Celexa I: Sexual Dysfunction
It's another antidepressant...with the most sexual dysfuntion.
There are some days when you just…can’t. Can’t anything. This is one of those days, and writing an article about Celexa (Citalopram) is, ironically, one of those things. As we will see, this is also dark humor of the foreshadowing variety. Welcome to The Frontier Psychiatrists, a health-themed publication edited by Owen Scott Muir, M.D., DFAACAP.
My book is Inessential Pharmacology. (amazon link) and contains many chapters like this article…consider reading it!
Citalopram is a selective serotonin reuptake inhibitor (SSRI). I’ve already covered why even this name is a lie: in animal models without the serotonin transporter gene, which codes for the protein that is the putative site of pharmacological action for these medicines, they still work just fine1. This means it can’t be the selective serotonin-ness of the SSRI medications that is responsible for their effects. It’s a bit like if doors were assumed to only open because of the twisting of the knob, and then someone made a door that just had a non-rotatable knob, and they still opened thanks to yanking alone. Door knob twisting orthodoxy in tatters!
According to the FDA, it is legal to advertise for the following indication:
Celexa is a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of major depressive disorder (MDD) in adults.
It’s not approved in youth. It’s not approved in anything else. It’s got a giant black box warning, like all other antidepressants, related to the risk of suicidal thoughts in youth. This is a class-wide effect, and it’s not trivial, as I noted in my prior and very personal take on Zoloft.
In other articles, I’ve addressed weight gain, lack of efficacy, and sedation and largely steered clear of sexual dysfunction. In part, this has been due to the desire not to get eaten alive by those on the internet who seem intent on a particular side effect.
has done an excellent overview of one specific variant of sexual adverse effect, Post-SSRI Induced Sexual Dysfunction (PSSD).The FDA label for Celexa is more concise than I’m arguing is sufficient on the topic of sexual dysfunction:
Sexual Dysfunction: CELEXA may cause symptoms of sexual dysfunction.
And further cautions:
Sexual Dysfunction: Use of SSRIs, including CELEXA, may cause symptoms of sexual dysfunction. In male patients, SSRI use may result in ejaculatory delay or failure, decreased libido, and erectile dysfunction. In female patients, SSRI use may result in decreased libido and delayed or absent orgasm.
It is important for prescribers to inquire about sexual function prior to initiation of CELEXA and to inquire specifically about changes in sexual function during treatment because sexual function may not be spontaneously reported. When evaluating changes in sexual function, obtaining a detailed history (including timing of symptom onset) is important because sexual symptoms may have other causes, including the underlying psychiatric disorder. Discuss potential management strategies to support patients in making informed decisions about treatment.
Celexa, however, may be the worst offender among oral depression treatments in terms of sexual dysfunction (from a 2001 paper by Montejo, et. al.)2:
Yes, dear readers, that is right. 72.7% of patients taking Celexa reported sexual dysfunction in this sample. These were patients treated in the community, not in a research setting. These numbers are much higher than reported to the FDA among those participating in clinical trials. There are some significant questions I have about the data as presented on the FDA website, as we shall see. The story of Celexa is a real “who done it.”