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Even when I drafted this node (based on the vast experience of three doses — click here for further details — over as many days) it was clear that I was/am exceptionally prone to several of these side effects. Other side effects not specifically mentioned in the package insert seems to include extreme nipple sensitivity ... really, there seems to be heightened sensitivity all over, but the tender nipples are a lot of what kept me from being able to remain asleep at night over first few few days taking Celexa. And that sensitivity re-emerged each time we increased the dose to try to reach a therapeutic level.

My therapist also warned me that there was likely to be a sense of tightness in the jaw, similar to temporal mandibular joint pain, like your lower jaw is being drawn up into your skull, something that can get so serious that in some cases people have been known to start doing a sort of involuntary "lizard tongue" thing.

For me there were positive effects — though reaching a bipolar diagnosis on Valentine's Day puts in doubt whether my psychiatrist and therapy team will ever feel safe having me on Celexa again. Frankly, given how "up" I feel as I write this, there's some question whether we will need to find a chemical anti-depressant. I had gone through over 3 years of therapy without one, and what I've learned about myself since the mania appeared may suggest that we don't need to go back there. I'd effectively been pushing myself into depression as a means of protecting myself from the sort of impulsive behavior I feared might be likely were my mood to range from normal into hypomanic (where, I recall, my energy has often been when I am really doing something I love, and have a social network that affirms that work).

Revisiting my experience with Celexa, I did notice that one of the most positive aspects of taking it seemed to be that it became easier to dismiss negative thoughts, and short-circuit a tendency to obsess in unproductive ways. Such thought patterns had been sapping my energy heavily since well before the holidays (in late 2000).

One of the soft-links here is to manic depression. Apparently, those who suffer from manic depression should be aware that Celexa and other SSRIs can throw one into a manic phase.

Updating this node now on March 4, 2001, I can certainly attest to this, since before receiving Celexa, I did not have a bipolar diagnosis. I do now. For more of the story, refer to my entry under Celexa Diary. I was really lucky in the sense that both my partner and my therapist saw the signs of suddenly emergent mania, and managed to get me medical attention almost immediately in order to manage it, and I had a therapist who was very aware of the risks associated with treating bipolar individuals with SSRI-class anti-depressants.

A lot of these points are raised in nodes for Paxil, Zoloft and SSRIs. Many of the strong negative experiences documented in other nodes on the SSRI class of antidepressants suggest that the person receiving the SSRI may have had strong manic depressive (aka bipolar) tendencies.

I've been in talk therapy for over 3 years for a depression that (I would say at the moment) has been present since at least 5th grade, but generally one I managed to muddle through, more or less, until now. While I share many concerns expressed about medicating depression, I feel that the real problem comes when people are given the drugs and no supporting cognitive therapy to go with it, or when they get psychiatric diagnoses from general practicioners or internists.

Antidepressants Selective serotonin reuptake inhibitor (SSRI)
Whats the deal with Celexa?

Celexa / Citalopram
Celexa is used in the treatment of patients who are suffering from depression. Celexa is classified as an SSRI antidepressant. As with other SSRI’s it works by selectively inhibiting the reuptake of serotonin in the CNS. The result is an increased level of serotonin in the brain.

Serotonin
Serotonin is known as a biogenic amine; it has shown to be a mood regulator. Interestingly, the relationship between depression and this hormone was linked during treatment for hypertension. Patients were being treated with a biogenic amine-depleting agent reserpine, and they became depressed. Patients who were being treated for tuberculosis with ipronazid, a biogenic enhancing agent became euphoric.
Serotonin generally serves inhibitory functions in the brain, and disturbances in its functioning may underlie the irritability, anxiety, and sleep disturbances common in depression.

Contraindications
*Use of MAO inhibitors in combination with SSRI’s can cause serotonin syndrome due to abnormally high levels of serotonin in the body. The signs and symptoms of this include: diarrhea, fever, hyperactive reflexes, increased sweating, mood changes, rapid heart rate, restlessness, and shivering or shaking
Refer to pharmacology reference for extensive list of drug interactions; including beta-blocking agents, Demerol, warfarin, antibiotics
Side Effects
Agitation, anxiety, asthenia, dizziness, fatigue, fever, tremor, anorexia, diarrhea, indigestion, nausea, vomiting, decreased libido, dysmenorrhea, impotence, myalgia, upper respiratory tract infection, diaphoresis

Route and dosage
Citalopram is taken by mouth. Normal initial adult dose is 20mg once a day. Daily doses are increased at 20mg at weekly intervals, as prescribed. Usual dose is 40mg once a day, to a max of 60 mg/day

Caution
Effective antidepressant therapy may transform depression into mania in predisposed individuals (ex. bipolar disorder). If you (your patient) develops mania expect to discontinue the drug.
Monitor patient during initial treatment for suicidal ideation
Hepatic patients should be monitored closely for adverse reactions because celexa is extensively metabolized in the liver

Notes on Celexa
Celexa is currently one of the most popular antidepressants. It is frequently prescribed due to low drug/food/EtOH interactions when comparing to other SSRIs such as Prozac. Celexa is generally the first try in a pharmacological treatment of depression because it is the least potentially harmful and can be very effective. MAO inhibitors are generally used as a last resort due to the high drug and food interactions.

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