How to safely discontinue citalopram (Celexa) 20 mg?

From the Guidelines

To safely discontinue citalopram (Celexa) 20 mg, you should gradually taper off the medication under medical supervision rather than stopping abruptly. A typical tapering schedule might involve reducing your dose to 10 mg daily for 1-2 weeks, then 10 mg every other day for 1-2 weeks, before completely stopping, as suggested by the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. The exact tapering schedule should be personalized by your healthcare provider based on how long you've been taking the medication, your specific symptoms, and your medical history.

Key Considerations

• During the tapering process, monitor yourself for discontinuation symptoms such as dizziness, nausea, headaches, irritability, anxiety, electric shock-like sensations, or sleep disturbances, which have been reported following missed doses or acute discontinuation of shorter-acting SSRIs, notably paroxetine but also (to a lesser extent) fluvoxamine and sertraline 1.
• If you experience severe discontinuation symptoms, contact your healthcare provider immediately as your tapering schedule may need adjustment.
• It's also important to maintain regular follow-up appointments during this process to monitor your mental health, as symptoms of the original condition may return.

Medical Supervision

Never discontinue citalopram without consulting your healthcare provider, as abrupt discontinuation can lead to more severe withdrawal symptoms and potential relapse of depression or anxiety. Medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications, including tapering off them 1.

Tapering Schedule

Some key points to consider when tapering off citalopram include:

• Starting with a subtherapeutic dose as a “test” dose may be advisable to assess initial adverse effects such as anxiety or agitation 1.
• Systematic assessment of treatment response using standardized symptom rating scales can be considered as a supplement during the tapering process 1.
• Parental oversight of medication regimens is of paramount importance in children and adolescents 1.

From the FDA Drug Label

A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate Symptoms associated with discontinuation of citalopram tablets and other SSRIs and SNRIs have been reported (see PRECAUTIONS). Patients should be monitored for these symptoms when discontinuing treatment.

To safely discontinue citalopram (Celexa) 20 mg, a gradual reduction in dose is recommended. The dose can be decreased to 10 mg before stopping completely. Patients should be monitored for symptoms of discontinuation, such as dysphoric mood, irritability, and dizziness. If intolerable symptoms occur, the previous dose may be resumed and then decreased at a more gradual rate 2.

From the Research

Stopping Citalopram 20mg Tablets

To safely discontinue citalopram (Celexa) 20mg, it is essential to follow a gradual tapering schedule to minimize withdrawal symptoms.

• The tablets are available in 20mg and 10mg doses, which can be used to gradually reduce the dosage.
• Studies have shown that abrupt discontinuation of serotonin reuptake inhibitors (SRIs) like citalopram can lead to discontinuation symptoms, which can be distressing and may lead to missed work days and decreased productivity 3.
• A gradual tapering schedule can help reduce the risk of these symptoms, which can include dizziness, nausea, fatigue, and anxiety 3, 4.

Tapering Schedule

The ideal tapering schedule for citalopram is not well established, but studies suggest that a slow and gradual reduction in dosage can be effective in minimizing withdrawal symptoms.

• One study recommends tapering citalopram over a period of months, with dose reductions of 10-25% every 2-4 weeks 4.
• Another study suggests that hyperbolic tapering, where the dose is reduced by a fixed percentage at each step, can be an effective way to minimize withdrawal symptoms 4.
• It is essential to work with a healthcare professional to determine the best tapering schedule for individual patients, as the risk of withdrawal symptoms can vary depending on the dose and duration of treatment 5, 6.

Withdrawal Symptoms

Withdrawal symptoms can occur when citalopram is discontinued, especially if the dosage is reduced too quickly.

• Common symptoms include dizziness, muscle tension, chills, confusion, and crying 5.
• These symptoms can be mild and self-limiting, but in some cases, they can be severe and require medical attention 3, 4.
• It is crucial to monitor patients for withdrawal symptoms during the tapering process and adjust the schedule as needed to minimize these symptoms 6, 7.