Tapering Citalopram: Yes, Gradual Discontinuation is Required
You should taper citalopram gradually rather than stopping abruptly to avoid potentially serious discontinuation symptoms. The FDA explicitly warns that "stopping citalopram tablets too quickly may cause serious symptoms including anxiety, irritability, high or low mood, feeling restless or changes in sleep habits, headache, sweating, nausea, dizziness, electric shock-like sensations, shaking, confusion" 1.
Why Tapering is Necessary
Citalopram, like other SSRIs with shorter half-lives, requires gradual tapering to minimize discontinuation symptoms 2. While one older study suggested minimal withdrawal phenomena with citalopram 3, more recent evidence and FDA labeling clearly establish that abrupt discontinuation causes significant problems:
- Discontinuation symptoms are common and can be severe, including both somatic symptoms (dizziness, nausea, fatigue, flu-like symptoms, sensory disturbances) and psychological symptoms (anxiety, irritability, crying spells) 2
- Abrupt cessation can cause sustained hypertension in addition to typical withdrawal symptoms, potentially requiring medical intervention 4
- The FDA mandates discussing tapering with your healthcare provider before stopping citalopram 1
Recommended Tapering Approach
Reduce the dose hyperbolically (by percentage of current dose) rather than linearly, tapering slowly over weeks to months down to very small doses:
- Reduce by 10-25% of the current dose every 1-2 weeks as a starting framework 2
- For patients on citalopram long-term (>1 year), consider slower tapers of 10% per month 5
- Each reduction should be a percentage of the current dose, not the original dose, to prevent disproportionately large final reductions 5
- Taper to doses much lower than minimum therapeutic doses before complete cessation, as hyperbolic tapering reduces serotonin transporter occupancy linearly and minimizes withdrawal 6
Critical Pitfall to Avoid
Never use alternate-day dosing when tapering citalopram. Dosing every other day causes pronounced increases in receptor occupancy variation and dramatically increases withdrawal risk, even at low doses 7. This common practice should be avoided entirely 7.
Managing the Taper
The taper rate must be determined by your tolerance to withdrawal symptoms, not a rigid schedule 5:
- Pauses in the taper are acceptable and often necessary when withdrawal symptoms emerge 5
- If moderate to severe symptoms occur, reinstitute the previous dose and slow the taper rate 2
- Some patients may need tapers extending over many months to avoid debilitating symptoms 5
- Monitor at least monthly during tapering, with more frequent contact during difficult phases 5
When to Seek Additional Support
Consider cognitive-behavioral therapy during the taper, as it increases success rates and helps manage anxiety related to discontinuation 8, 5. If you experience severe or persistent withdrawal symptoms despite slow tapering, consult your healthcare provider about additional supportive strategies or even slower taper rates 2.
Do not attempt to stop citalopram without first discussing a tapering plan with your healthcare provider 1. Misdiagnosing withdrawal symptoms as physical illness or depression relapse can lead to unnecessary testing and treatment 2.