Can you overdose on Citalopram?

In this article we will discuss whether one can overdose on citalopram and how one can identify citalopram overdose. 

We will also explore what citalopram is, what causes citalopram overdose, what one can do in the case of overdose, and what are the side effects are risks of the drug.

Can you overdose on Citalopram?

Yes, one can overdose on citalopram in extremely high doses or due to toxicity caused by inability of the body to metabolise the drug.

Citalopram and SSRIs are relatively safe. According to a study on the trends of antidepressant overdose in 2003, there has been a plateau in the overdose and hospitalisation cases due to antidepressants. 

The researcher of this study noted that SSRIs such as citalopram had lesser fatality rate and hospitalisations as compared to Tricyclic antidepressant (TCA). 

Citalopram overdoses tend to have mild to moderate symptoms in adults who might have ingested below 600 mg. However, if there is an ingestion above 600 mgs in one intake, there are severe repercussions. 

In such cases, symptoms that arise usually include QTc prolongation, TdP,- meaning heart and ECG abnormalities- and seizures (Kraai & Seifert, 2015) including Serotonin syndrome. 

According to one case study of a fatal case of citalopram overdose,  a 35 year old woman was taken into emergency services after she experienced seizures after an intended overdose.

The woman experienced seizures, and manifested cardiac and neurological symptoms related to serotonin syndrome, and all attempts to resuscitate her failed. 

What are the symptoms of Citalopram overdose?

Symptoms of Citalopram an antidepressant overdose include:

  • Agitation
  • Diarrhoea
  • Drowsiness
  • Dry mouth
  • Headache
  • Nausea
  • Vomiting

Severe symptoms of toxicity include:

  • Coma
  • Confusion
  • Delirium
  • Hallucinations
  • Increasingly worsening heart pace (dysrhythmia)
  • Involuntary eye movement
  • Respiratory distress
  • Seizures
  • Tremors
  • Unconsciousness

.

The easiest signs of an overdose is irregular or rapid and faster heartbeat which along with other symptoms signal an overdose that needs immediate medical attention. 

How does Citalopram overdose occur?

Some of the reasons why citalopram overdose occur could be:

  • Because the individual took a dose that is higher than the recommended dosage and because they did not follow the doctor’s orders leading to toxicity. 
  • It could also be because the individual is sensitive to the medication leading them to experience toxicity even at a low dose because their metabolism cannot process the drug leading to cardiovascular toxicity in these cases according to one study
  • Overdose can occur due to intent to commit suicide sicne antidepressants increase suicidal thoughts in individuas below th age of 25 and more so in teenagers, overdose could be a result of a suicide attempt since citalopram has highest fatality rate according to a research done on the trends of antidepressant overdoses in 2003.
  • Another cause could be accidental overdose in children and infants due to curiosity. 
  • Other causes could be when Citalopram is taken with other drugs that interact with citalopram such as Tramadol, anti-migraine, carbamazepine drugs, and Lithium that could lead to serotonin syndrome (high levels of serotonin) and eventual overdose. 

What should one do if there is a case of citalopram overdose?

Here are the steps you should take if you notice that you or someone else is experiencing signs of overdose after taking citalopram:

Contact emergency services right away. Remain calm when you call them and tell them clearly that they are experiencing OD symptoms related to citalopram and give them the address as soon as possible, especially if you are the one experiencing the symptoms. 

If someone else is experiencing the symptoms or you are able enough then provide the following information as well:

  • What other drugs or medications were taken 
  • What substances were they mixed with
  • How much drug was taken
  • When the last dose was administered
  • How long ago the symptoms began

Give any other vital information that the operator asks for and follow the instructions of the operator.

You might be instructed to perform first aid or move the individual into various positions, follow the instructions given to the dot as you wait for help to arrive and make sure that you do not panic and try to remain as calm as possible.  

What is Citalopram?

Citalopram is an antidepressant and is part of a class of antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs). 

Celexa, the brand name of citalopram,  is FDA-approved and prescribed by physicians for the treatment for the symptoms of major depression. It is also to be mentioned that the drug is also prescribed for off label uses to treat anxiety disorders such as- PTSD, Panic disorder, and also eating disorders. 

How does Citalopram Affect The Brain and Body?

Citalopram is believed to treat depression by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance, in the brain.

It is a SSRI- a selective serotonin reuptake inhibitor which means that the drug slows down the uptake of serotonin in the brain making the levels of the neurochemical higher for people with depression who are typically observed to have lowered levels of serotonin.  

It is to be mentioned that this drug can affect not just the brain chemicals but also one’s bodies. It can cause various side effects such as lethargy, nausea, dry mouth, loss of appetite, blurred vision, and increased yawning. 

How does Citalopram Affect The Brain and Body?

Citalopram is believed to treat depression by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance, in the brain.

It is a SSRI- a selective serotonin reuptake inhibitor which means that the drug slows down the uptake of serotonin in the brain making the levels of the neurochemical higher for people with depression who are typically observed to have lowered levels of serotonin.  

It is to be mentioned that this drug can affect not just the brain chemicals but also one’s bodies. It can cause various side effects such as lethargy, nausea, dry mouth, loss of appetite, blurred vision, and increased yawning. 

What are the side effects of citalopram?

