Citalopram - is it safe?

[AnxiousJen]

Hi
I have taken Citalopram on and off over a period of 13 years for GAD. Due to another flare up of extreme anxiety I have been prescribed them (20mg) again by GP. However, after reading an article about them being bad for your heart, I am too scared to take them! I took one and my anxiety went through the roof and I had a panic attack. I then decided not to take them. I have always felt better within a few weeks of taking in the past and know I should take them and ride the side affects out but I am petrified all of a sudden of the side affects and possible damage they may be doing to my heart. I should point out that it doesnt help that I have Health Anxiety and am convinved I already have a heart problem....I dont know what to do!

[AntsyVee]

I take escitalopram which is a derivative. They can affect people who already have heart issues, but for the average person, they're fine. Your doc would not have prescribed them if s/he was worried about your heart.

[panic_down_under]

Hi
I have taken Citalopram on and off over a period of 13 years for GAD. Due to another flare up of extreme anxiety I have been prescribed them (20mg) again by GP. However, after reading an article about them being bad for your heart, I am too scared to take them! I took one and my anxiety went through the roof and I had a panic attack. I then decided not to take them.

Citalopram may affect the electrical system of the heart causing a change in the QTc interval of the beat. Many drugs can do this, including some for heart disease and most antidepressants to some degree, but it is an issue only for those with specific heart disease, or taking several QTc prolonging drugs and even then only at high doses. This is why the recommended maximum citalopram dose was reduced from 60mg to 40mg.

Whether that change was actually necessary has become a matter of debate because some recent studies have raised doubts about how accurately modern ECG/EKG machines calculate QTc suggesting some algorithms such as Bazett's formula don't adequately correct for variations in factors such as bpm rates (see: Sano M, 2014; Barbey JT, 2015; Vandenberk B, 2016; Patel PJ, 2016).

A second issue is that relatively small increases in QTc interval are raising concerns when the danger is in fact very low. For example, the FDA imposed dose restrictions on citalopram (Celexa) even though the data suggests its affect on the heart isn't clinically significant. To quote from van Haelst IMM, 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 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, 28 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.23-PDF Another commonly accepted threshold for a clinically significant drug-induced change in QTc length is even higher, with an increase = 60 milliseconds.28, 30

So if you're in reasonably good health this really isn't an issue for you, but for peace of mind ask your doctor for an ECG/EKG before taking citalopram and repeat it after a month or two.

[AnxiousJen]

Thank you for your comments. I have taken it before with no adverse effects to my health, im fact ot makes me feel "normal" again after the period of side effects have worn off. I am just so anxious at the moment and paranoid about my heart. I might start off with 10mg for a week and increase to the prescribed 20mg and see if that reduces the side effects x

[panic_down_under]

I might start off with 10mg for a week and increase to the prescribed 20mg and see if that reduces the side effects x

Starting on only 10mg for the first week is the best way of limiting the severity of initial side-effects.