Side effects from medications are common, although usually not severe enough to halt treatment. Anyone who has listened, perhaps unwillingly, to the recital of side effects on a television commercial for a medication is aware of the number of health problems that might arise while taking that particular drug. But unless the side effect is death, one assumes that most of these adverse events go away once the medication is no longer taken.
Weight gain is a common side effect associated with many medications prescribed for depression, and/or anxiety, or the pain of fibromyalgia. We know that the weight is gained for the same reason weight is usually gained: More calories are consumed than needed by the body for energy. But even though most of the people gaining weight as a side effect of antidepressants and related medications may become overweight, they differ from the typical overweight or obese individual. The latter typically struggle with their weight because of a lifestyle of eating too much, exercising too little, and in many cases using food to deflect emotional issues. But people whose obesity is a side effect of their medication may never have had a problem maintaining a normal weight prior to their treatment. To them, gaining weight was as much of a shock and disruption to their body as losing hair is to a patient on chemotherapy.
They’d never dieted. Why would they? They never needed to
Antidepressants, mood stabilizers, and atypical antipsychotic drugs seem to alter appetite by inhibiting serotonin-based regulation of the appetite function. A persistent need to eat remains after the stomach is full of food, along with cravings for carbohydrate snacks. Sometimes the need to eat interferes with sleep, and leads to waking up in the middle of the night. Medication-associated fatigue frequently accompanies the overeating side effects, so the motivation, and indeed the ability, to work the extra calories off through exercise becomes difficult or impossible.
All of this is well known, and even if a prescribing physician may not mention weight gain as a side effect, countless studies have confirmed it to be so.
So if weight gain is caused by the medication, then weight loss should follow its discontinuation. And it does, for many people: Once the medication is out of the body, normal appetite returns, fatigue diminishes, and the patient returns to eating and exercising normally. Increasing serotonin level and activity prior to meals diminishes any lingering inability to feel full after eating or to control snacking. Consuming small amounts of fat-free, low-protein carbohydrate foods such as oatmeal an hour before mealtime or as an afternoon snack increases serotonin sufficiently to resume normal appetite control. Returning to a vigorous workout schedule once the side effect of fatigue disappears accelerates weight loss.
But not everyone is able to lose the weight even months after the medication is stopped — and no one knows why.
Formerly fit individuals are horrified to find that the 15, 25, or 50 pounds they gained on their medication is hanging around like a relative who won’t quit the guest room. Diets are tried and discarded for lack of success. Aerobic and strength-training workouts are increased in frequency and duration. Yet the pounds stay on.
The result can be feelings of despair and desperation. It is as if someone who loses her hair while undergoing chemotherapy learns that she will be bald for the rest of her life. Patients who have become obese due to their medication believe their bodies will be permanently changed. They believe they will never return to the bodies they had before their medications, and grudgingly and often angrily resign themselves to accept being overweight or obese.
- What Is Psychopharmacology?
- Find counselling near me
Some suggest that water retention may be responsible for the increased weight, but once the medication is out of the body, the excess water should be lost. Others point to some muscle loss before and during the early stages of treatment, when depression had led to weeks of inactivity. However, rebuilding muscle mass doesn’t seem to produce any significant weight loss. It is possible that metabolic rate decreased as a result of treatment, and therefore is slowing weight loss. But studies on thyroid function in patients treated with Zoloft or Prozac did not show any functional change in thyroid hormones.
So at this point, there is little to offer someone who has tried to lose the medication-associated weight by dieting and exercising, and is failing.
Is the weight finally lost, many months or even years after the antidepressants or related drugs are out of the body? Are the extra pounds still attached to the body five or ten years later? No one knows. There are no long-term studies following patients after they discontinue treatment to see if weight is lost and, if so, what produced the weight loss. Interestingly, there are many studies showing that after a weight-loss diet is over, people’s weight eventually returns to the heavier pre-diet weight or "set-point." Perhaps it is time to see whether people whose weight gain is a consequence of antidepressant treatment will also return to their own set-point.
Anyone who takes citalopram or other antidepressants may experience withdrawal symptoms after stopping. Doctors recommend tapering off antidepressant medications gradually under medical supervision to minimize withdrawal symptoms.
Citalopram, which people may know by the brand name Celexa, can cause some people to experience withdrawal symptoms on stopping the drug. These symptoms may include muscle aches, chills, digestive upset, and changes in mood.
Citalopram withdrawal symptoms can vary in their onset, duration, and intensity.
Withdrawal or discontinuation symptoms are common after coming off antidepressants. Some research suggests that these symptoms affect 56% of people who stop taking their depression medication.
In this article, we discuss citalopram withdrawal in more detail, including its symptoms and ways to minimize or prevent them.
Citalopram withdrawal occurs when a person stops taking the medication.
Symptoms can develop because the brain experiences rapid changes in the level of serotonin that is available to it.
A 2019 review states that more than half of people coming off various antidepressants experience withdrawal effects, with 46% of these individuals reporting “severe” symptoms.
Citalopram, however, may pose a lower risk of these effects than other antidepressants. The reason for this is that compared with other common antidepressants, citalopram has a relatively long half-life of 38–48 hours.
