klein-Schwartz W, Clark RF et al. Comparison of toxicity of acute overdoses with citalopram and escitalopram. J Emerg Med. 2010; 39(1): 44-8. https://doi.org/10.1016/j.jemermed.2008.06.030.
35. Heinz MV, Yom-Tov E, Mackin DM et al. A large-scale observational comparison of antidepressants and their effects. J Psychiatr Res. 2024; 178: 219-24. https://doi.org/10.1016/j.jpsychires.2024.08.001.
2. Siwek M, Chrobak AA, Krupa AJ et al. TED (Trazodone Effectiveness in Depression): effectiveness of trazodone extended-release in subjects with unsatisfactory response to SSRIs. Psychiatr Pol. 2023: 1-18. https://doi.org/10.12740/PP/OnlineFirst/174432.
3. Dudek D, Chrobak AA, Krupa AJ et al. TED-trazodone effectiveness in depression: a naturalistic study of the effeciveness of trazodone in extended release formulation compared to SSRIs in patients with a major depressive disorder. Front Pharmacol. 2023; 14: 1296639. https://doi.org/10.3389/fphar.2023.1296639.
4. Kasper S, Sacher J, Klein N et al. Differences in the dynamics of serotonin reuptake transporter occupancy may explain superior clinical efficacy of escitalopram versus citalopram. Int Clin Psychopharmacol. 2009; 24(3): 119-25. https://doi.org/10.1097/YIC.0b013e32832a8ec8.
5. Siwek M. Dekalog leczenia depresji – kompendium. ITEM Publishing, Warszawa 2024.
6. Pollock BG. Citalopram: a comprehensive review. Expert Opin Pharmacother. 2001; 2(4): 681-98. https://doi.org/10.1517/14656566.2.4.681.
7. Pollock BG. Commentary on „When and How to Treat Agitation in Alzheimer’s Disease Dementia With Citalopram and Escitalopram”. Am J Geriatr Psychiatry. 2019; 27(10): 1108-9. https://doi.org/10.1016/j.jagp.2019.05.016.
8. Cytochrome P-450 CYP2C19 Inhibitors (strong).
9. Anderson LL, Doohan PT, Oldfield L et al. Citalopram and Cannabidiol: In Vitro and In Vivo Evidence of Pharmacokinetic Interactions Relevant to the Treatment of Anxiety Disorders in Young People. J Clin Psychopharmacol. 2021; 41(5): 525-33. https://doi.org/10.1097/JCP.0000000000001427.
10. Assimon MM, Pun PH, Al-Khatib SM et al. Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis. Pharmacoepidemiol Drug Saf. 2022; 31(6): 670-9. https://doi.org/10.1002/pds.5428.
11. Montgomery S, Hansen T, Kasper S. Efficacy of escitalopram compared to citalopram: a meta-analysis. Int J Neuropsychopharmacol. 2011; 14(2): 261-8. https://doi.org/10.1017/S146114571000115X .
12. Fagan HA, Baldwin DS. Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions. Expert Rev Neurother. 2023; 23(6): 535-48. https://doi.org/10.1080/14737175.2023.2211767.
13. Lenze EJ, Mulsant BH, Shear MK et al. Efficacy and tolerability of citalopram in the treatment of late-life anxiety disorders: results from an 8-week randomized, placebo-controlled trial. Am J Psychiatry. 2005; 162(1): 146-50. https://doi.org/10.1176/appi.ajp.162.1.146.
14. Montgomery S, Chatamra K, Pauer L et al. Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder. Br J Psychiatry. 2008; 193(5): 389-94. https://doi.org/10.1192/bjp.bp.107.037788.
15. Mezhebovsky I, Mägi K, She F et al. Double-blind, randomized study of extended release quetiapine fumarate (quetiapine XR) monotherapy in older patients with generalized anxiety disorder. Int J Geriatr Psychiatry. 2013; 28(6): 615-25. https://doi.org/10.1002/gps.3867.
16. Guaiana G, Meader N, Barbui C et al. Pharmacological treatments in panic disorder in adults: a network meta-analysis. Cochrane Database Syst Rev. 2023; 11(11): CD012729. https://doi.org/10.1002/14651858.CD012729.pub3.
17. Uguz F. Citalopram in Treatment of Pregnant Women With Panic Disorder: A Retrospective Study. J Clin Psychopharmacol. 2020; 40(6): 615-7. https://doi.org/10.1097/JCP.0000000000001279.
