Citalopram

INTRODUCTION

Indications

Depression. Unlabeled Use: Premenstrual dysphoric disorder (PMDD). Obsessive-compulsive disorder (OCD). Panic disorder. Generalized anxiety disorder (GAD). Posttraumatic stress disorder (PTSD). Social anxiety disorder (social phobia).

Action

Selectively inhibits the reuptake of serotonin in the CNS. Therapeutic Effects: Antidepressant action.

Adverse Reactions/Side Effects

CNS: apathy, confusion, drowsiness, insomnia, weakness, agitation, amnesia, anxiety, decreased libido, dizziness, fatigue, impaired concentration, increased depression, migraine headache, suicide attempt. EENT: abnormal accommodation. Resp: cough. CV: postural hypotension, tachycardia. GI: abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, increased saliva, nausea, altered taste, increased appetite, vomiting. GU: amenorrhea, dysmenorrhea, ejaculatory delay, erectile dysfunction, polyuria. Derm: increased sweating, photosensitivity, pruritus, rash. Metab: decreased weight, increased weight. F and E: hyponatremia. MS: arthralgia, myalgia. Neuro: tremor, paresthesia. Misc: fever, yawning.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression or other changes in mood and behavior.

• Watch for confusion, apathy, sedation, agitation, anxiety, or other alterations in cognitive status (See Appendix D). Notify physician promptly if these symptoms develop.

• Assess blood pressure (BP) when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg or diastolic BP falls >10 mm Hg.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess any joint of muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess paresthesias (numbness, tingling) or tremor. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Report signs of low sodium levels (hyponatremia), including headache, confusion, lethargy, fatigue, decreased consciousness, or muscle abnormalities (weakness, spasms, cramps).

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or weight loss.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall-prevention strategies (See Appendix ...