What is the Cost of Citalopram?

Depression is one of the most common mental illnesses in the United States, with approximately 17.3 million adults, or about 7 percent of Americans over the age of 18, experiencing a major depressive episode each year.

Depression is commonly treated with medications that include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), and demand for these medications continue to grow.

Citalopram is a popular SSRI that has been used for the treatment of depression in the United States since 1998, but what is the cost of citalopram? 

What is citalopram?

Citalopram is an antidepressant medication that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs).

The medication was first used in Denmark for the treatment of depression in 1989, and by 1998, citalopram had been approved by the U.S.  Food and Drug Administration (FDA).

Citalopram is primarily used for the treatment of major depressive disorder, although some doctors and healthcare providers also prescribe the medication for other “off-label” uses.

Citalopram is the generic form of the brand name medication Celexa, not to be confused with escitalopram, which is slightly different.

What is citalopram used to treat?

Citalopram is FDA-approved for the treatment of major depressive disorder, but some doctors prescribe the medication off label to patients with a variety of other mental health conditions such as anxiety disorders, premenstrual dysphoric disorder, and psychiatric disorders.

These conditions include: 

• “Change of life” signs
• Obsessive-compulsive disorder
• Bipolar depression/bipolar disorder
• Repeated episodes of anxiety
• Anxiety associated with depression
• Panic disorder
• Post-traumatic stress disorder
• Binge eating disorder

What is major depressive disorder?

Major depressive disorder, also known as clinical depression, is a mental health condition characterized by persistent and intense feelings of sadness that last for extended periods of time.

The condition often affects mood and behavior as well as physical functions like appetite and sleep.

It is common for people with major depressive disorder to stop having interest in activities they once enjoyed, and many patients have difficulty performing everyday tasks.

The diagnostic criteria for major depressive disorder indicate that individuals must experience at least five of the following symptoms a minimum of once a day for a period of more than two weeks:

• Feeling sad or irritable most of the day nearly every day
• Less interested in most activities they once enjoyed
• Difficulty concentrating, thinking, or making decisions
• Thinking about self-harm or committing suicide
• Feelings of restlessness
• Unusually tired/lack of energy
• Sudden weight loss or weight gain, or change in appetite
• Trouble falling asleep or sleeping more than usual
• Feeling worthless or guilty about things that wouldn’t normally cause those feelings

How does citalopram treat depression?

Citalopram, like other SSRIs, works by blocking the reabsorption, or reuptake, of serotonin, a neurotransmitter in the brain, into nerve cells.

As a result, the levels of serotonin in your brain increase, helping to reduce feelings of depression and anxiety.

Citalopram and other SSRIs are generally most effective when used in combination with talk therapy.

Most patients will not notice an improvement in their symptoms for several weeks, because citalopram takes time to restore balance to your brain chemistry.

While some people begin to notice a decrease in their symptoms in as little as two to three weeks, it may take up to four weeks before your symptoms improve.

What is the cost of citalopram?

Citalopram can be purchased in 10 mg, 20 mg, and 40 mg oral tablets in both the generic and brand name forms of the drug (Celexa); the medication is also available in an oral suspension (liquid).

In general, there are slight differences in the cost of the medication based on dosage, but the biggest difference is in the costs of the generic and brand name medications.

Celexa ranges in price from about $9.50 – 10.50  per pill on average, while citalopram can be purchased for less than 50 cents per pill.

Citalopram is covered by nearly all commercial and Medicare drug insurance plans, and pharmacy discount cards can offer savings on both the brand name and generic forms of the medication.

Manufacturers coupons and patient assistance programs may be available for Celexa through the manufacturer’s website.

Approximate Costs of Celexa and Citalopram

	Celexa		Citalopram
	Per Pill	30 Day Supply	Per Pill	30 Day Supply
10 mg oral tablet	$9.57	$287.10	$0.44	$13.28
20 mg oral tablet	$9.97	$299.10	$0.43	$12.86
40 mg oral tablet	$10.40	$312.00	$0.46	$13.74

What are the benefits of using citalopram?

Citalopram is an effective and non-habit forming medication for people who want to take medication for their depression once per day.

As a generic drug, citalopram is widely available from a number of manufacturers,and the medication is covered by most commercial insurance policies, as well as Medicare, and can be obtained inexpensively in its generic form.

Citalopram is also available as an oral suspension for people who have difficulty swallowing pills. 

How do I know which dose of citalopram I should take?

Citalopram is available in oral capsules at doses of 10 mg, 20 mg, and 40 mg; the medication is also available in an oral suspension.

To reduce the likelihood that a patient will experience side effects, doctors often start patients on a low dose of the medication, such as 10 mg, and increase the dosage over time as needed to alleviate symptoms.

