Celexa Addiction: Risk for Abuse and Misuse

Last Updated: July 16, 2021

Authored by Sharon Levy, MD, MPH

Reviewed by Michael Espelin APRN

Citalopram, the Celexa generic, is an antidepressant belonging to the class of Selective Serotonin Reuptake Inhibitor (SSRI) drugs. Celexa medication is approved for the treatment of depression in adults and can also be used “off-label” for other mental health conditions. As the conditions that Citalopram and other SSRI drugs treat are chronic with a tendency to relapse, patients often have to use these medications for months or even years at a time. This often raises questions regarding how long Celexa stays in the system, the risk and liability of Celexa addiction and abuse with prolonged use. As such, this article will offer an overview of the pharmacologic properties of Celexa medication; the likelihood of its abuse, dependence, or even addiction, as well as the path to recovery from Celexa addiction.

What Is Celexa?

Celexa drug class belongs to a group of Central Nervous System-acting antidepressant drugs known as Selective Serotonin Reuptake Inhibitors(SSRIs). Celexa, and Celexa generic Citalopram, have been widely available on the American pharmaceutical market since 1998. It and other SSRIs function by selectively potentiating the effects of Serotonergic transmission within the central nervous system by inhibiting neuronal reuptake of Serotonin. This action over time results in the accumulation of Serotonin in the neuronal synapses, which restores the deficient levels of serotonergic activity that is seen in mental disorders such as depression and various types of anxiety disorders. Furthermore, the highly specific and selective nature of SSRIs towards Serotonin receptors, makes SSRIs have minimal effects on other neurogenic monoamines such as Norepinephrine or Dopamine. Their selectivity renders Citalopram and other SSRI drugs one of the safest forms of treatment for depression without sacrificing efficacy.

Furthermore, although Citalopram requires a prescription for use, it is not classified as a controlled substance under the United States Controlled Substances Act. Generally, a controlled substance is defined as one whose manufacturing, use, handling, storage, and distribution are tightly controlled by the government because of its liability for abuse or addiction.

What Is Celexa Used For?

Citalopram has one primary FDA-approved use as well as several other off-label uses.

The only FDA-approved usage of Celexa antidepressant is for the treatment of Major Depression in adults 18 years or older. Through the above-mentioned effects, Citalopram can help improve symptoms of depression such as insomnia, anhedonia, avolition, guilt, fatigue, reduced concentration, reduced appetite, decreased sexual drive, as well as feelings of helplessness and hopelessness within 1 to 4 weeks from the start of therapy.

The off-label uses of Citalopram can be many. Below are offered some of the most common off-label indications for the use of Citalopram.

Celexa for Anxiety SSRIs, and in some cases Citalopram, are often used as first-line drugs for the treatment of various forms of anxiety. This can include Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Panic Disorders, Separation Anxiety Disorder,  and Premenstrual dysphoric disorder (PMDD), amongst others. Acting again on Serotonergic transmission, SSRIs can help reduce anxiety and anxious thought, as well as reduce the physiological symptoms of anxiety such as autonomic instability and muscle tension.
Celexa for Pain Neuropathic pain and Depression are frequently seen together. Antidepressants have been often employed in the concurrent treatment of Neuropathic pain and Depression, but Citalopram and other Citalopram drug class agents have been less efficacious in the treatment of neuropathic pain when compared to older antidepressants. The mechanism through which SSRIs relieve neuropathic pain is unknown, but it is assumed that it is once again through their effects on Serotonergic transmission.
Celexa for Bipolar Disorder Depression Although not FDA-approved for use in Bipolar Disorder, many doctors use antidepressants, like Citalopram, as adjunctive therapy in the treatment of patients with bipolar disorder depression.
Celexa for Sleep Although antidepressants are employed in the management of sleep disorders,  SSRIs are not the ones primarily used. SSRIs can help resolve disturbances with sleep if these disturbances are depression-associated. Furthermore, some studies report that the use of Citalopram in low doses can be an alternative to the commonly used sedative antidepressants in the treatment of insomnia.
Celexa for Obsessive-Compulsive Disorder (OCD) SSRIs, including Citalopram, are First-line pharmaceutical agents in the treatment of OCD. However, additional therapy with other psychotropic drugs is often required to achieve a result.

