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Citalopram

Prescription ·Strong evidence ·Reviewed May 2026

Prescription selective serotonin reuptake inhibitor (SSRI) approved for major depressive disorder. The racemic mixture of S-citalopram and R-citalopram. Well tolerated with few drug interactions due to minimal CYP450 inhibition. FDA-mandated maximum dose of 40 mg daily (20 mg in patients over 60) due to dose-dependent QT prolongation risk. Dosage must be determined by your prescribing physician.

Evidence tier
Strong
Indexed sources
10 1992–2025
Interactions
9
Depletes
2 nutrients
Read the sources → Compare profiles
What it's good for
  • Depression symptom relief1,2
  • Anxiety reduction
  • Few drug-drug interactions2,7
  • Generally well tolerated
What to watch for
  • Nausea
  • Dry mouth
  • Drowsiness
  • Concurrent MAOI use (within 14 days)
  • Concurrent pimozide use

The bottom line

Evidence rating strong. Most-documented uses: depression symptom relief, anxiety reduction, few drug-drug interactions. 10 sources indexed (1992–2025), with 9 interaction records on file.

The science

How it works, mechanistically.

Core mechanism

Inhibits the reuptake of serotonin (5-HT) by blocking SERT. The S-enantiomer is primarily responsible for serotonin reuptake inhibition; the R-enantiomer has minimal pharmacologic activity at SERT but may interact with cardiac ion channels at higher doses.6

Class
SSRI
Dosing

Dosing & protocol.

Common range
10–40 mg daily; max 20 mg daily in patients >60 years (as prescribed by your physician)
Recommended form
Tablet or oral solution

Can be taken with or without food. May be taken morning or evening.8

Depletions

What it depletes.

Nutrients this medication can lower over time, and what to replace.

Sodium

Significant

SSRI-induced SIADH can lower serum sodium, especially in older adults and during the first weeks of therapy.

Monitor Serum sodiumOnset Most often within the first 2-12 weeks

Folate

Mild

Lower folate status is associated with poorer SSRI response and may be reduced in some chronic users through altered one-carbon metabolism.

Replace MethylfolateMonitor Serum folate or RBC folateOnset Usually over months
Genetics

Who responds differently.

CYP2C19*2 / *3 / *17~25% of population

Citalopram concentrations vary meaningfully with CYP2C19 activity, which matters because higher exposure can worsen adverse effects and QT-related risk.

Recommendation: Unexpected side effects or poor response should trigger a medication review rather than assuming a supplement interaction alone.

Safety

Full safety detail.

Side effects

  • Nausea
  • Dry mouth
  • Drowsiness
  • Insomnia
  • Sexual dysfunction
  • Increased sweating
  • QT prolongation at higher doses

Contraindications

  • Concurrent MAOI use (within 14 days)
  • Concurrent pimozide use
  • Known hypersensitivity to citalopram1,2
  • Congenital long QT syndrome
  • Doses exceeding 40 mg/day8
Interactions

Interaction records.

DangerousContraindicated

5-HTP

5-HTP combined with citalopram creates serotonin syndrome risk. Citalopram also prolongs QTc, and serotonin excess can worsen cardiac effects.

Recommendation: Do NOT take 5-HTP with citalopram.

DangerousContraindicated

St. John's Wort

Dual serotonin reuptake inhibition from citalopram and St. John's Wort creates serotonin syndrome risk.

Recommendation: Do NOT combine St. John's Wort with citalopram.

SeriousCaution

Melatonin

Severe sedation has been reported after melatonin was added to a regimen that included citalopram, with the authors judging a melatonin-citalopram pharmacokinetic interaction as the most likely explanation. The case also involved other sedating medicines, so the risk is most important when melatonin is stacked with citalopram plus opioids, tricyclic antidepressants, sleep medicines, alcohol, or other CNS depressants. Watch for unusual next-day grogginess, confusion, slowed breathing, or impaired coordination.

