Feeling Worse on Citalopram? Why Your Brain Is Reacting & Medical Next Steps

If you've recently started citalopram and feel worse instead of better, you are not alone. Many people expect quick relief when beginning an antidepressant. But in the first few days or weeks, symptoms can temporarily intensify before improvement begins.

This can feel confusing and discouraging. The good news is that in many cases, this reaction is temporary and manageable. However, some reactions require prompt medical attention. Understanding what's happening in your brain can help you respond wisely and safely.

---

What Is Citalopram?

Citalopram is a selective serotonin reuptake inhibitor (SSRI). It is commonly prescribed for:

• Major depressive disorder
• Anxiety disorders
• Panic disorder
• Obsessive-compulsive symptoms

Citalopram works by increasing levels of serotonin, a brain chemical involved in mood regulation. However, the brain needs time to adjust to these changes.

---

Why You Might Feel Worse at First

When starting citalopram, your brain chemistry begins shifting quickly. But symptom relief takes longer because brain networks need time to rebalance.

Here are the most common reasons you may feel worse initially:

1. Early Side Effects

During the first 1–3 weeks, you may experience:

• Increased anxiety or restlessness
• Nausea
• Headache
• Insomnia or vivid dreams
• Fatigue
• Mild agitation

These effects often improve within a few weeks as your body adapts.

---

2. Temporary Increase in Anxiety

It may seem strange, but citalopram can temporarily increase anxiety before reducing it. This happens because serotonin affects multiple brain circuits, including those involved in alertness.

You might notice:

• Racing thoughts
• Feeling "on edge"
• Physical jitteriness
• Panic-like sensations

This usually improves within 2–4 weeks.

---

3. Activation Syndrome

In some individuals, SSRIs like citalopram can cause "activation." Symptoms may include:

• Restlessness
• Irritability
• Trouble sitting still
• Impulsivity

This is more common in younger adults and adolescents.

---

4. Sleep Disruption

Citalopram can alter sleep patterns early on. Poor sleep alone can worsen mood, anxiety, and concentration, making it feel like the medication isn't helping.

---

5. Suicidal Thoughts (Rare but Serious)

In people under age 25 especially, antidepressants including citalopram carry a small increased risk of:

• New or worsening suicidal thoughts
• Increased agitation
• Sudden behavioral changes

While uncommon, this is serious and requires immediate medical attention.

If you experience thoughts of harming yourself, feeling unsafe, or sudden drastic mood changes, seek urgent care immediately.

---

How Long Does It Take for Citalopram to Work?

Citalopram does not work instantly.

Typical timeline:

• Week 1–2: Side effects may appear. Mood may not improve yet.
• Week 3–4: Early mood improvement may begin.
• Week 6–8: Full therapeutic effect often becomes clearer.

Stopping too early can prevent you from seeing benefits.

---

When Feeling Worse Is a Red Flag

Some reactions are not normal adjustment effects. Contact your doctor promptly if you experience:

• Severe agitation
• Extreme mood swings
• New suicidal thoughts
• Hallucinations
• Severe confusion
• High fever with muscle stiffness
• Rapid heart rate with sweating and tremors

These may indicate rare but serious conditions such as serotonin syndrome or an underlying bipolar disorder being unmasked.

---

Could It Be the Dose?

Citalopram dosing matters. Too low may not help. Too high may cause side effects.

Doctors typically start at a lower dose and increase gradually. If you're feeling worse, your provider may:

• Lower the dose
• Slow the titration
• Switch medications
• Add short-term anti-anxiety support

Never adjust your dose without medical guidance.

---

Could You Have Bipolar Disorder?

If citalopram makes you feel unusually energized, impulsive, or unable to sleep — especially if you feel "wired" rather than depressed — this could signal bipolar disorder.

Warning signs include:

• Decreased need for sleep
• Racing ideas
• Grandiosity
• Risk-taking behavior

Antidepressants alone can worsen bipolar symptoms. If this sounds familiar, speak to your doctor promptly.

---

Practical Steps If You Feel Worse on Citalopram

If symptoms are uncomfortable but not dangerous, consider:

• Taking the medication at the same time daily
• Taking it with food (if nausea occurs)
• Prioritizing sleep hygiene
• Reducing caffeine
• Gentle daily movement
• Staying in close contact with your prescriber

If you're unsure whether your symptoms are typical adjustment effects or something more serious, you can use a free AI-powered symptom checker for those currently on antidepressants to help assess what you're experiencing and determine whether you should seek immediate medical attention.

This can help you organize your symptoms and prepare for a medical conversation.

---

Should You Stop Citalopram?

Do not abruptly stop citalopram unless directed by a doctor.

Stopping suddenly can cause discontinuation symptoms such as:

• Dizziness
• Brain "zaps"
• Irritability
• Flu-like symptoms
• Mood crashes

If stopping is appropriate, your doctor will guide you through a gradual taper.

---

Who Is More Likely to Struggle Early On?

Certain individuals may have a harder adjustment period with citalopram:

• People with high baseline anxiety
• Younger adults
• Those sensitive to medications
• Individuals with undiagnosed bipolar disorder
• People taking interacting medications

Your medical history plays a large role in how your brain reacts.

---

When to Speak to a Doctor Immediately

Seek urgent medical care if you experience:

• Thoughts of suicide or self-harm
• Severe agitation or aggression
• Signs of serotonin syndrome (fever, confusion, muscle stiffness)
• Fainting or heart rhythm changes
• Severe allergic reactions

These symptoms can be life threatening and should not be ignored.

---

The Bigger Picture: Recovery Is Often Nonlinear

Mental health recovery is rarely a straight line. Starting citalopram is a biological adjustment. Feeling temporarily worse does not automatically mean:

• The medication is wrong
• You are failing treatment
• Things will not improve

Many people who initially struggle go on to experience meaningful relief.

---

Questions to Ask Your Doctor

If you're concerned, consider discussing:

• Is this a normal adjustment reaction?
• Should my dose be changed?
• How long should I wait before evaluating effectiveness?
• Are there signs of bipolar disorder?
• Should therapy be added?

Combining medication with psychotherapy often improves outcomes.

---

Final Thoughts

Feeling worse after starting citalopram can be distressing — but it is often a temporary phase as your brain adjusts to changing serotonin levels. Understanding what is typical versus dangerous empowers you to respond calmly and appropriately.

Most early side effects improve within weeks. However, new suicidal thoughts, severe agitation, or signs of serotonin toxicity require immediate medical attention.

If you are unsure whether your symptoms are expected or concerning, a free symptom checker for those currently on antidepressants can help you identify what needs urgent attention — and most importantly, speak to a doctor about anything that could be serious or life threatening.

You deserve safe, informed, and compassionate care as you navigate treatment.