Citalopram (Celexa) Tapering Schedule
The recommended tapering schedule for citalopram (Celexa) is a gradual reduction of 10% of the previous dose every 2-4 weeks to minimize withdrawal symptoms and prevent relapse. 1, 2
Recommended Tapering Protocol
- Begin with a 10% reduction of the previous dose every 2-4 weeks 1, 3
- For patients on long-term citalopram therapy (years), slower tapers of 10% per month or less are more appropriate 1, 4
- The FDA label specifically states: "A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible" 2
- Monitor for withdrawal symptoms after each dose reduction before proceeding to the next step 1
Tapering Strategy Example
- For a patient on 40mg daily dose: 1
- First reduction: 36mg daily (10% reduction)
- Second reduction: 32.4mg daily (10% of 36mg)
- Continue with 10% reductions of each new dose
- As doses become smaller, the absolute reductions also become smaller (hyperbolic tapering) 3, 5
- For patients on the lowest available tablet strength (10mg), consider alternate-day dosing in the final stages of tapering 1, 6
Scientific Rationale for Slow Tapering
- PET imaging data shows that hyperbolic dose reductions of SSRIs produce a more linear decrease in serotonin transporter inhibition 3
- Tapering too quickly can lead to withdrawal symptoms that may be mistaken for depression recurrence 3
- Studies show that traditional short tapers (2-4 weeks) provide minimal benefits over abrupt discontinuation 3
- Longer tapers over months have shown greater success in reducing withdrawal symptoms 3, 6
Managing Withdrawal Symptoms
- Common withdrawal symptoms include dizziness, nausea, headache, paresthesia, irritability, anxiety, and insomnia 1
- If withdrawal symptoms become severe, return to the previous well-tolerated dose and slow the taper further 1
- Use adjunctive medications to manage specific withdrawal symptoms if they occur 1
- For insomnia: short-term use of non-benzodiazepine sleep aids may be beneficial 7
Common Pitfalls to Avoid
- Avoid tapering too quickly (less than 10% reduction every 2-4 weeks) 1, 3
- Never abruptly discontinue citalopram except in cases of serious medical toxicity 2
- Avoid setting arbitrary time limits for completing the taper; individualize based on patient response 1, 4
- Don't mistake withdrawal symptoms for recurrence of depression 3
Special Considerations
- Patients who have been on citalopram for years require much slower tapers than those on short-term therapy 1, 4
- Consider cognitive-behavioral therapy during tapering to improve success rates 8
- Final doses before complete cessation may need to be very small to prevent a large decrease in serotonin transporter inhibition 3, 5
- Tapering strips (where available) can facilitate precise dose reductions and have shown 72% success rates in antidepressant discontinuation 6