Antidepressants have improved dramatically in recent years. Antidepressants started when a clinician noticed that a blood pressure medication improved his patients’ depression (Ramachandraih, Subramanyam, Bar, Baker, & Yeragani, 2011). Then the monoamine oxidase inhibitors (MAOIs) were developed, but patients had to be careful not to eat certain foods or it could cause negative reactions. The tricyclic antidepressants followed, but they had a lot of side effects. Prozac was the first antidepressant of its kind and was better at targeting the symptoms of depression and caused fewer side effects, and it was followed by a flood of new antidepressants.
One of these is citalopram, known by the brand name Celexa. Citalopram is a selective serotonin reuptake inhibitor (SSRI) (PubMed Health, 2016). SSRIs are thought to act by targeting the serotonin (5-HT) receptors on neurons, preventing the reuptake of the neurotransmitter serotonin, which increases the amount of serotonin available in the synapse. This is still being debated and a new theory of depression as the result of an inflammatory process claims that SSRIs are effective because they have anti-inflammatory properties (Walker, 2013). Physiological studies have not proven the mechanism of action because the results have not reflected the effects seen in clinical studies.
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For example, the therapeutic effect may not be observed until several weeks after starting citalopram. Also, increasing the level of serotonin experimentally does not cause antidepressant action (Walker, 2013). It is important to keep in mind that the most effective treatment for depression has been shown to be the combination of talk therapy and medication. As a health professional, the most important thing to remember about citalopram is that it may increase the risk of suicide in children, adolescents, and young adults up to age 24 (PubMed Health, 2016). This seems counter-intuitive but several studies have confirmed it. Something else to be familiar with is serotonin syndrome (Buckley, Dawson, & Isbister, 2014).
This can occur when a patient takes two serotonergic medications together or takes an overdose. Serotonin syndrome causes a rapid rise in temperature resulting in hyperthermia, agitation, and confusion. It can be fatal if not treated promptly. Less dramatic side effects include nausea, agitation, blurry vision, confusion, lack of emotion, and memory problems. There are many drugs that can interact with citalopram and it is important to check the patient’s medications against the list. Non-FDA (off-label) uses for citalopram include alcoholism, bulimia, generalized anxiety disorder, panic disorder, hot flashes, obsessive-compulsive disorder, and premenstrual dysphoric disorder (Schneider, 2014).
The most surprising thing I discovered when researching citalopram was the theory that depression, or at least some types of depression, may be due to inflammation. It is such a radical departure from the standard theory of increasing the level of serotonin in the synapses. It seems like inflammation is being proposed as the cause of a wide range of illnesses. The most comforting thing about citalopram was that it works in the majority of patients, and it may work more quickly than clinicians think. The most disturbing aspect was the increase in suicide risk in children, adolescents, and young adults.
It would be terrible to prescribe a medication to help prevent suicide only to find it caused the suicide of the patient, and the fact that the risk is to young people makes it even more disturbing. The most positive thing I learned was that there are new treatments under development, including a drug that may work immediately, and a non-drug, non-invasive treatment that uses magnetic fields to alleviate depression for up to a month. In fact this last treatment is currently in use for patients who have treatment-resistant depression, and hopefully will eventually be available to anyone suffering from depression. Depression is so widespread and so devastating, as treatments get better and better, more and more lives can be salvaged.
