From the Guidelines
The recommended starting dose of citalopram is the minimal effective dosage, which is the minimal approved dosage, typically 20 mg once daily for adults with depression or anxiety. This dose is recommended based on the most recent evidence from the Molecular Psychiatry study in 2022 1, which suggests that the minimal licensed dose is sufficient for most patients, with higher doses increasing the risk of side effects and discontinuation.
When initiating treatment with citalopram, it's essential to consider individual factors, such as age, liver function, and sensitivity to medications, which may require a lower starting dose of 10 mg daily. The American College of Physicians also recommends selecting second-generation antidepressants, including citalopram, based on adverse effect profiles, cost, and patient preferences 1.
After starting treatment, patients should be monitored for several weeks before considering any dose adjustments, as citalopram typically takes 2-4 weeks to begin showing therapeutic effects 1. Common initial side effects include nausea, headache, drowsiness, dry mouth, and sleep disturbances, which often improve over time. It's crucial to take citalopram exactly as prescribed by the healthcare provider and not to adjust the dose without consulting them, as this can cause withdrawal symptoms.
Key points to consider when starting citalopram include:
- Starting with the minimal effective dosage, typically 20 mg once daily
- Monitoring patient response for several weeks before considering dose adjustments
- Considering individual factors, such as age and liver function, when determining the starting dose
- Being aware of common initial side effects and the potential for withdrawal symptoms if the dose is adjusted or stopped abruptly.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Citalopram tablets (citalopram HBr) should be administered once daily, in the morning or evening, with or without food. Initial Treatment Citalopram tablets should be administered at an initial dose of 20 mg once daily, with an increase to a maximum dose of 40 mg/day at an interval of no less than one week
- The initial dose of citalopram is 20 mg once daily.
- This dose may be increased to a maximum of 40 mg/day at an interval of no less than one week 2.
From the Research
Citalopram Dosage
The recommended dosage for citalopram can vary depending on the individual and their specific condition.
- According to a study published in 2003 3, the typical dosage of citalopram for patients with depression is 20-60 mg once daily.
- A 2019 study 4 mentions that eligible participants were those taking citalopram 20 mg, among other medications, but does not specify the starting dose.
- Another study from 1995 5 found that citalopram in doses of 20-60 mg is effective in preventing depression relapse.
- A systematic review from 1999 6 does not provide specific guidance on the starting dose of citalopram but notes that it is one of several selective serotonin reuptake inhibitors (SSRIs) with similar efficacy.
Key Considerations
When determining the starting dose of citalopram, it is essential to consider the individual's specific condition, medical history, and potential interactions with other medications.