Does Citalopram Cause Akathisia? (3 factors)
By
Dr Drielli Vital-Fujii (PhD)
Author bio
Dr Drielli Vital-Fujii, PhD, is a Pharmacist with expertise in Drug Design and Development, Enzymes, Molecular Modelling, and Photodynamic Therapy. She writes and reviews content on these topics.
Dr Drielli Vital-Fujii’s Highlights:
- Postdoctoral fellow at the Department of Biochemistry at the University of São Paulo, emphasizing therapy of neglected diseases using light.
- PhD in Pharmaceutical Sciences focusing on drug design and development at the Faculty of Pharmaceutical Sciences of the University of São Paulo.
- Six months as an international researcher at the Center for Discovery and Innovation in Parasitic Diseases (University of California San Diego)
- Master’s degree in Pharmaceutical Sciences focusing on drug design and development at the Faculty of Pharmaceutical Sciences of the University of São Paulo.
- Bachelor of Pharmacy at the University of Mogi das Cruzes – São Paulo / Brazil
Professional Experience:
2012 – 2018 Project manager at University of São Paulo – Pharmacy Department
Dr Drielli Vital-Fujii has worked with computational studies, synthesis, biological evaluation, design, and development of new inhibitor candidates for Chagas Disease and Leishmaniasis.
2017 – 2017 International research fellow at University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences – Center for Discovery and Innovation in Parasitic Diseases.
She used Virtual Screening (VS) and High-Throughput Screening (HTS) Integration in the Discovery of new drugs against neglected tropical diseases (NTDs).
2018 – 2019 Faculdades Oswaldo Cruz
Dr Drielli Vital-Fujii was a professor in the Faculty of Pharmacy, teaching the subjects of Pharmaceutical Chemistry and Drug Development.
2019 – 2021 Researcher in Biochemistry University of São Paulo – Biochemistry Department
She applied Photodynamic Therapy in Leishmaniasis Treatment, mentored undergraduate students in scientific activities, and wrote, executed, translated, and reported scientific projects with funding agencies.
2023-2023 UniPiaget – University Center.
Dr Drielli Vital-Fujii was a Biology, Nutrition, Physiotherapy, and Pharmacy professor.
Education:
2018 -2021 Postdoctoral at the Department of Biochemistry at the University of São Paulo
2013 -2018 PhD of Science: Drugs and Medicines at Department of Pharmacy at University of São Paulo
2012 -2013 M.Sc. of Sciences: Drugs and Medicines at the Department of Pharmacy at the University of São Paulo
2005-2008 Bachelor of Pharmacy at the University of Mogi das Cruzes
The leading publications of Dr Drielli Vital-Fujii are:
Vital-Fujii, D.G, Baptista, M.S. (2021). Progress in the photodynamic therapy treatment of Leishmaniasis. Brazilian Journal of Medical and Biological Research, 54, 1-11.
Gatti, F. M., Gomes, R.A., da Fonseca, A.L., Lima, E.J.C., Vital-Fujii, D.G., Taranto, A.G., Varotti, F.P., Trossini, G.H.G. (2020). Antiplasmodial activity of sulfonylhydrazones: in vitro and in silico approaches. Future medicinal chemistry, 13, 233-250.
Silva, E.J., Bezerra-Souza, A., Passero, L.F., Laurenti, M.D., Ferreira, G.M., Fujii, D.G.V., et al. (2018). Synthesis, leishmanicidal activity, structural descriptors and structure-activity relationship of quinoline derivatives. Future medicinal chemistry, 10, 2069-2085.
Leite, F.H.A., Froes, T.Q., da Silva, S.G., de Souza, E.I.M., Vital-Fuji,i D.G., Trossini, G.H.G., et al. (2017). An integrated approach towards the discovery of novel non-nucleoside Leishmania major pteridine reductase 1 inhibitors. European Journal of Medicinal Chemistry, 132, 322-332.
Vital, D.G., Damasceno, F.S., Rapado, L.N., Silber, A.M., Vilella, F.S., Ferreira, R.S., et al. (2017). Application of bioisosterism in design of the semicarbazone derivatives as cruzain inhibitors: a theoretical and experimental study. Journal of Biomolecular Structure and Dynamics, 35, 1244–1259.
