Citalopram (Celexa) for Anxiety: Dosing and Treatment Plan
The recommended dosage of citalopram for anxiety is an initial dose of 20 mg once daily, which can be increased to a maximum of 40 mg daily after at least one week if needed for symptom control. 1
Initial Dosing and Titration
- Start with 20 mg once daily, taken in the morning or evening with or without food 1
- After at least one week, dose can be increased to 40 mg daily if needed 1
- Doses above 40 mg/day are not recommended due to risk of QT prolongation 1
Special Population Considerations
- Maximum dose of 20 mg/day is recommended for:
- Patients over 60 years of age
- Patients with hepatic impairment
- CYP2C19 poor metabolizers
- Patients taking CYP2C19 inhibitors like cimetidine 1
- Use with caution in patients with severe renal impairment 1
Treatment Duration and Monitoring
- A full therapeutic trial requires at least 4-8 weeks to assess efficacy 2
- Typical treatment approach involves increasing dosage in increments of the initial dose every 5-7 days until therapeutic benefits or significant side effects appear 2
- After 9 months, consider dosage reduction to reassess the need for continued medication 2
- If adverse reactions are bothersome, a decrease to 20 mg/day can be considered 1
Efficacy for Anxiety Disorders
Studies have demonstrated citalopram's effectiveness for various anxiety disorders:
- In generalized anxiety disorder (GAD), citalopram at a mean dose of 33 mg/day (range 10-60 mg/day) showed significant improvement in anxiety symptoms after 12 weeks 3
- For social anxiety disorder with comorbid depression, citalopram at a mean dose of 37.6 mg/day showed response rates of 66.7% for social anxiety symptoms 4
Side Effects and Management
Common side effects include:
Patients should be monitored closely during the first 2-4 weeks for:
- Behavioral activation or agitation
- Suicidal ideation (particularly in younger patients)
- Initial anxiety symptoms 5
Discontinuation
- Abrupt discontinuation should be avoided to prevent withdrawal symptoms 1
- A gradual reduction in dose rather than abrupt cessation is recommended 1
- If intolerable symptoms occur during discontinuation, resuming the previously prescribed dose may be considered before continuing with a more gradual taper 1
Important Precautions
- Allow at least 14 days between discontinuing an MAOI and starting citalopram 1
- Monitor for signs of serotonin syndrome when combining with other serotonergic medications 5
- For pregnant women, carefully consider risks and benefits, especially during the third trimester 1
Citalopram is well-tolerated and effective for anxiety disorders, with clinical improvement often beginning within 1-2 weeks, though full therapeutic effect may take 4-8 weeks to develop.