Risks of Abruptly Stopping Citalopram
Abruptly stopping citalopram is dangerous and can lead to significant withdrawal symptoms including dizziness, anxiety, sensory disturbances, and potentially serious cardiovascular effects. All SSRIs, including citalopram, should be slowly tapered when discontinued to minimize withdrawal effects.
Withdrawal Symptoms
Abrupt discontinuation of citalopram can cause various withdrawal symptoms:
- Neurological symptoms: dizziness, sensory disturbances (electric shock-like sensations), paresthesias, vertigo, and confusion or trouble concentrating 1, 2
- Psychological symptoms: anxiety, irritability, agitation, emotional lability, and mood changes 2
- Physical symptoms: headache, nausea, vomiting, lethargy, fatigue, muscle tension, chills, sweating, and insomnia 2, 3
- Cardiovascular effects: In rare cases, new onset hypertension has been reported following abrupt discontinuation 4
Severity and Duration
The severity and likelihood of withdrawal symptoms depend on several factors:
- Higher doses of citalopram are associated with more severe withdrawal symptoms 3
- Higher plasma concentrations increase the risk of withdrawal syndrome 3
- Symptoms typically begin within 1-3 days after discontinuation 5
- While many symptoms are mild to moderate, they can be severe enough to impair daily functioning 2
- Symptoms may persist for weeks in some cases, though most are self-limiting 2, 6
Specific Risks
Abrupt discontinuation carries several specific risks:
- Cardiovascular risks: Potential for blood pressure fluctuations and cardiovascular effects 4
- Neurological risks: Sensory disturbances, dizziness, and balance problems that may increase fall risk 2
- Psychological risks: Rebound anxiety, irritability, and mood disturbances that may be mistaken for relapse of depression 5
- Sexual dysfunction: Unusual sexual side effects such as premature ejaculation have been reported during withdrawal 7
Proper Discontinuation Approach
To minimize risks when stopping citalopram:
- A gradual taper is strongly recommended rather than abrupt cessation 2
- The FDA label specifically states: "A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible" 2
- For patients with risk factors (previous withdrawal symptoms, higher doses, or longer treatment duration), consider a more gradual taper with non-linear dose reduction steps 6
- Monitor closely for withdrawal symptoms during the tapering process 2
- If withdrawal symptoms emerge during tapering, slow the taper rate or temporarily return to a previous dose 6
High-Risk Scenarios
Some situations increase the risk of severe withdrawal effects:
- Patients on higher doses of citalopram (e.g., 40-60mg daily) 3
- Those with a history of withdrawal symptoms when missing doses 6
- Patients with cardiovascular conditions may be at higher risk for blood pressure fluctuations 4
- Those with a history of anxiety disorders may experience more pronounced psychological withdrawal symptoms 2
Conclusion
The evidence clearly demonstrates that abrupt discontinuation of citalopram poses significant risks. Proper tapering under medical supervision is essential to minimize withdrawal symptoms and prevent potential complications. If a patient has already abruptly discontinued citalopram and is experiencing withdrawal symptoms, resuming the previously prescribed dose and implementing a proper tapering schedule may be necessary 2.