Celexa is the brand name of a prescription antidepressant belonging to a family of drugs called selective serotonin reuptake inhibitors (SSRIs).
Like other SSRIs, Celexa works by increasing levels of a brain chemical called serotonin, which is linked to mood, sleep regulation and emotions. Celexa is approved for the treatment of major depression, but is also used off-label to treat anxiety disorders, obsessive-compulsive disorder, eating disorders and diabetic neuropathy.
After Forest Laboratories introduced Celexa in 1998, it quickly became one of the most widely used antidepressants in the U.S., with more than 16 million prescriptions written each year. Although Celexa is still prescribed today, sales and use have declined significantly since generic versions of the drug (citalopram) became available. Forest Laboratories’ also introduced a similar drug, Lexapro in 2002, that has also eaten into sales.
Celexa is among the most selective of the SSRI class of antidepressants. Selectivity means the degree to which a dose of a drug produces the desired effect in relation to side effects.
What Should People Know Before Taking Celexa?
Clinical trials have shown Celexa is effective in maintaining an antidepressant response for up to 24 weeks after just six to eight weeks of treatment. But it may take several weeks before symptoms improve after a patient starts taking the drug.
However, doctors who prescribe Celexa should carefully monitor patients on an individual basis. The recommended initial dose of Celexa is 20 mg daily, with an increase to a maximum dose of 40 mg each day. In 2012, the FDA said that Celexa is not recommended at doses greater than 20 mg a day in patients older than 60. Celexa is not approved for use in children and young people who have had suicidal thoughts after first taking it.
To avoid a dangerous drug interaction, people who have used an MAO (monoamine oxidase) inhibitor in the previous two weeks should not take Celexa.
Patients should always consult their doctor before stopping use of Celexa. It is important to work out a plan with your doctor to slowly “step-down” the dosage of any SSRI. Stopping suddenly can result in potentially dangerous withdrawal symptoms.
Suddenly stopping use can result in withdrawal symptoms, including:
- Dysphoria (profound state of unease or dissatisfaction)
- Sensory disturbances
Patients should be monitored for these symptoms if they stop treatment.
Celexa is not considered addictive. However, some patients may abuse the drug, taking more than the recommended dosage while trying to elevate their mood.
Physicians should carefully evaluate patients with a history of drug abuse and monitor them for signs of abuse or misuse.
Patients should inform their doctors of any history of these conditions before taking Celexa:
- Heart conditions
- Bleeding or clotting disorders
- Seizures or epilepsy
- Suicidal thoughts
- Kidney or liver disease
- Electrolyte imbalance
- Bipolar disorder
Common Side Effects of Celexa
The most common side effects of Celexa are nausea and vomiting, increased sweating, dry mouth and headaches. Insomnia and drowsiness are also common, appearing in 15 percent or more of patients in clinical trials.
These side effects are more likely with higher doses, and side effects such as nausea, insomnia and drowsiness are likely to go away once the body adjusts to the medication. As with other SSRIs, men who take Celexa may experience abnormal ejaculation, a decreased libido and erectile dysfunction (impotence).
Celexa is not recommended for patients with heart conditions, low blood sugar (hypoglycemia) or low magnesium in the blood (hypomagnesemia).
Black Box Suicide Warning
Although Celexa is FDA-approved only to treat depression in adults, doctors may prescribe it to adolescents. This is called an off-label use.
A short term study has shown that SSRIs, including Celexa, can increase the risk of suicidal thoughts and behaviors in children, adolescents and young adults.
The study compared people in different age groups, some taking Celexa and others taking a placebo. Researchers compared the groups to see who experienced suicidal thoughts or behaviors.
Among patients younger than 18, those taking Celexa experienced 14 more cases of suicidal thoughts or behaviors.
Patients 25 and older taking Celexa actually experienced one fewer case than their placebo-taking counterparts. Patients 65 and older saw an even greater reduction in suicide risk, with six fewer cases.
Suicide is a known risk factor of depression and other mental disorders.
Like other SSRIs, Celexa’s label carries a black box warning for an increased risk of suicide. Black box warnings are the strictest warnings the FDA can require for prescription drugs. The agency can require they be added when there is reasonable evidence of a serious hazard.
Celexa During Pregnancy, Link to Birth Defects, Autism
Studies link Celexa and other SSRIs to an increased risk of autism and several birth defects when taken during pregnancy.
Despite this, some doctors continue to prescribe Celexa to pregnant women, believing that untreated maternal depression could have even more serious effects.
