When someone with bipolar disorder is prescribed citalopram hydrobromide, it’s not because their doctor is ignoring the risks-it’s because they’re trying to fix something that isn’t working. But here’s the truth most patients don’t hear until it’s too late: citalopram hydrobromide can make bipolar disorder worse. Not for everyone. Not always. But often enough that doctors who know the science now avoid it unless there’s no other choice.
What Is Citalopram Hydrobromide?
Citalopram hydrobromide is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder. Also known as Celexa, it was approved by the FDA in 1998 and works by increasing serotonin levels in the brain to improve mood. It’s taken once daily, usually in doses between 20 and 40 mg, and starts showing effects in 2 to 6 weeks.
It’s not a mood stabilizer. It doesn’t calm mania. It doesn’t prevent mood swings. It only targets depression. That’s why it’s dangerous in bipolar disorder-unless it’s paired with something that controls the highs.
Why SSRIs Like Citalopram Can Trigger Mania in Bipolar Patients
One in five people with bipolar disorder who take an SSRI without a mood stabilizer will experience a manic or hypomanic episode within the first few months. That’s not rare. That’s predictable.
A 2021 study in the Journal of Affective Disorders tracked 1,200 patients with bipolar depression treated with SSRIs. Nearly 22% had a manic switch-meaning they went from crying and sleeping all day to staying up for days, spending recklessly, or believing they could fly. Citalopram hydrobromide was among the most common SSRIs linked to these switches.
Why does this happen? Bipolar disorder isn’t just low serotonin. It’s a brain that swings between two extremes. Boosting serotonin alone can push the system over the edge into mania. It’s like adding fuel to a fire you’re trying to put out.
What the Guidelines Actually Say
The American Psychiatric Association (APA) and the British National Institute for Health and Care Excellence (NICE) both agree: SSRIs should not be used as first-line treatment for bipolar depression.
They recommend mood stabilizers first-like lithium, valproate, or lamotrigine. Or atypical antipsychotics like quetiapine or lurasidone. These drugs treat both depression and mania. Citalopram hydrobromide? Only if the patient has tried at least two mood stabilizers and still has lingering depression. Even then, it’s used with extreme caution and always alongside a mood stabilizer.
Most psychiatrists won’t prescribe citalopram hydrobromide alone to someone with bipolar disorder. If they do, they’re either unaware of the guidelines-or the patient is in crisis and there’s no time to wait for safer options.
Real Stories: When Citalopram Made Things Worse
Anna, 34, was diagnosed with bipolar II after years of being told she had "just depression." Her doctor prescribed citalopram hydrobromide 20 mg. Within three weeks, she stopped sleeping, bought a car she couldn’t afford, and sent angry texts to her entire family. She was hospitalized for hypomania.
"I thought the medicine was helping," she said. "I felt energized. I thought I was finally normal. Then everything collapsed."
Mark, 41, was on citalopram hydrobromide for six months. He’d been stable on lithium, but his doctor added the SSRI because he "still felt down." He ended up in the ER after a 72-hour manic episode where he drove across state lines without a plan, convinced he was starting a tech company.
These aren’t outliers. They’re textbook cases.
When Is Citalopram Hydrobromide Actually Used in Bipolar Disorder?
There are two rare scenarios where it might be considered:
- After multiple mood stabilizers failed-and the patient still has severe depressive symptoms that aren’t improving. Even then, it’s added to lithium or lamotrigine, never used alone.
- For patients with a history of antidepressant-induced mania who now need another SSRI-but this is a last-ditch effort. Doctors will monitor blood levels, sleep patterns, and behavior daily.
There’s no scenario where citalopram hydrobromide is the first, second, or even third choice. It’s a backup plan with a high risk.
What Are the Safer Alternatives?
If you have bipolar disorder and your depression isn’t improving, here are the proven alternatives-with less risk of triggering mania:
| Medication | Type | Effectiveness for Depression | Mania Risk |
|---|---|---|---|
| Lamotrigine | Mood stabilizer | High | Very low |
| Quetiapine (Seroquel) | Atypical antipsychotic | High | Low |
| Lithium | Mood stabilizer | Moderate | Very low |
| Lurasidone (Latuda) | Atypical antipsychotic | High | Low |
| Cariprazine (Vraylar) | Atypical antipsychotic | Moderate to high | Low |
Lamotrigine is often the top choice. It’s the only mood stabilizer proven to prevent depressive episodes without increasing mania. Quetiapine and lurasidone work fast and are FDA-approved specifically for bipolar depression. Lithium has been the gold standard for over 70 years-it’s not glamorous, but it works.