Patients should always remember that the decision on which specific pharmacologic agent is right for their condition should be made only through consultation with their physician. Therefore, patients should contact their doctor if they think that they would benefit from treatment with Citalopram.

Celexa Generic and Brand Names

All SSRIs are available in both generic and brand forms. Citalopram is no exception to this. The generic form of this substance is Citalopram Hydrobromide. While the only brand name currently available in the United States is Celexa, marketed by Allergan, Inc.

Celexa Dosage Forms and Strength

Celexa antidepressant is administered via an oral route. Therapy is usually started with a Celexa dosage of 20 mg once daily, with a possibility to increase the Celexa dosage to a maximum of 40 mg per day after an interval of no less than one week.

Celexa medication is available in the following dosage forms:

  • 10 mg Tablet, which comes in a bottle containing 100 tablets. The tablets themselves are beige, oval, and film-coated. One side of the tablet contains the engraving “FP,” and the other has “10 mg” on it.
  • 20 mg Tablet, which also comes in a bottle containing 100 pills. The tablets themselves are pink, oval, scored, and film-coated. Engraving onto the scored side includes the letter “F” on the left while the letter “P” is on the right side. The engravement on the non-scored side contains  “20 mg.”
  • 40 mg tablets also come in a bottle containing 100 pills. The tablets themselves are white, oval, scored, and film-coated. Engraving onto the scored side includes the letter “F” on the left while the letter “P” is on the right side. The engravement on the non-scored side contains “40 mg.”
  • The oral solution comes premixed as 10mg per 5mL solution with peppermint flavor.

It is important to remember that the correct dosing regimen for a given patient is highly individualized and takes into account numerous factors such as age, metabolizing capacity, other medications taken, etc. As such this decision should only be made by a prescribing physician.

Close up of African American young woman feel sick drink antibiotic or antidepressant pill with water.

The Likelihood of Celexa Addiction and Abuse

When it comes to the misuse, abuse, dependence, and addiction of antidepressant medications the picture tends to get muddled. The reasoning behind this is the fact that patients often confuse and use the aforementioned terms interchangeably when in reality they represent different entities.

  • Celexa abuse or misuse refers to the use of a Celexa medication without a prescription belonging to the user, in greater amounts, more often, longer than prescribed, or use for the sole purpose of experiencing a “feeling” that it can cause.
  • Dependence can be of two types. Physical dependence refers to the development of “withdrawal” or “rebound” symptoms upon discontinuation, which forces the patient to continue taking the medication. Psychological dependence refers to the fear of the imagined or anticipated consequences of stopping a drug that leads to its continued use. However, neither physical nor psychological dependence alone is indicative of being addicted to a drug.
  • Addiction refers to a Drug dependence syndrome. This syndrome is defined by specific criteria and is generally characterized by loss of control over drug use due to cravings and strong or compulsive urges to use it. Furthermore, Addiction almost always features characteristics of drug abuse, but it does not necessarily require that psychological or physical dependence with withdrawal be a component.

Another issue with regard to Celexa Addiction and abuse is the fact that large-scale studies which evaluate abuse and addiction of prescription medications do not include antidepressants, and as such information regarding addiction and abuse liability of Citalopram and similar SSRIs is lacking. However, from what is known from available resources SSRIs, including Citalopram, show very low addiction potential as they are neither associated with a prominent pleasurable effect nor do they lead to cravings or compulsive urges to use. Although, abuse/misuse due to physical and/or psychological dependence or other reasons is certainly possible.