First-trimester usage of SSRIs is linked to a slight increase in the risk of miscarriage. Studies also suggest that women who take SSRIs during that window may experience premature delivery or a baby with low birth weight. Late-pregnancy SSRI use can lead to withdrawal symptoms in the baby, including seizures, feeding difficulty and behavioral problems like constant crying. These symptoms are typically short-lived.
Link to Autism
Research remains mixed on whether there is an increased risk of autism for babies born to mothers who used SSRIs during pregnancy.
A 2015 study published in JAMA Pediatrics found Celexa and other SSRIs were linked to an increased risk of autism.
Researchers analyzed more than 145,000 health records of children born between January 1999 and December 2009. They found no increased risk of autism for children of mothers who took SSRIs in the first trimester of pregnancy, but they found an 87 percent increased risk if mothers took the antidepressants during the second or third trimester.
Three subsequent studies published in JAMA and JAMA Pediatrics in 2017 mirrored the nearly doubling of risk for autism. However, one of those, looking at 1.5 million infants, found the risk did not increase as much when there were other risk factors such as past psychological conditions of the mother and autism diagnoses in siblings.
Celexa and Birth Defects
Celexa and most other SSRIs fall under the FDA’s Class C pregnancy risk. This means they have shown harm to animal fetuses but there are no adequate and well-controlled studies in human fetuses. Medical experts believe the risk of birth defects is low when women take Celexa while pregnant.
Other studies have found links between SSRI use during pregnancy and an increased risk of persistent pulmonary hypertension of the newborn (PPHN). This disorder prevents the infant’s lungs from providing oxygen to the brain. It can be potentially fatal and even when treated, can result in long term health issues for the newborn.
- Anencephaly – missing a portion of the brain or skull
- Craniosynostosis – a birth defect to the skull causing it to fuse too early and requiring surgery to treat
- Omphalocele – organs form outside the newborn’s body which may require multiple surgeries to repair
Even though studies link Celexa and other SSRIs taken during pregnancy to increased risks of birth defects, the overall risk of birth defects remains small. Failure to treat depression during pregnancy can also result in serious health risks, including miscarriage and low birth weight. Pregnant women should consult with their doctor for the best balance of risk versus benefit in treating depression during pregnancy.
Pregnant women should never discontinue taking Celexa or any other SSRI without first talking with their doctor. Suddenly stopping an antidepressant can pose serious complications or life threatening risks to the mother and fetus.
FDA Warns of Heart Conditions Related to Celexa
In 2012, the FDA revised health warnings about Celexa regarding the drug’s potential to disrupt normal heart function, especially in those taking higher dosages. Labels are now marked to warn people with heart conditions of this possibility.
In 2012, the FDA revised approved changes to Celexa’s label to show the drug’s potential to disrupt normal heart function, especially in those taking higher dosages. Labels now warn people with heart conditions of this risk.
Patients with long QT syndrome could be at high risk of serious complications if they take Celexa or generic versions of the drug. But because it may still be beneficial for some of these people to use Celexa, the agency approved label revisions to specifically caution these patients about the dangers.
Label changes include:
- Recommending discontinuation of Celexa in patients with persistent QTc measurements greater than 500 milliseconds. QT intervals measure the amount of time between waves of the heart’s electrical cycle.
- ECG monitoring in Celexa patients at high risk of QT prolongation.
- The maximum recommended dose of 20 mg per day for patients 60 years of age or older.
In the label revisions, the FDA advises patients currently taking a dose greater than 40 mg per day to consult their The label revisions advised patients taking a dose greater than 40 mg per day to consult with their health care professional and to seek immediate care if they experience an irregular heartbeat, shortness of breath, dizziness or fainting while taking Celexa.
Other Potential Serious Side Effects of Celexa
Other potential side effects associated with Celexa that may require emergency medical attention include serotonin syndrome and allergic reactions.
Serotonin syndrome is a potentially fatal condition that occurs when there is too much serotonin in the brain. This generally occurs when two drugs that increase serotonin levels are taken together. Symptoms can include changes in mental condition (agitation or hallucinations), coma, muscle twitching, racing heartbeat, changes in blood pressure, fever, nausea or diarrhea, and stiff muscles.
Severe allergic reactions can be fatal. People allergic to Celexa may experience trouble breathing, facial swelling, or itchy welts or hives, accompanied by a fever and joint pain. People who have allergic reactions to Celexa should seek medical attention right away.
Terry Turner is an Emmy-winning, former television journalist who holds six Health Literacy certificates from the Centers for Disease Control and Prevention and a Bachelor of Arts in Media Arts from Lyon College. As a Washington-based reporter, he routinely reported on health and medical policy issues before Congress, the FDA and other federal agencies on behalf 100 local news departments across the U.S. Prior to that, he covered state and federal courts for several local television stations in the Midwest and on the East Coast.