What to Do If You’re Already on Citalopram Hydrobromide
If you have bipolar disorder and are taking citalopram hydrobromide:
- Don’t stop cold turkey. Withdrawal can cause dizziness, nausea, and brain zaps.
- Track your mood daily. Use an app or journal. Note sleep, energy, spending, irritability.
- Watch for early signs of mania: needing less sleep, racing thoughts, impulsive decisions, grandiosity.
- Ask your doctor: "Am I on a mood stabilizer too?" If the answer is no, ask why.
- Request a referral to a psychiatrist who specializes in bipolar disorder. Not a general practitioner.
Many patients are on citalopram hydrobromide because their primary care doctor didn’t know the risks. That’s not your fault. But it’s your responsibility to ask the right questions now.
Final Reality Check
Citalopram hydrobromide isn’t evil. It helps millions with unipolar depression. But in bipolar disorder, it’s like using a hammer to fix a leaky pipe. It might seem like it’s working-until the whole thing bursts.
The goal isn’t to feel better for a few weeks. It’s to stay stable for years. That means using tools designed for the full illness-not just one side of it.
If you’re living with bipolar disorder, your treatment plan should protect you from both the lows and the highs. Citalopram hydrobromide alone doesn’t do that. And if your doctor hasn’t explained why they’re using it-or what the alternatives are-you deserve a second opinion.
Can citalopram hydrobromide cause mania in people with bipolar disorder?
Yes. Studies show that about 1 in 5 people with bipolar disorder who take an SSRI like citalopram hydrobromide without a mood stabilizer will experience a manic or hypomanic episode. This is not rare-it’s a well-documented risk. The drug can push the brain from depression into overdrive, leading to impulsive behavior, reduced sleep, and risky decisions.
Is citalopram hydrobromide ever safe for bipolar depression?
Only under very specific conditions: after at least two mood stabilizers have failed, and only when used alongside a proven mood stabilizer like lithium or lamotrigine. Even then, it’s a last-resort option. Most psychiatrists avoid it entirely because safer, more effective alternatives exist.
What are the best medications for bipolar depression?
The most effective and safest options are lamotrigine, quetiapine, lurasidone, and lithium. Lamotrigine is especially valued because it prevents depressive episodes without triggering mania. Quetiapine and lurasidone work quickly and are FDA-approved specifically for bipolar depression. These drugs treat both sides of the disorder, unlike SSRIs that only target depression.
Why do some doctors still prescribe citalopram for bipolar disorder?
Some doctors, especially general practitioners, aren’t trained in bipolar disorder and assume depression is depression. Others prescribe it in emergencies when a patient is severely depressed and no mood stabilizer has worked yet. But this is off-label, risky, and not aligned with clinical guidelines. If you’re on citalopram and have bipolar disorder, ask if you’re also on a mood stabilizer-and why.
How long does it take for citalopram to trigger mania in bipolar patients?
Manic episodes can start as early as 1 to 3 weeks after starting citalopram hydrobromide. Most occur within the first two months. The risk is highest in the first few weeks, especially if the patient is already prone to rapid mood shifts or has a history of previous antidepressant-induced mania.
What should I do if I think citalopram is making my bipolar symptoms worse?
Don’t stop taking it suddenly. Contact your doctor right away. Start tracking your mood, sleep, energy levels, and behavior daily. Ask for a referral to a psychiatrist who specializes in bipolar disorder. Request a review of your full medication plan. You may need to switch to a mood stabilizer or an antipsychotic that treats both depression and mania.
10 Comments
Andrew Baggley November 20, 2025
This is the kind of post that should be mandatory reading for anyone on SSRIs with a bipolar diagnosis. I was on citalopram for 8 months before my mania hit - thought I was ‘finally fixed.’ Turned out I was just wired for three days straight, maxed out three credit cards, and quit my job to ‘launch an app.’ No one warned me. Thanks for laying it out so clearly.
Codie Wagers November 21, 2025
Let us not mince words: the medical-industrial complex thrives on pharmaceutical band-aids. Citalopram is not a treatment-it is a temporal distraction, a chemical soporific that masks the deeper systemic failure of psychiatric care. The brain is not a serotonin vending machine. To reduce bipolar disorder to a monoamine imbalance is not science-it is reductionist dogma dressed in white coats.