18. Stein DJ, Andersen EW, Overo KF. Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo. Braz J Psychiatry. 2007; 29(4): 303-7. https://doi.org/10.1590/s1516-44462007000400003.
19. Stein DJ, Montgomery SA et al. Predictors of response to pharmacotherapy with citalopram in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2001; 16(6): 357-61. https://doi.org/10.1097/00004850-200111000-00007.
20. Marazziti D, Golia F, Consoli G et al. Effectiveness of long-term augmentation with citalopram to clomipramine in treatment-resistant OCD patients. CNS Spectr. 2008; 13(11): 971-6. https://doi.org/10.1017/s1092852900014024.
21. Jespersen C, Lauritsen MP, Frokjaer VG et al. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database Syst Rev. 2024; 8(8): CD001396. https://doi.org/10.1002/14651858.CD001396.pub4.
22. Wikander I, Sundblad C, Andersch B et al. Citalopram in premenstrual dysphoria: is intermittent treatment during luteal phases more effective than continuous medication throughout the menstrual cycle? J Clin Psychopharmacol. 1998; 18(5): 390-8. https://doi.org/10.1097/00004714-199810000-00007.
23. Parnowski T, Borzym A, Broczek K et al. Rekomendacje leczenia pobudzenia u chorych z otępieniem dla lekarzy POZ. Lekarz POZ. 2018; 4(4): 239-62.
24. Chen K, Li H, Yang L et al. Comparative efficacy and safety of antidepressant therapy for the agitation of dementia: A systematic review and network meta-analysis. Front Aging Neurosci. 2023; 15: 1103039. https://doi.org/10.3389/fnagi.2023.1103039.
25. Porsteinsson AP, Drye LT, Pollock BG et al.; CitAD Research Group. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA. 2014; 311(7): 682-91. https://doi.org/10.1001/jama.2014.93.
26. Viscogliosi G, Chiriac IM, Ettorre E. Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in Nursing Home Residents With Alzheimer Dementia. J Am Med Dir Assoc. 2017; 18(9): 799-802. https://doi.org/10.1016/j.jamda.2017.06.010.
27. Aga VM. When and How to Treat Agitation in Alzheimer’s Disease Dementia With Citalopram and Escitalopram. Am J Geriatr Psychiatry. 2019; 27(10): 1099-107. https://doi.org/10.1016/j.jagp.2019.04.016.
28. Ehrhardt S, Porsteinsson AP, Munro CA et al.; S-CitAD Research Group. Escitalopram for agitation in Alzheimer’s disease (S-CitAD): Methods and design of an investigator-initiated, randomized, controlled, multicenter clinical trial. Alzheimers Dement. 2019; 15(11): 1427-36. https://doi.org/10.1016/j.jalz.2019.06.4946.
29. Hughes LE, Rittman T, Regenthal R et al. Improving response inhibition systems in frontotemporal dementia with citalopram. Brain. 2015; 138(Pt 7): 1961-75. https://doi.org/10.1093/brain/awv133.
30. Goff DC, Freudenreich O, Cather C et al. Citalopram in first episode schizophrenia: The DECIFER trial. Schizophr Res. 2019; 208: 331-7. https://doi.org/10.1016/j.schres.2019.01.028.
31. de Bardeci M, Greil W, Stassen H et al. Dear Doctor Letters regarding citalopram and escitalopram: guidelines vs real-world data. Eur Arch Psychiatry Clin Neurosci. 2023; 273(1): 65-74. https://doi.org/10.1007/s00406-022-01392-x.
32. Krupa AJ, Siwek M. Zaburzenia rytmu serca w przebiegu psychofarmakoterapii. In: Działania niepożądane i powikłania leczenia psychotropowego. Warszawa 2024: 315-28.
33. Aakjaer M, Werther SK, De Bruin ML et al. Serious arrhythmia in initiators of citalopram, escitalopram, and other selective serotonin reuptake inhibitors: A population-based cohort study in older adults. Clin Transl Sci. 2022; 15(9): 2105-15. https://doi.org/10.1111/cts.13319.
34. Hayes BD, Klein-Schwartz W, Clark RF et al. Comparison of toxicity of acute overdoses with citalopram and escitalopram. J Emerg Med. 2010; 39(1): 44-8. https://doi.org/10.1016/j.jemermed.2008.06.030.
35. Heinz MV, Yom-Tov E, Mackin DM et al. A large-scale observational comparison of antidepressants and their effects. J Psychiatr Res. 2024; 178: 219-24. https://doi.org/10.1016/j.jpsychires.2024.08.001.