Can mirtazapine be abruptly discontinued and replaced with citalopram?

From the FDA Drug Label

Patients currently taking mirtazapine should NOT discontinue treatment abruptly, due to risk of discontinuation symptoms At the time that a medical decision is made to discontinue treatment with mirtazapine, a gradual reduction in the dose, rather than an abrupt cessation, is recommended A gradual reduction in the dose over several weeks, rather than abrupt cessation, is recommended whenever possible

Mirtazapine should not be abruptly discontinued. To replace mirtazapine with citalopram, a gradual reduction in the dose of mirtazapine over several weeks is recommended, followed by the initiation of citalopram. This approach minimizes the risk of discontinuation symptoms associated with mirtazapine 1 1.

From the Research

Discontinuation of Mirtazapine

• Mirtazapine should not be abruptly discontinued due to the risk of withdrawal symptoms, as illustrated by a case report where a patient experienced recurrent panic attacks after sudden discontinuation of mirtazapine treatment 2.
• Abrupt withdrawal of mirtazapine can lead to symptoms such as palpitations, dyspnea, retro-sternal pain, dizziness, and nausea, and it is advisable to progressively taper off the medication, even after a medium-long therapy period 2.
• Gradually tapering off medicines that act on the central nervous system, such as psychotropic drugs, is necessary to avoid rebound effects or withdrawal symptoms 3.

Replacement with Citalopram

• There is no direct evidence to suggest that mirtazapine can be abruptly discontinued and replaced with citalopram without risking withdrawal symptoms.
• Studies have compared the efficacy and tolerability of mirtazapine and citalopram in the treatment of major depressive disorder, with results indicating that both treatments are effective, but mirtazapine may have a faster onset of efficacy 4, 5.
• When switching from one antidepressant to another, it is essential to consider the potential for interactions and to taper off the first medication gradually to minimize the risk of withdrawal symptoms 3.