Recommendation: Use the lowest effective melatonin dose if you take citalopram, and avoid adding melatonin when other sedating medicines are already in the stack unless your prescriber approves it. Do not drive or use machinery after starting or increasing melatonin until you know how the combination affects you. Seek urgent care for extreme sleepiness, confusion, fainting, or slow breathing.

ModerateCaution

Rhodiola Rosea

Citalopram is serotonergic. Rhodiola has preclinical monoamine and MAO-related findings, but direct human evidence for serotonin syndrome with Citalopram is limited. Combined use should be treated as a theoretical serotonergic-interaction risk, not as a proven prescription-MAOI-like contraindication.

Recommendation: Do not use Rhodiola to self-augment Citalopram. Discuss Rhodiola with the prescriber or pharmacist first, especially if other serotonergic agents are present, and seek care for serotonin-toxicity symptoms if both are used.

DangerousContraindicated

MDMA

Citalopram blocks the serotonin transporter MDMA uses to release serotonin, blunting the subjective effect while still permitting serotonergic load. Combined use risks serotonin syndrome and hyperthermia, and citalopram independently prolongs the QT interval, adding cardiac risk when MDMA causes catecholamine surges.

Recommendation: Do not combine MDMA with citalopram. Wait at least 1-2 weeks after stopping citalopram before any MDMA exposure.

ModerateCaution

Ginkgo Biloba

Citalopram impairs platelet aggregation by depleting platelet serotonin; Ginkgo's ginkgolides inhibit platelet-activating factor. The combination compounds bleeding risk, particularly with concurrent NSAIDs, aspirin, or anticoagulants.

Recommendation: Avoid Ginkgo biloba while taking citalopram. Watch for unusual bruising or bleeding and stop Ginkgo 7-14 days before any planned surgery.

DangerousContraindicated

L-Tryptophan

L-Tryptophan is the upstream precursor to serotonin. Combined with citalopram's serotonin reuptake blockade, supplemental tryptophan can push synaptic serotonin to toxic levels and trigger serotonin syndrome (agitation, tremor, sweating, hyperthermia, clonus).

Recommendation: Do not take L-tryptophan supplements with citalopram. Food intake of tryptophan is fine; concentrated supplemental doses are the issue.

SeriousCaution

SAMe

SAMe has independent serotonergic and antidepressant activity. Combined with citalopram, the additive serotonergic effect raises the risk of serotonin syndrome — agitation, sweating, tremor, hyperreflexia, clonus, and hyperthermia.

Recommendation: Do not start SAMe alongside citalopram without explicit prescriber approval. If used together, start SAMe at the lowest dose and watch for tremor, restlessness, sweating, or rapid heart rate.

InfoSynergy

Magnesium Citrate

Citalopram produces dose-dependent QT interval prolongation and carries a black-box warning at doses above 40 mg/day (or 20 mg in older adults). Hypomagnesemia is an independent QT prolongation risk and amplifies citalopram's cardiac effect. Maintaining adequate magnesium intake helps protect against torsades de pointes in this setting.

Recommendation: If you take citalopram, ensure adequate magnesium intake from diet or a modest supplement (200-350 mg/day supplemental elemental magnesium from magnesium citrate is typical). Avoid letting magnesium fall low, particularly if you also take a diuretic or PPI that depletes magnesium.

Search all 9 interaction records for Citalopram →

Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Meta-analyses & systematic reviews

5

Randomized controlled trials

1

Reference material

4
Keep exploring

Deep dives & adjacent profiles.

SertralinePrescriptionParoxetinePrescriptionFluoxetinePrescriptionEscitalopramPrescriptionVenlafaxinePrescriptionTrazodonePrescription

This page is educational. Do not start, stop, or change a supplement or medication based on it without checking with a qualified healthcare professional.

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NutriStack is an informational and organizational tool, not a medical service, and not a substitute for professional advice. Always consult a qualified healthcare professional before starting, stopping, or changing any supplement or medication.