Major
citalopram × Lithium
SSRI (selective serotonin reuptake inhibitor)×Psycholeptics. Lithium
Mechanism
Additive serotonergic effect of SSRIs and lithium (lithium enhances synaptic serotonergic transmission). SSRI-related lithium level rises have also been reported.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, hypertension, fever. First signs appear within hours of co-administration.
Management
The combination is possible with careful monitoring. Check lithium level at 2 and 4 weeks after starting citalopram. If agitation, tremor, or diarrhoea appears, reassess lithium level and serotonergic status.