Like all medicines, citalopram can cause side effects, however it is important to mention that many people who take the drug did not experience side effects or when they did, they were minor. 

Common side effects

  • dry mouth
  • sweating a lot
  • being unable to sleep
  • feeling sleepy
  • feeling tired or weak

Serious side effects

  • chest pain 
  • shortness of breath
  • severe dizziness or passing out
  • painful erections 
  • any irregular bleeding that do not stop within 10 minutes

Common side effects of this drug usually improve as your body gets used to the drug and might even disappear after prolonged use. If you observe any serious side effects, reach out to your doctor immediately. 

However, if you notice that the symptoms persist even after two weeks, it is best that you speak to your doctor to adjust a more appropriate dose. 

How to take citalopram?

The best way to take citalopram is exactly as prescribed by your doctor while also being educated about the directions given on your prescription label. 

The usual dose of citalopram is 20mg a day in adults however your doctor might start you at a lower dose and increase to a maximum dose of 40mg a day.

If you’re over the age of 65, or have liver problems, the maximum recommended dose is 20mg a day.

In children 10mg a day is the recommended usage, but this may be increased to 40mg a day while with liquid drops of citalopram, 4 drops is equivalent to a 10mg tablet.

Make sure that you keep using the drug as prescribed even if it might seem like there are no improvements as it takes up to 4 weeks for symptoms to improve. 

Do not stop using citalopram suddenly as you might experience unpleasant withdrawal symptoms. Discontinuing the use of this drug must be under the guidance or observation of your physician. 

What are the risks and precautions when taking citalopram?

Some of the precautions and risks you should be aware of when taking this drug include:

  • Allergy of citalopram or escitalopram (Lexapro)
  • if you also take pimozide.
  • If you have used an MAO inhibitor in the past 14 days.
  • If you have a bleeding or blood clotting disorder
  • If you have a liver or kidney disease;
  • If you have narrow-angle glaucoma;
  • If you experience seizures or epilepsy;
  • If you are at risk of heart disease, heart failure, or recent history of heart attack;
  • If you have a personal or family history of Long QT syndrome;
  • Experience an electrolyte imbalance (such as low levels of potassium or magnesium)
  • If you have been diagnosed with bipolar disorder
  • Or have a history of drug abuse or suicidal thoughts.
  • If you are trying to become pregnant, already pregnant or breastfeeding.
  • If you have diabetes, citalopram can make it difficult to keep your blood sugar stable.

If you are at risk of any of these factors mentioned above, make sure that you speak to your doctor and keep them informed because discussing the use of citalopram for the treatment of depression.

FAQ related to Citalopram overdose

What happens if you stop taking citalopram suddenly?

If you suddenly stop taking citalopram, you may experience withdrawal symptoms such as:

  • an electric shock-like sensation in the head
  • Anxiety and anxiety related symptoms. 
  • changes in mood, such as irritability, and mood swings
  • digestive complaints such as diarrhoea, nausea, cramps, and vomiting
  • dizziness or vertigo related to imbalance. 
  • Fatigue and tiredness that is not appropriate to activity done.
  • feeling “detached” from life or others
  • Chills and body aches
  • Loss of balance or coordination
  • Difficulty focusing and concentrating
  • Tinnitus
  • sleep problems, including distressing dreams
  • thoughts of suicide and suidical behavior

These symptoms can make it hard for you to go about your daily life and might also put you at risk for resurfacing depression symptoms. 

What happens when you stop taking citalopram?

If you stop taking Citalopram suddenly, you can experience withdrawal symptoms such as irritability, nausea, feeling dizzy, vomiting, nightmares, headaches. It is highly recommended that you talk to your doctor first before stopping the treatment. 

How long does citalopram take to wear off?

Citalopram is believed to be very effective and there are no reports as to after how long the positive effects of the drug start to wear off. 

As long as you are consistent with your dosage, the positive effects of the drug in treating depression symptoms should be the same, even after years of treatment.

What is the half-life of citalopram?

It is believed that the half-life of Citalopram is 35 hours and 80% is cleared by the liver and the remaining 20% by the kidneys.

However, this can vary depending on metabolism, body mass, life stye, liver and kidney functioning. 

References

Citalopram-Brand name: Cipramil. NHS. 10th Dec, 2018. Retrieved on 17th January 2022. https://www.nhs.uk/medicines/citalopram/

Schimelpfening.N. How to Tell If Someone Has Overdosed on Antidepressants. VerywellMind. Retrieved on 17th January 2022. https://www.verywellmind.com/can-you-overdose-on-antidepressants-1066859

Levy.S.Celexa Overdose: Overdosing Symptoms And Risk Factors. AddictionResource. Retrieved on 17th January 2022. https://addictionresource.com/drugs/celexa/overdose/

Howland RH. A critical evaluation of the cardiac toxicity of citalopram: part 2. J Psychosoc Nurs Ment Health Serv. 2011 Dec;49(12):13-6. doi: 10.3928/02793695-20111102-04. Epub 2011 Nov 16. PMID: 22085614.

Kraai, E. P., & Seifert, S. A. (2015). Citalopram Overdose: a Fatal Case. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 11(2), 232–236. https://doi.org/10.1007/s13181-014-0441-0

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