Medication

Citalopram

Commonly Used Brand Name

Celexa

What This Medication Is Most Often Prescribed For

***Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern ­- mostly SSRIs (Selective Serotonin Re-uptake Inhibitors) - are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants .

How This Medication Works

Citalopram is one of a class of drugs called selective serotonin reuptake inhibitors or SSRIs. These medications work by increasing the activity of the brain chemical serotonin, which helps regulate mood.

Other Drugs of This Class (SSRIs):

Possible Sexual Side Effects

Men or women may experience sexual side effects, such as:

  • Decreased sexual desire
  • Difficulty with sexual arousal
  • Difficulty reaching orgasm or inability to reach orgasm
  • Impotence in men
  • Delayed ejaculation

How This Medication Can Affect Sexual Function

It is not yet clear how SSRIs affect sexual function. The effects are believed to be related to the increased levels of serotonin, which may affect sexual reflex centers in the central nervous system. Research shows that the sexual side effects are often dose-related.

Although some sexual side effects are troublesome for people, others may in fact solve certain sexual problems. For example, men who experience unwanted premature ejaculation prior to starting antidepressant medication may find that the side effect of delayed ejaculation is actually preferable.

Treatment Options

Wait it out

As you adjust to your new medication, the sexual side effects may go away.

Decrease the dosage

This tactic will work occasionally, but carries the risk of a relapse of the depression or disorder. Never change your dosage without checking with your doctor first.

Switch medications

Since the medical response to SSRIs and other drugs to treat these disorders can vary among people, your physician will consider the severity of your depression or disorder as well as your response to the drug before switching to another. When switching is appropriate, your three main options are:

  • Bupropion (Wellbutrin) – this antidepressant medication does not affect serotonin. It is less likely than the commonly used SSRIs to cause sexual dysfunction and may actually have prosexual effects. However, it is not recommended for people with eating disorders, panic disorders, seizure disorders, or obsessive-compulsive disorders .
  • Nefazodone (Serzone) – this drug does affect serotonin, but not in the same way as SSRIs. It can be used to treat depression and has been found to cause fewer sexual side effects. It's most troublesome adverse effect is sedation.
  • Mirtazapine (Remeron) – this drug is similar to nefazodone in its effect on depression and sexual function.

Try an antidote

This involves maintaining your current level of citalopram, while adding a second medication to offset the sexual side effects. This option is generally less desirable since antidotes frequently have their own side effects and may adversely interact with the primary medication you are taking. Drugs that have shown some promise as antidotes are:

  • Bupropion (Wellbutrin) – not recommended for people with eating disorders, panic disorders, seizure disorders, or obsessive-compulsive disorders. The most common side effects include:
    • Drowsiness
    • Fatigue
    • Weakness
    • Dry mouth
    • Difficulty sleeping
    • Affects on appetite and/or weight
    • Excitement
    • Anxiety
    • Nightmares
    • Abdominal pain
    • Nausea
    • Vomiting
    • Constipation
    • Increased sweating

    Some of these are temporary side effects that should disappear once you’ve acclimated to the drug.

  • Sildenafil (Viagra) – commonly known as a treatment for male impotence, sildenafil may also help women with sexual dysfunction. However, the expense of this drug may prohibit many patients from using it.
  • Amantadine (Symmetrel) – several case reports have shown amantadine to be an effective antidote for SSRI-related sexual dysfunction, however one double-blind clinical study, the gold standard for drug efficacy, has failed to show any benefit.

Take a drug holiday

This involves taking your usual doses throughout the week, stopping with your Thursday morning dose. You take nothing again until noon on Sunday, when you resume your previous dosage schedule.

There is a risk with this technique that you may feel well enough during the short drug holiday to discontinue your medication all together, which can lead to a relapse. Again, discuss this option with your doctor before trying it.

Consider herbal supplements

The efficacy of herbal supplements to treat the sexual side effects of SSRIs is not clear. There have not been any double-blind clinical studies, only case reports, some of which have shown positive effects and others that have shown no effects. Care should also be taken with herbal products because they are not strictly regulated, as drugs are. Two herbs commonly used to resolve the sexual dysfunction associated with SSRIs are:

  • Yohimbine
  • Ginkgo