PsychRounds: The Psychiatry Podcast [SSRI] - Citalopram (Celexa)
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Dec 16, 2023 Dive into the world of Citalopram as it treats Major Depressive Disorder, especially in older adults. Discover its unique antihistamine effects that may aid the elderly in managing sleep and agitation. Learn about factors influencing its declining popularity, including FDA warnings and the rise of escitalopram as a top choice. Explore the crucial role of the CYP2C19 enzyme in Citalopram's metabolism and its implications for personalized medicine, shedding light on risks of elevated drug concentrations.
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Citalopram's FDA Indication and Dosing
- Citalopram (Celexa) is FDA-approved only for Major Depressive Disorder (MDD) in adults.
- The recommended starting dose is 20mg daily, with a maximum of 40mg, but lower for certain populations.
Citalopram's Properties and Decline in Use
- Citalopram is a 'clean' SSRI with minimal drug interactions, primarily affecting the serotonin system.
- It fell out of favor partly due to an FDA warning about QTC prolongation and the emergence of escitalopram.
Antihistamine Properties of Citalopram
- Citalopram has antihistamine properties due to its R-enantiomer, which can aid sleep and reduce agitation in the elderly.
- This can be a useful alternative to antipsychotics.