Worried about increase of citalopram dose

[WildChinchilla]

I recently had a very bad health anxiety episode that lasted about a week. I'm feel mostly better now, but I informed my doctor about it and he has put me on 20mg of Citalopram. I'm currently on 10mg, but I'm worried about increasing the dose. I'm aware that citalopram can cause long QT (a type of irregular heartbeat). I'm worried that this could cause sudden death, especially if I'm also doing exercise or having a panic attack while on it. I also find it disturbing that if I go on American websites they basically say mixing alcohol with citalopram is a death sentence, but on the NHS website it says that it's safe to drink alcohol while on it. I know I should try to trust the NHS over the other sites, but why is there such a divergence in opinion? Is the NHS ignoring how dangerous it is?

[nomorepanic]

Hi

This is just a courtesy reply to let you know that your post was moved from its original place to a sub-forum that is more relevant to your issue.

This is nothing personal - it just enables us to keep posts about the same problems in the relevant forums so other members with any experience with the issues can find them more easily.

Please also read this post:

http://www.nomorepanic.co.uk/showthread.php?t=213239

[panic_down_under]

I informed my doctor about it and he has put me on 20mg of Citalopram. I'm currently on 10mg, but I'm worried about increasing the dose. I'm aware that citalopram can cause long QT (a type of irregular heartbeat). I'm worried that this could cause sudden death, especially if I'm also doing exercise or having a panic attack while on it.

there are many medications that can prolonge the QTc interval (https://www.nps.org.au/australian-prescriber/articles/drugs-and-the-qtc-interval), including meds used to treat heart disease. CredibleMeds (https://www.crediblemeds.org/) maintains a list of these meds for the FDA.

The FDA imposed dose restrictions on citalopram (Celexa®) even though the data suggest the increase doesn't appear to be clinically significant. To quote from van Haelst IMM (http://www.psychiatrist.com/_layouts/PPP.Psych.Controls/ArticleViewer.ashx?ArticleURL=/JCP/article/Pages/2014/v75n01/v75n0103.aspx), 2013:


In a thorough QT/QTc study of citalopram, a mean change in QTc interval of 8.5 milliseconds was found for 20 mg per day and 18.5 milliseconds for 60 mg per day. On the basis of these findings, the FDA stated that citalopram should no longer be prescribed at doses of greater than 40 mg per day and that the maximum citalopram dose is 20 mg per day in elderly patients.12 (http://www.fda.gov/drugs/drugsafety/ucm297391.htm) However, there is still no consensus whether an increase in QTc of this magnitude (< 20 milliseconds) for a dosage of 60 mg is clinically relevant.4 (http://doi.wiley.com/10.1111/bcp.12040), 28 (http://dx.doi.org/10.1016/j.amjmed.2011.12.002) The guidelines of the Committee for Proprietary Medicinal Products (CMPC) suggest that individual changes of QTc interval length need to be at least between 30 and 60 milliseconds from baseline to raise concern for potential risk of drug-induced arrhythmias.PDF (https://www.fda.gov/media/71372/download) Another commonly accepted threshold for a clinically significant drug-induced change in QTc length is even higher, with an increase = 60 milliseconds.28 (http://dx.doi.org/10.1016/j.amjmed.2011.12.002), 30 (http://dx.doi.org/10.1186/1744-859X-4-1)


I also find it disturbing that if I go on American websites they basically say mixing alcohol with citalopram is a death sentence, but on the NHS website it says that it's safe to drink alcohol while on it.

Drinking alcohol while on ADs is unlikely to cause harm, at least not directly, however, the combination can be unpredictable. Some days you might be able to drink a herd of alcoholic elephants under the table without raising a sweat, on others a small shandy may turn legs to rubber. Definitely do not drink and drive while on ADs!

That said, there is a much bigger issue you need to be aware of. Anxiety and depression are the emotional manifestations of an underlying physical brain dysfunction, atrophy (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045) of the twin hippocampal regions of the brain caused by high brain stress hormone levels, particularly of cortisol, killing brain cells and inhibiting the growth of replacements. See also: Depression and the Birth and Death of Brain Cells (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)). Both therapy (https://doi.org/10.1016/j.biopsych.2013.05.017) and antidepressants (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/) work by stimulating the growth of new hippocampal brain cells. The cells produce the therapeutic effect, not the treatments directly.

The problem is alcohol has the same affect on hippocampal neurogenesis as cortisol. Even moderate drinking can result in significant hippocampal atrophy (https://www.popsci.com/moderate-drinking-bad/) (Topiwala A (https://www.bmj.com/content/357/bmj.j2353), 2017; - see also: Anderson ML (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568748/), 2012; Morris SA (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861155/), 2010; Crews FT (https://pubs.niaaa.nih.gov/publications/arh27-2/197-204.htm), 2003).