Recommended Dosage and Treatment Protocol for Citalopram (Celexa) in Depression
The recommended initial dosage of citalopram for depression is 20 mg once daily, with a maximum dose of 40 mg/day due to risk of QT prolongation. 1
Initial Dosing and Titration
- Start with 20 mg once daily (morning or evening, with or without food) 1
- If needed, increase to 40 mg/day after at least one week 1
- Do not exceed 40 mg/day as higher doses increase QT prolongation risk and show no additional benefit 1
Special Population Considerations
- Maximum 20 mg/day for:
- Use with caution in severe renal impairment 1
Duration of Treatment
- Acute episodes of depression require several months or longer of sustained therapy 1
- Continue treatment for 4-9 months after achieving satisfactory response for first episode 2
- For patients with 2 or more episodes, longer duration (years to lifelong) may be beneficial 2
Monitoring Protocol
- Begin monitoring within 1-2 weeks of treatment initiation 2
- Assess therapeutic response and adverse effects regularly 2
- If no adequate response within 6-8 weeks, modify treatment 2
- Monitor for QT prolongation, especially at higher doses 1
Discontinuation
- Never stop abruptly - gradual dose reduction is essential 1
- If discontinuation symptoms occur, resume previous dose and taper more slowly 1
- Common discontinuation symptoms include dizziness, sensory disturbances, anxiety, and nausea 1
Efficacy Considerations
- Citalopram has demonstrated effectiveness at 40 mg/day in clinical trials 1
- 60 mg/day showed no additional benefit over 40 mg/day 1
- 10 and 20 mg/day doses showed less clear effects in some studies 1
Common Side Effects to Monitor
- Gastrointestinal: nausea, diarrhea
- Neurological: headache, insomnia, dizziness
- Sexual dysfunction (less common than with paroxetine) 2
- Increased risk for suicide attempts (particularly in first 1-2 months) 2
Important Cautions
- QT prolongation risk increases with doses above 40 mg/day 1
- Drug interactions with MAOIs require 14-day washout period 1
- CYP2C19 inhibitors may increase citalopram levels, requiring dose adjustment 1
- Monitor closely for suicidal thoughts/behaviors, especially in first 1-2 months 2
Citalopram is considered a preferred agent among second-generation antidepressants due to its favorable adverse effect profile 2. No evidence suggests any second-generation antidepressant is more effective than another, so selection is often based on side effect profiles and patient-specific factors 2.