Mello, J. F.R., Gomes, R.A., Vital-Fujii, D.G., Ferreira, G.M., Trossini, G.H.G. (2017). Fragment-based drug discovery as alternative strategy to the drug development for neglected diseases. Chemical Biology & Drug Design, 90, 1067-1078.
Pantaleao, S.Q., Fujii, D.G.V., Maltarollo, V.G., da C. Silva, D., Trossini, G.H.G., Weber, K.C., et al. (2017). The Role of QSAR and Virtual Screening Studies in Type 2 Diabetes Drug Discovery. Medicinal Chemistry, 13, 706-720.
Vital, D., Arribas, M., Trossini, G. (2014). Molecular Modeling and Docking Application to Evaluate Cruzain Inhibitory Activity by Chalcones and Hydrazides. Letters in Drug Design and Discovery, 11, 249-255.
Blau, L., Menegon, R.F., Trossini, G.H.G., Molino, J.V.D., Vital, D.G., Cicarelli, R.M.B., et al. (2013). Design, synthesis and biological evaluation of new aryl thiosemicarbazone as antichagasic candidates. European Journal of Medicinal Chemistry, 67, 142-151.
You can view some of Dr Drielli’s work below and links to her professional profile.
Orcid: https://orcid.org/0000-0001-9270-0466
Research Gate: https://www.researchgate.net/profile/Drielli-Gomes-Vital-Fujii
Scopus: https://www.scopus.com/authid/detail.uri?authorId=55829534000
Google Scholar: https://scholar.google.com/citations?user=F9U50AEAAAAJ&hl=pt-BR
Linkedin: linkedin.com/in/driellivital
Escavador: https://www.escavador.com/sobre/6101380/drielli-gomes-vital
CDIPD: https://cdipd.org/index.php/about-us/visiting-scientists
In this article, we will discuss whether citalopram causes akathisia. This can also be referred to as citalopram-induced akathisia. We will also examine related research studies, factors contributing to your risk, and how they affect you. Lastly, how to manage citalopram-induced akathisia will also be discussed.
Does citalopram cause akathisia?
Yes, citalopram can cause akathisia. Although it isn’t one of its typical side effects, some studies suggest that citalopram is linked to akathisia. Moreover, specific individuals may be more susceptible to it than others.
Citalopram is a selective reuptake inhibitor (SSRI) commonly used as an antidepressant. It is a medication that can affect your mood.
On the other hand, akathisia is characterized by inner restlessness, anxiety, and discomfort. It is described as a subjective feeling with an irresistible urge to move, and a person can’t sit or stand still.
What does research suggest?
Citalopram is associated with akathisia or psychomotor restlessness. The drug description for Celexa (citalopram) warns about the issues that may occur while taking citalopram. It includes akathisia as a side effect that is considered to be clinically worsening and a suicide risk (1).
Akathisia was reported in adult and pediatric patients treated for major depressive disorder and other indications while taking citalopram. There is also a concern that symptoms such as akathisia may be a precursor to suicidal tendencies.
During postmarketing evaluation with citalopram of over 30 million patients, akathisia was a reported side effect temporally associated with citalopram (2).
Moreover, recent research studies find akathisia as a potential side effect of citalopram. It was observed in patients taking citalopram during clinical trials (3). An issue raised is the possibility of akathisia being associated with suicidal ideation.
Changes in emotions, mood, and behavior caused by selective serotonin reuptake inhibitors (SSRIs) heighten the clinical importance of citalopram-induced akathisia.
One study investigated the relationship between drug-induced akathisia, dysphoria, suicidality, and feelings of depersonalization. It was assessed that, like other extrapyramidal effects, it is related to the impact of medication on dopamine (4).
What factors contribute to Citalopram-induced akathisia
Numerous factors may cause citalopram-induced akathisia. Antidepressants are known for this side effect, but citalopram was found to have low prevalence. Regardless, the following factors may increase your risk of experiencing akathisia.
Being aware of these factors may help prevent the risk of citalopram-induced akathisia from occurring.
