Switching from Citalopram (Celexa) to Sertraline (Zoloft)
You should gradually taper off citalopram over 10-14 days before starting sertraline to minimize withdrawal symptoms. 1
Safe Switching Process
- Discontinuing an antidepressant abruptly can lead to withdrawal symptoms including anxiety, irritability, mood changes, headache, dizziness, electric shock-like sensations, insomnia, and sensory disturbances 1, 2
- A discontinuation syndrome is particularly associated with shorter-acting SSRIs like citalopram and sertraline 1
- The recommended approach is to taper citalopram over 10-14 days before starting sertraline 1
Withdrawal Considerations
- Citalopram withdrawal symptoms may include:
- Anxiety, irritability, mood changes
- Headache, dizziness, electric shock-like sensations
- Insomnia, nausea, sweating 2
- These symptoms typically emerge within the first few days after stopping or reducing the dose 1
- Tapering reduces the risk and severity of these symptoms 1, 2
Starting Sertraline
- After completing the citalopram taper, start sertraline at a low dose (typically 25-50 mg per day) 1
- Sertraline is well tolerated and has less effect on the metabolism of other medications compared to other SSRIs 1
- The dose can be increased gradually as needed, with typical therapeutic doses ranging from 50-200 mg daily 1, 3
- Consider starting with a subtherapeutic "test" dose if you're concerned about initial anxiety or agitation 1
Potential Side Effects When Switching
- Initial side effects of sertraline may include:
- Nausea, diarrhea, loss of appetite
- Sleep disturbances
- Increased sweating
- Sexual problems
- Tremor or shaking 3
- Most side effects are temporary and improve within a few weeks 3
Important Precautions
- Never take both medications at full doses simultaneously due to risk of serotonin syndrome 1, 3
- Do not take sertraline if you've taken a monoamine oxidase inhibitor (MAOI) in the past 2 weeks 3
- Inform your healthcare provider about all other medications you're taking, as sertraline may interact with:
- Other antidepressants
- Migraine medications (triptans)
- Blood thinners
- NSAIDs 3
Follow-up Recommendations
- Monitor for both withdrawal symptoms from citalopram and side effects from sertraline 1
- Schedule a follow-up appointment within 1-2 weeks of starting sertraline 1
- Report any concerning symptoms such as increased anxiety, agitation, or suicidal thoughts immediately 3
- Allow 4-6 weeks to evaluate the full effectiveness of sertraline 1
Remember that both citalopram and sertraline are effective SSRIs, but individual responses vary. The switch should be supervised by a healthcare provider who can adjust the tapering and starting doses based on your specific situation.