Yet, here we are, prescribing SSRIs like they’re aspirin for existential dread. The real tragedy? Patients are taught to trust authority, not to question. And when the mania hits? They blame themselves. Not the system. Not the guidelines ignored. Not the fact that lamotrigine has been available since 1994, yet remains underutilized because it’s not profitable.
It is not the patient’s fault. It is the failure of education, of oversight, of ethics. We treat symptoms, not syndromes. And until we acknowledge that bipolar disorder is a neurodevelopmental oscillation-not a depressive disorder with occasional highs-we will keep poisoning people with hope disguised as medication.
Paige Lund November 21, 2025
Wow. So… citalopram can make you go full Elon Musk on a sugar high? Who knew?
Reema Al-Zaheri November 21, 2025
The data is unequivocal: SSRIs, including citalopram hydrobromide, carry a well-documented, statistically significant risk of inducing manic or hypomanic episodes in individuals with bipolar disorder, particularly when administered without concurrent mood stabilization. The 2021 study cited in the Journal of Affective Disorders, with its sample size of 1,200 patients, demonstrates a 22% switch rate-far exceeding the placebo-controlled baseline. This is not anecdotal; it is epidemiological. Furthermore, the APA and NICE guidelines are explicit: first-line treatment must include mood stabilizers or atypical antipsychotics. The persistence of off-label SSRI monotherapy reflects a critical gap in primary care training, not a clinical rationale.
Michael Salmon November 23, 2025
Oh, so now we’re blaming doctors for being human? You think every GP is a psychiatric genius? Most of these patients are seen for 12 minutes, handed a script, and told to ‘come back in six weeks.’ Meanwhile, psychiatrists are booked six months out. You want to cry about citalopram? Go fight the insurance companies that won’t cover lamotrigine because it’s generic and ‘not new enough.’ Stop pretending this is about medical ethics-it’s about access, and you’re ignoring the real villain.
Joe Durham November 24, 2025
I’ve been on lamotrigine for five years now. I was on citalopram for two before that. The difference? Before, I’d go from crying in bed to cleaning my entire apartment at 3 a.m. and calling my ex at 5 a.m. After? I just… feel like me. Not a rollercoaster. Not a ticking bomb. Just me. I get it’s not perfect. But it’s stable. And stability? That’s everything.
To anyone reading this: if you’re on an SSRI and you have bipolar, don’t panic. But do talk to your doctor. Ask about alternatives. Ask if you’re on anything that covers the highs. You deserve to feel safe in your own mind.
Derron Vanderpoel November 25, 2025
oh my god i just read this and i started crying because i remember when i was on citalopram and i bought a motorcycle and then sold it 3 days later because i thought i was going to be a pro racer and then i cried for 3 days straight because i realized i had no idea what i was doing and my mom had to come pick me up from my apartment because i hadn't eaten and my dog was sleeping on my chest because i was too tired to move and i just kept thinking i was fixed and i wasn't and i'm so glad someone wrote this because i thought i was the only one who went crazy on antidepressants
Timothy Reed November 27, 2025
Thank you for this comprehensive and clinically accurate breakdown. The distinction between unipolar and bipolar depression is not just academic-it’s life-or-death. The fact that SSRIs remain inappropriately prescribed highlights a systemic failure in mental health education, particularly in primary care settings. I encourage all patients to request a referral to a bipolar specialist if they’re prescribed an SSRI without a mood stabilizer. Also, tracking mood with apps like Daylio or Moodfit is one of the most effective tools for early detection of manic shifts. Knowledge is power, and this post empowers.
Christopher K November 28, 2025
So now we’re telling Americans they can’t take a simple pill to feel better? This is why the U.S. is falling apart-over-medicated, over-litigated, over-psychoanalyzed. Back in my day, people just dealt with it. Now we need a 10-page essay to tell someone not to take Celexa? Get a grip. If you’re bipolar, you’re bipolar. Stop blaming the medicine and start taking responsibility.
Andrew Baggley November 28, 2025
@Christopher K - I get where you’re coming from. I used to think the same. But when you wake up in the ER after spending $12,000 on a boat you don’t know how to drive, and your sister says, ‘You were talking to the ceiling fan like it was your therapist,’ you start realizing this isn’t about weakness. It’s about biology. And sometimes, biology needs the right tool-not just grit.