Panic Attacks Associated With Citalopram

Heidi R. Brauer, MD, Paul W. Nowicki, MD, Glenn Catalano, MD, Maria C. Catalano, DO


South Med J. 2002;95(9) 

In This Article

Abstract and Introduction

Citalopram is the newest selective serotonin reuptake inhibitor (SSRI) available in the United States. It is currently approved by the Food and Drug Administration for the treatment of major depression. However, a number of studies have found it to be effective in the treatment of panic disorder as well. While there have been no previous case reports of citalopram inducing panic attacks in patients, this phenomenon has been reported with other members of the SSRI class of antidepressants. We present the case of a 61-year-old woman who had frank panic attacks after her citalopram dose was increased. She had had no history of anxiety symptoms. Anxiety abated completely upon discontinuance of citalopram therapy.

Citalopram hydrobromide (Celexa) is a selective serotonin reuptake inhibitor (SSRI) with established safety and efficacy in the treatment of depression.[1] Some citalopram studies have shown promising results in the treatment of panic disorder.[2] The most common side effects seen with citalopram use are nausea (21%), dry mouth (20%), somnolence (18%), insomnia (14%), and increased sweating (11%).[3]

In a review of SSRI side-effect reports in Sweden, psychiatric symptoms were the second leading adverse reaction reported, occurring in 19.5% of patients.[4] The most common psychiatric side effect reported was "anxiety," which began, on average, 4 days after institution of treatment.[4] The development of anxiety and panic attacks during treatment with SSRIs has been well documented in the literature. Increased anxiety or the onset of panic attacks has been associated with sertraline,[5,6,7] fluoxetine,[8,9,10,11,12] paroxetine,[13,14] and fluvoxamine,[15] despite the fact that they all have some efficacy in the treatment of panic disorder.[16]

No case reports of increased anxiety or panic associated with citalopram treatment were found on MEDLINE. We now report the first known case of panic attacks induced by citalopram.


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