Citalopram (Celexa): what to expect and how to use it safely

Citalopram, often sold as Celexa, is an SSRI used for depression and some anxiety disorders. It raises serotonin in the brain, which can lift mood and reduce worry. If your doctor prescribed it, this page will help you understand how it works, common doses, likely side effects, and smart safety steps to take while on it.

How it works and how fast you’ll notice changes

Citalopram blocks serotonin reuptake, so more serotonin stays active between nerve cells. Many people feel small changes in sleep, appetite, or anxiety in the first 1–2 weeks. Noticeable mood improvement usually takes 4–6 weeks. If you don’t see progress after 6–8 weeks, talk with your prescriber—doses or a different drug may be needed.

Typical adult dosing starts at 10–20 mg once daily. The usual effective range is 20–40 mg/day, but the FDA warns against exceeding 40 mg because higher doses raise the risk of heart rhythm changes (QT prolongation). If you’re over 60, have liver problems, or take certain medicines, doctors commonly limit the dose to 20 mg/day to reduce that risk.

Side effects, interactions, and safety tips

Common side effects include nausea, drowsiness, dry mouth, sweating, and sexual problems (reduced libido, delayed orgasm). Most side effects ease in a few weeks. If you get severe symptoms—fainting, fast/irregular heartbeat, chest pain, or severe mood changes—seek medical care quickly.

Citalopram interacts with several drugs: don’t combine it with MAO inhibitors or try to stop an MAOI then start citalopram without a safe gap. Combining with other serotonergic drugs (certain triptans, tramadol, or other SSRIs/SNRIs) can cause serotonin syndrome—look for high fever, stiff muscles, confusion, or rapid heartbeat. Citalopram can increase bleeding risk with NSAIDs, aspirin, or blood thinners (warfarin). Tell your doctor about all meds and supplements you take.

Alcohol lowers mood and increases drowsiness with citalopram—avoid or limit it. Driving or operating heavy machinery can be risky until you know how the drug affects you. Don’t stop citalopram abruptly; tapering reduces withdrawal symptoms like dizziness, irritability, and flu-like feelings.

If you have heart disease, certain electrolyte problems, or take drugs that affect heart rhythm, your doctor may order an ECG before and during treatment. Also mention pregnancy or breastfeeding—doctors will weigh risks and benefits and may offer alternatives or monitoring plans.

Questions for your prescriber: What dose should I start with? How long before we check progress? Any tests or EKGs needed? What’s the plan to stop or switch? Bring a written list of your medicines to every visit.

Citalopram can help many people, but safe use means knowing the risks and communicating with your healthcare team. If anything feels off, call your provider rather than guessing.