Celexa Abuse Statistics

As previously mentioned, large-scale studies of prescription medication abuse do not include SSRIs specifically, as such, no information is known specifically about Celexa abuse statistics. However, some information is known about statistics of antidepressant misuse:

  • In 2011, 1,244,872 ED visits were related to prescription medication misuse/abuse, out of which 88,965 were related to antidepressants as a group.
  • In 2011, 228,366 ED visits were related to a drug-related suicide attempt, out of which 20% were related to antidepressants as a group.
  • In 2010, 38,329 deaths related to drug overdose were reported in the USA, out of which 17.6% or 3,889 deaths were related to antidepressants as a group.

The majority of the numbers mentioned above are probably related to the older generation of antidepressants such as TCAs and MAOIs, but it can be assumed that a small number could be related to SSRIs. As such, one could state that a small liability for Celexa abuse.

What Makes Celexa Addiction and Abuse so Frequent?

There are several factors that could contribute to the frequency of Celexa abuse and addiction. These factors include:

  • Increased availability of prescription drugs such as SSRIs obtained through contact with friends, relatives, or through illegal websites.
  • Perception of misuse/abuse of prescription drugs as more socially acceptable and safer than illicit or other commonly abused with Celexa substances such as alcohol, opioids, or benzodiazepines
  • Undetectability of certain prescription antidepressants on standard drug panels

It is worth mentioning that nonmedical use of psychotherapeutics, including antidepressants, is second only to marijuana in terms of drug misuse. As such, there are bound to be various other predisposing factors that require elucidation through future research.

Who Is Most at Risk?

Once again, due to the lack of research and resources analyzing the epidemiological prevalence of Celexa drug class misuse and addiction, there is no specific information about which demographic is most at risk. However, according to various behavioral science studies, certain demographics with particular risk factors in their past medical history can be at an increase for overall substance use disorders, which would also be applicable to Celexa addiction and abuse.

  • Family or previous history of addiction and substance abuse, such as alcohol, opioids, or benzodiazepines
  • Current or past incidence of mental health disorders such as depression or anxiety
  • Coping with difficulties in the family such as neglect, lack of support, marital discord, and unemployment

Regular contact with a social environment where substance abuse is not stigmatized

Doctor taking patients hand in clinic closeup.

Symptoms And Signs of Celexa Addiction

There are no signs and symptoms related specifically to Celexa abuse or addiction, but there are certain behavioral and psychological features that can be identified in patients with substance use disorders:

  • Difficulties in controlling substance-taking behavior
  • A strong craving or sense of compulsion to take the substance
  • Progressive neglect of other social, occupational, or recreational activities
  • Persisting with substance use despite clear evidence of harmful consequences or hazards to one’s health
  • Evidence of tolerance
  • Physiological withdrawal state when substance use has ceased or been reduced is characterized by the development of a withdrawal syndrome.

These are some of the many tell-tale signs of substance abuse. It is important that these signs be recognized early so that help through contact to a rehab center for aided recovery can be sought.

Dangers of Celexa Use And Abuse

Abuse of Celexa antidepressant can be associated with a heightened experience of associated side effects also known as drug toxicity or overdose.  These include various Neurologic, Gastrointestinal, Musculoskeletal, Cardiovascular, and Hematologic symptoms. Furthermore, patients are more likely to experience sexual dysfunction, weight gain, as well as increased suicidal ideation. Furthermore, it is important to contact emergency medical services if a patient experiences severe overdose intoxication as this can be detrimental to their health.

Recovery from Citalopram Addiction

When abuse and addiction to Citalopram occurs, patients need medical assistance through a recovery center to get clean. The user can seek these resources out on their own, or their loved ones can help them find rehab facilities. Citalopram withdrawal can be dangerous, so users should not discontinue use abruptly or attempt to stop taking the drug on their own. Rehabilitation centers can come up with a step-down plan for the user, steadily decreasing their dose until the medication is no longer used. After the user has stopped using Citalopram, a physician can recommend alternatives to Celexa, and they can then work with their medical provider to stay on the path to recovery and find a new medication to treat their depression or other mood disorder.

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Published on: April 23rd, 2019

Updated on: July 16th, 2021

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.