The half-life of a drug is the time it takes for the amount of its active substance to reduce by half in the body.
Drugs with a longer half-life, such as citalopram, tend to cause fewer withdrawal symptoms than those with a short half-life.
However, citalopram may still cause more symptoms than other antidepressants with a longer half-life, such as fluoxetine (Prozac).
Citalopram and other SSRIs may cause withdrawal symptoms such as:
- an electric shock-like sensation in the head
- anxiety
- changes in mood, such as depression, irritability, and mood swings
- digestive complaints, including diarrhea, nausea, cramps, and vomiting
- dizziness or vertigo
- fatigue
- feeling “detached” from life or others
- flu-like symptoms, including chills and body aches
- movement problems, such as loss of balance or coordination
- problems concentrating
- ringing in the ears, known as tinnitus
- sensory disturbances, such as smelling things that are not there
- sleep problems, including vivid or distressing dreams
- thoughts of suicide
Withdrawal vs. return of symptoms
Although citalopram withdrawal may cause mood-related symptoms, this does not necessarily mean that someone is experiencing a return of depressive symptoms.
To distinguish between withdrawal and return, individuals should consider:
The onset of symptoms
Withdrawal symptoms appear soon after coming off antidepressants, whereas returning depressive symptoms may take several weeks to emerge.
The symptoms over time
Withdrawal symptoms will get better as the body adjusts to the lack of antidepressant medications, but returning symptoms of depression will persist or get worse.
Antidepressant withdrawal symptoms can last for a few weeks to a few months.
Typically, doctors advise that discontinuation symptoms are self-limiting and resolve within a couple of weeks.
However, a review of other studies indicates that this is not always the case. The authors note that for some people, antidepressant withdrawal symptoms can persist for several weeks or months.
Some of the included research found that 40% of people had symptoms for at least 6 weeks while 25% had them for 12 weeks or more.
Many treatment and self-care options exist to help people safely come off citalopram while minimizing any potential symptoms. Options include:
- Discussing medication cessation with a doctor: A person should always speak with their doctor before making any medication changes. Suddenly stopping antidepressant use increases the risk of severe symptoms.
- Taking a tapering-off approach: Doctors typically advise people to reduce their antidepressant dosage slowly — usually over at least 4 weeks. This advice is especially relevant for those who have been taking the medication for an extended time or are on a higher dosage.
- Taking medication for withdrawal symptoms: Some withdrawal symptoms may respond to medications. For example, people can try using pain relievers for muscle aches or sleep medications for insomnia.
- Seeing a doctor regularly: Regular medical checkups during the withdrawal process can help people better manage their symptoms and monitor for recurrent depression.
- Considering psychotherapy: Cognitive behavioral therapy (CBT) or mindfulness-based cognitive therapy (MBCT), for example, may support the discontinuation process without increasing the relapse risk.
- Leading a healthy lifestyle: Taking steps to exercise regularly, get enough sleep, follow a balanced diet, and practice stress reduction techniques can help people manage depression symptoms without medication. These habits may also ease some withdrawal symptoms.
Citalopram is a category C drug. As a result, the FDA advises only taking citalopram during pregnancy in situations where the benefit to the pregnant person justifies the potential risk to the fetus.
For example, a doctor may deem it necessary for some people to take SSRIs such as citalopram during their pregnancy to prevent the return of depression.
The National Alliance on Mental Illness advises anyone who becomes pregnant while taking citalopram to contact their doctor immediately.
Withdrawal symptoms during pregnancy are likely to resemble those in people who are not pregnant. The management techniques are also likely to be similar.
People should contact their doctor if they:
- develop adverse effects from antidepressant use and wish to discuss other options
- wish to stop taking citalopram in a safe manner under medical supervision
- experience withdrawal symptoms after coming off citalopram
Individuals should call a doctor immediately if any side effects are severe. They should call 911 if their symptoms feel life threatening.
It is also essential to call 911 if someone is having suicidal thoughts and is at immediate risk of self-harm, suicide, or hurting another person.
The National Suicide Prevention Lifeline is available 24-7 at 800-273-8255 to provide support to those having thoughts of suicide.
The long-term use of citalopram is safe when people take it as their doctor prescribes.
However, research indicates that using any antidepressant for more than 6 weeks can cause withdrawal symptoms on tapering or stopping the drug.
Abruptly stopping or rapidly reducing the dosage can increase the risk of these symptoms.
Those taking citalopram or other antidepressants for an extended period should work with their doctor to find effective treatments and strategies to minimize withdrawal effects.
It is also important to monitor for the return of depressive symptoms after stopping long-term antidepressant use.
Coming off citalopram can lead to withdrawal symptoms, particularly if people have been taking it for more than 6 weeks.
Common discontinuation symptoms include flu-like symptoms, sleep disturbances, and mood changes.
It is important that people who wish to stop taking antidepressants do so under medical supervision.
Individuals should discuss their options with a doctor. These may include alternative medications and strategies for minimizing withdrawal symptoms and preventing the return of depressive symptoms.