Citalopram QT Prolongation: Risks, Signs, and What You Need to Know

When you take citalopram, an SSRI antidepressant used to treat depression and anxiety. Also known as Celexa, it helps balance brain chemicals—but it can also affect your heart in ways most people don’t expect. One of the most serious, yet under-discussed, risks is QT prolongation, a delay in the heart’s electrical recovery phase that can trigger dangerous irregular heartbeats. This isn’t just a footnote in the prescribing info—it’s a real, measurable danger that can lead to torsades de pointes, a type of life-threatening arrhythmia.

QT prolongation doesn’t happen to everyone, but certain factors make it much more likely. People over 65, those with existing heart conditions, or anyone taking other drugs that affect heart rhythm are at higher risk. Even something as simple as a high dose of citalopram—above 40 mg per day—can push the QT interval past safe limits. The FDA actually lowered the maximum recommended dose for citalopram in 2012 because of this exact issue. And it’s not just about dosage. If you’re also on antibiotics like clarithromycin, antifungals like fluconazole, or even some anti-nausea meds, your risk goes up fast. These drugs block the same enzyme your body uses to break down citalopram, causing it to build up in your system.

You won’t feel QT prolongation until it’s too late. No chest pain, no warning buzz. The first sign might be dizziness, a sudden flutter in your chest, or fainting. That’s why doctors check your ECG before starting citalopram if you have risk factors—and why they might repeat it after a few weeks. It’s not about fear. It’s about control. If you’re on citalopram and have a history of heart problems, electrolyte imbalances (like low potassium or magnesium), or are taking other meds, ask your doctor for a simple ECG. It takes five minutes and could save your life.

Some people think switching to another SSRI like sertraline or escitalopram solves the problem—but escitalopram is the active part of citalopram, so it carries the same risk. Sertraline is generally safer for the heart, but that doesn’t mean it’s risk-free. The real answer isn’t just swapping drugs—it’s understanding your personal risk profile. Are you on multiple meds? Do you have kidney or liver issues? Are you dehydrated or taking diuretics? These aren’t minor details. They’re part of the equation.

Below, you’ll find real-world insights from people who’ve dealt with this issue, doctors who’ve seen the consequences, and guides on how to monitor your heart while staying on medication. You’ll learn what tests matter, which drugs to avoid, and how to talk to your provider without sounding alarmist. This isn’t theoretical. It’s practical. And if you’re taking citalopram, you need to know it.