Because of the risks and dangers associated with serotonin syndrome (described below), patients should not increase their dose or the frequency of their dose without first consulting with their doctor, as serious and potentially fatal complications can occur.

Are there any side effects associated with citalopram?

Citalopram is a popular medication despite the risk of numerous side effects caused by the drug.

Some side effects associated with citalopram can be serious and dangerous, and the medication can also cause allergic reactions in some patients. To minimize your risk of experiencing side effects, your doctor may suggest that you start taking a low initial dose and gradually increase your dose of the medication over time.

Common side effects of citalopram include:

• Problems with memory or concentration
• Headache
• Numbness or tingling
• Cold symptoms such as a stuffy nose, sneezing, sore throat
• Changes in weight
• Increased appetite, nausea, diarrhea or gas
• Drowsiness
• Dry mouth
• Increased sweating
• Fast heart rhythm (qt prolongation)
• Feeling shaky
• Trouble sleeping (insomnia), feeling tired
• Difficulty having an orgasm

Less common, but serious side effects associated with citalopram include:

• Shaking (tremor)
• Easy bruising/bleeding
• Hyponatremia
• Decreased interest in sex
• Changes in sexual ability/sexual dysfunction

Citalopram may cause very serious side effects in rare cases Get medical help right away if you experience any of the following:

• Black stools
• Vomit that looks like coffee grounds 
• Fainting
• Fast/irregular heartbeat
• Widened pupils
• Vision changes (such as seeing rainbows around lights at night)
• Seizures
• Eye pain/swelling/redness

Medications that increase or influence serotonin levels, including citalopram, can sometimes cause a very rare but very serious condition called serotonin syndrome/toxicity.

Serotonin syndrome occurs as a result of too much serotonin in the brain, which causes excessive nerve cell activity and can be fatal.

People are most likely to experience serotonin syndrome when taking two or more medications that influence serotonin at the same time, and the condition is most likely to occur when you first start taking a new medicine or increase your dose.

Most people start to experience symptoms within a few hours of taking a new medication or increasing their dose and include:

• Dilated pupils
• Headache
• Diarrhea
• Rapid heart rate
• Tremor
• Changes in blood pressure and/or temperature
• Nausea and/or vomiting
• Confusion
• Agitation or restlessness
• Loss of muscle coordination or twitching muscles
• Shivering and goosebumps
• Heavy sweating

Serotonin syndrome can be life threatening in severe cases. Seek medical attention immediately if you experience:

• Irregular heartbeat
• Unconsciousness
• High fever
• Seizures

Additionally, some prescription drugs and over the counter drugs can cause adverse effects or have other drug interactions when taken with citalopram, including but not limited to: tricyclic antidepressants, St. John’s Wort, monoamine oxidase inhibitors (MAOIs/MAO inhibitors) such as methylene blue, phenelzine, and tranylcypromine, antipsychotics such as pimozide, NSAIDs such as ibuprofen, SSRIs including fluoxetine, sertraline, and isocarboxazid, antibiotics including linezolid, and omeprazole (risk of long QT syndrome).

Also, those who have a history of heart failure or heart attacks should use citalopram with additional caution. 

In order to keep the brain chemistry balanced and ensure consistent serotonin levels, it is recommended that the medication be taken at the same time every day.

Citalopram is available in 10 mg, 20 mg, and 40 mg oral tablets and in an oral suspension; patients may start with a 10 mg dose at the advice of their doctor and increase the dose under a doctor’s supervision as needed, but the maximum dose is 40 mg per day. When using the liquid form of the drug, the medication should be measured using the included measuring device rather than a household spoon in order to ensure that the correct dose is received. 

Some patients want to stop taking citalopram as their symptoms are relieved and they start feeling better.

However, it is critical that patients do not stop taking citalopram without a healthcare professional’s supervision. Do not stop taking citalopram without consulting your doctor. 

The dose of citalopram should gradually be reduced on your doctor’s orders rather than stopped abruptly and cutting out use of the medication “cold turkey” due to potential severity of withdrawal symptoms such as chest pain.

Just as use of citalopram should not be stopped abruptly, only a doctor should increase your dose. Do not increase your dose without the medical advice of a doctor, or take it more often or for longer than prescribed.

References, Studies and Sources: 

https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758

https://www.nimh.nih.gov/health/statistics/major-depression.shtml

https://www.psychiatry.org/patients-families/depression/what-is-depression

https://www.healthline.com/health/citalopram-oral-tablet

https://www.webmd.com/drugs/2/drug-1701/citalopram-oral/details

https://www.drugs.com/citalopram.html