Citalopram dosage and duration
Citalopram at higher doses can increase your risk of having akathisia. It is crucial to monitor your dosage and schedule of intake to reduce risks. If you have been prescribed citalopram for years, monitoring and adjusting the optimal dosage may be challenging.
Personal Factors
Each individual will react differently to citalopram. This can be due to age, genes, and overall health. The drug’s efficacy can be affected by personal factors. Others can have higher sensitivity, which increases their risks for akathisia.
Pre-existing condition
A person with certain conditions may become susceptible to citalopram. Neurological or psychiatric disorders that can influence your mood will increase the occurrence of akathisia. An example would be patients with panic conditions, baseline anxiety, or previous brain trauma (3).
How can Citalopram-induced akathisia affect you?
It is presumed that akathisia increases the risk for people to experience anxiety and depression. The impact it can have on your mental health should not be underestimated. The following are symptoms and effects of akathisia that may affect you both physically and mentally:
- Agitation
- Restlessness
- Inability to focus and concentrate
- Mood and behavior
- Insomnia or sleeping problems
- Social withdrawal
- Separation anxiety
- Depersonalization
- Impulsivity
- Suicidal ideation
An adverse consequence of akathisia that is most concerning is impulsive self-harm behavior. However, the relationship between akathisia and suicidality lacks conclusive evidence (4).
How can you manage Citalopram-induced akathisia?
Citalopram-induced akathisia can be managed by first detecting signs to acquire early diagnosis. Diagnosis can be challenging because it is defined as a subjective feeling manifested by constant movement. There is a lack of specific criteria to determine this condition.
Every patient may also present akathisia differently. Considering suspected medications, subjective reports, and objective findings is essential. Fortunately, the Barnes Akathisia Rating Scale (BARS) can measure citalopram-induced akathisia’s subjective and objective aspects.
After diagnosis, your healthcare provider will adjust your dosage of citalopram and may recommend an alternative drug.
Strict monitoring of your symptoms will be required to ensure proper management of akathisia. Citalopram-induced akathisia can also be managed by adding a centrally-acting beta-blocker, benzodiazepine, or an anticholinergic drug.
Nevertheless, a drug like propranolol is frequently used for therapy (1,5).
Conclusion
Citalopram-induced akathisia can be recognized by identifying the risk factors present in a patient. Awareness of the characteristics that may manifest akathisia and its early signs would prevent further adverse consequences.
Your healthcare provider will inquire about your medical history to identify citalopram-induced akathisia and evaluate its effect.
They will recommend an adjustment in dosage or alternative treatment. These strategies will prevent further discomfort and reduce the risk of nonadherence to treatment. More importantly, it will avoid self-harming behavior that may be caused by citalopram-induced akathisia for patients with depression.
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References
1.-
Tachere RO, Modirrousta M. Beyond anxiety and agitation: A clinical approach to akathisia. Aust Fam Physician. 2017;46(5):296-298. PMID: 28472575. Available from: https://www.racgp.org.au/afp/2017/may/beyond-anxiety-and-agitation-a-clinical-approach-t
2.-
Food and Drug Administration. Celexa (citalopram) [Internet]. U.S: FDA; 2019 [cited 2023 Oct 25]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020822s051lbl.pdf
3.-
Advokat, Claire. A Brief Overview of Iatrogenic Akathisia. Clinical Schizophrenia & Related Psychoses [Internet]. 2010 [cited 2023 Oct 25]; 3(4). 226-236. Available from: https://www.clinicalschizophrenia.net/articles/a-brief-overview-of-iatrogenic-akathisia.pdf
4.-
Cem Atbaşoglu E, Schultz SK, Andreasen NC. The relationship of akathisia with suicidality and depersonalization among patients with schizophrenia. J Neuropsychiatry Clin Neurosci. 2001 Summer;13(3):336-41. doi: 10.1176/jnp.13.3.336. PMID: 11514639. Available from: https://neuro.psychiatryonline.org/doi/10.1176/jnp.13.3.336
5.-
Koliscak LP, Makela EH. Selective serotonin reuptake inhibitor-induced akathisia. J Am Pharm Assoc (2003). 2009 Mar-Apr;49(2):e28-36; quiz e37-8. doi: 10.1331/JAPhA.2009.08083. PMID: 19289334. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1544319115309614
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