Weaning Protocol for Citalopram (Celexa)

The recommended protocol for weaning off Celexa (citalopram) is a gradual reduction in dose over 10 to 14 days to limit withdrawal symptoms. 1

General Tapering Principles

Abrupt discontinuation of citalopram should be avoided as it may cause withdrawal symptoms; a gradual reduction in dose rather than abrupt cessation is recommended whenever possible 2
The standard tapering period for antidepressants is 10-14 days, which helps limit withdrawal symptoms while ensuring safe discontinuation 1
If intolerable symptoms occur during dose reduction, resuming the previously prescribed dose may be considered, followed by continuing the taper at a more gradual rate 2

For patients on standard doses (20-40 mg/day), reduce the dose by approximately 10-20% every 2-4 days 1, 2
A common approach is to decrease from 40 mg to 30 mg, then to 20 mg, then to 10 mg, and finally to discontinuation, with each step lasting 3-4 days 2
For patients on the maximum dose of 40 mg/day, a more conservative approach may be needed with smaller incremental reductions 2
For elderly patients (>60 years) who are typically on lower doses (maximum 20 mg/day), even more gradual tapering may be appropriate 2

Monitor for withdrawal symptoms which may include dizziness, nausea, headache, paresthesia, irritability, anxiety, and sleep disturbances 1
If withdrawal symptoms become severe or intolerable, slow the tapering schedule by making smaller reductions or extending the time between dose decreases 2
Patients with a history of severe depression may need closer monitoring during the tapering process to watch for signs of relapse 1

Patients who have been on citalopram for longer periods (months to years) may require a more extended tapering schedule than the standard 10-14 days 1
Those with a history of antidepressant discontinuation syndrome may benefit from an even more gradual taper 1
For patients with comorbid anxiety disorders, a slower taper may be necessary to prevent exacerbation of anxiety symptoms 1

Common withdrawal symptoms include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal 1
These symptoms typically begin within 1-3 days of dose reduction and may last 1-2 weeks 1
Distinguishing between withdrawal symptoms and depression recurrence is important - withdrawal symptoms typically emerge quickly after dose reduction and diminish over time, while recurrence develops more gradually and persists 1

If severe withdrawal symptoms occur despite a gradual taper, consult with a healthcare provider about adjusting the tapering schedule 2
If signs of depression recurrence emerge (persistent low mood, anhedonia, changes in sleep/appetite lasting more than two weeks), prompt medical evaluation is needed 1
Suicidal thoughts or severe mood disturbances during tapering warrant immediate medical attention 1