What is the dosage of Citalopram for treating depression?

From the Guidelines

The recommended dosage of Citalopram for treating depression is 10 mg per day, with a maximum dosage of 40 mg per day. This dosage is based on the guidelines provided by the American Family Physician 1. The initial dosage of 10 mg per day is recommended to minimize side effects, and the dosage can be increased as needed and tolerated by the patient.

Important Considerations

• Citalopram is generally well-tolerated, but some patients may experience nausea and sleep disturbances 1.
• The medication should be taken consistently at the same time each day, and patients should not stop taking it abruptly, as this can cause withdrawal symptoms.
• Common side effects of Citalopram include nausea, dry mouth, increased sweating, drowsiness, and sexual dysfunction.
• It is essential to monitor patients for severe side effects, such as significant agitation, suicidal thoughts, or unusual bleeding, especially when first starting treatment 1.

Special Precautions

• Citalopram may cause QT prolongation associated with Torsade de Pointes, ventricular tachycardia, and sudden death at daily doses exceeding 40 mg/d, and should be avoided in patients with long QT syndrome 1.
• The medication may interact with other drugs that prolong the QT interval, and patients should be closely monitored for any adverse effects.
• Citalopram has a lower propensity for drug interactions compared to other SSRIs, but patients should still be cautious when taking other medications concurrently 1.

Patient Education

• Patients should be educated on the importance of taking Citalopram consistently and not stopping the medication abruptly.
• They should also be informed about the potential side effects and the importance of monitoring for severe adverse effects.
• Patients should be encouraged to report any concerns or questions to their healthcare provider, and to seek immediate medical attention if they experience any severe side effects.

From the FDA Drug Label

Study 1, a 6-week trial in which patients received fixed citalopram doses of 10,20,40, and 60 mg/day, showed that citalopram at doses of 40 and 60 mg/day was effective as measured by the Hamilton Depression Rating Scale (HAMD) total score, the HAMD depressed mood item (Item 1), the Montgomery Asberg Depression Rating Scale, and the Clinical Global Impression (CGI) Severity scale In study 2, a 4-week, placebo-controlled trial in depressed patients, of whom 85% met criteria for melancholia, the initial dose was 20 mg/day, followed by titration to the maximum tolerated dose or a maximum dose of 80 mg/day

The recommended dosage of Citalopram for treating depression is:

• Initial dose: 20 mg/day
• Effective doses: 40 mg/day and 60 mg/day
• Maximum dose: 80 mg/day (in some studies)
• Maximum recommended dose in patients taking concomitant cimetidine or another CYP2C19 inhibitor: 20 mg/day
• Maximum recommended dose for hepatically impaired patients: 20 mg/day 2 2 2

From the Research

Citalopram Dosage for Treating Depression

The recommended dosage of Citalopram for treating depression is:

• 20 mg per day, as stated in the study 3
• This dose appears appropriate for most patients, with the option of raising the dose in non-responders, particularly if they have more severe depression

Key Points to Consider

• Citalopram is a selective serotonin reuptake inhibitor (SSRI) with cardiac and neurologic toxicities, as well as the potential for serotonin syndrome 4
• The therapeutic range for Citalopram is 9-200 ng/mL, and doses above this range can lead to severe manifestations, including QTc prolongation, torsades de pointes, and seizures 4
• Citalopram has been shown to be effective in treating depression, with a high degree of selectivity for serotonin reuptake pump 5

Comparison with Other Antidepressants

• The dose equivalence of Citalopram to other antidepressants has been studied, with the following equivalents:

• Fluoxetine 40mg/day is equivalent to Citalopram 20mg/day (not directly stated, but implied from the dose equivalents of other antidepressants) 6
• Escitalopram 18.0mg/day is equivalent to fluoxetine 40mg/day, which is equivalent to Citalopram 20mg/day (not directly stated, but implied from the dose equivalents of other antidepressants) 6

• These dose equivalents can be useful for clinicians when switching antidepressants and for researchers when comparing various antidepressants in their research 6

Long-Term Maintenance Treatment

• Citalopram is used for long-term maintenance treatment to prevent relapse of depression, with a typical dose of 20 mg per day 7
• The clinical effectiveness and cost-effectiveness of continuing on long-term maintenance antidepressants, including Citalopram, is being investigated in the ANTLER trial 7