[mitchie]

Sorry to bother everyone. Have just been prescribed citalopram (20mg/day start) but am not sure whether to take at night or morning?... Dr didn't say and only works part time, CPN doesn't know, psych was a locum and has since left.
Also, my CPN forwarded a message from the psychiatrist to tell me to steer clear of yeast products and mushrooms, I thought this was an MAOI concern...can't find anything about this and citalopram.
Any advice or experiences would really help as I'm flying blind on this one.

Thanks,
m

(Background: Depressed for 4 years, 1st asked for help 3 years ago and currently finding it hard to get consistent help, (20+ weeks between psychiatric appointments about medication instead of stated 6, different psych each time as they all leave/retire/work as locums). Most successful to date was Venlafaxine 300mg/day but effect wore off and I couldn't tolerate an increased dose. I'm currently at my wits end, I'm not very good at asking for help anyway and I'm so low after a disastrous few weeks on reboxetine that i'm tired of having to fight so hard to be heard. So, please help, even if it's a pat on the back because I could do with it).

[CamW]

Mitchie - Citalopram (Celexa™) is the SSRI that is the most selective blocker of the serotonin reuptake mechanisms. It does not bind to other types of receptors as do all of the other SSRIs, like paroxetine (Paxil™), fluoxetine (Prozac™), sertraline (Zoloft™), and fluvoxamine (Luvox™).

As for when to take the citalopram, it really doesn't matter when you take it. If it makes you tired, take it at night; if it activates you, take it in the morning. My experiences with those who take it seem to be evenly split between taking it in the morning or at bedtime. I guess it really comes down to which time is most convenient for you to take it.

As for eating fungi (yeast or mushrooms), I know of no reason to avoid either. I do not recommend taking the "magic variety of mushrooms with it, but even then I do not think that there is a serious interaction (actually, magic mushrooms do act as partial agonists - stimulators - at some serotonin receptor subtypes, so I guess that there could be a remote possiblity of serotonin syndrome - manifested by a racing heart, sweating, fever, tremor, etc.).

Citalopram, like all antidepressants, will take about 2 or 4 weeks to begin to work, and 8 to 12 weeks to achieve full effect (ie. remission). As I said, it is the "cleanest" of the SSRIs (serotonin selective reuptake inhibitors). By not binding to other neuroreceptors (eg. muscarinic/cholinergic, norepinephrine reuptake, dopamine, alpha-1 adrenergic, sigma, etc.) it should theoretically have the propensity to cause fewer side effects than the other SSRIs. It still does have some start-up side effects that can be bothersome, in some people. The more common of these being, headache (actually, more of a sensation of increased pressure in the frontal and temporal - sides - of the head), nausea, dry mouth, insomnia or tiredness, sweating, dizziness, constipation or diarrhea, unsteadiness. These strat-up side effects begin to wane within the first couple of weeks and, for the most part, completely disappear within 4 to 6 weeks.

Long term side effects, in some people, seem to be sexual dysfunction (eg. decreased libido [loss of interest in sex], delayed ejaculation or orgasm, difficulty in maintaining an erection) and "incidious" weight gain. What I mean by incidious weight gain is that, at first, some people will lose weight, but 4 or 6 months into treatment, these people will begin to notice that their clothes are getting tigher. This seems to happen with no apparent reason, but most people who gain weight seem to be eating more. This has been blamed on a carbohydrate craving that may occur, or could be due to stimulation of certain certain serotonin receptor subtypes.

The resolving of depressive symptoms has also been linked to weight gain. In this scenario, it has been noticed that some people with depression have no appetite, but when the depression resolves, the appetite returns. The loss of appetite during a depressive episode can result in the learning of poor eating habits, which can be maintained when the appetite returns upon remission of the depressive symptoms, possibly leading to the weight gain that is seen in some people. Just being aware that weight gain can happen sometimes help people to avoid or change poor eating habits. It is far, far easier to avoid weight gain than it is to lose the weight once it has been gained.

if you have any more specific questions about citalopram, I would be glad to try to anser them. - Cam

[mitchie]

Thankyou for taking the time to reply, it's really useful and appreciated, even more so after I read your previous posts about the dreadful time you and your wife have been having.

Thanks again,
Mitchie

[curlyq]

Cam, I read your reply and the way you explained it fully today made me understand better about weight gain. I'm a person who ate too much when I got depressed even before meds. and then the craving theory from the meds. you mentioned makes sense. I am trying to eat less carbs by doctors request, too. Eating too much can become a bad habit for sure but it's not impossible to resolve it either, I see. Compulsive eating is a bad habit that can be replaced with sensible eating habits and doing constructive things to keep ones mind off of food.

Mitchie, good luck with your treatment. I hope the Celexa will help you.