What is the recommended dosage reduction schedule to taper off Celexa (citalopram)?

Tapering Celexa (Citalopram): Recommended Approach

Gradually reduce citalopram by 25% of your current dose every 1-2 weeks, continuing this pattern down to very small doses before complete discontinuation, rather than stopping at the FDA's minimum therapeutic dose of 20 mg. 1, 2

FDA-Approved Tapering Guidance

The FDA label for citalopram explicitly states: "A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate." 1

Practical Tapering Protocol

Standard Reduction Schedule

• Reduce by 25% of your current dose every 1-2 weeks (not 25% of the original dose), which prevents disproportionately large reductions at the end of the taper 2
• For example, if starting at 40 mg daily:
  • Weeks 1-2: Reduce to 30 mg (25% reduction)
  • Weeks 3-4: Reduce to 22.5 mg (25% of current dose)
  • Weeks 5-6: Reduce to 17 mg (25% of current dose)
  • Continue this pattern 2

Extended Tapering for Long-Term Users

• If you've been on citalopram for more than 1 year, consider reducing by only 10% of your current dose per month rather than the faster 25% every 1-2 weeks 2
• This slower approach significantly reduces withdrawal symptoms and relapse risk 3, 4

Critical Considerations About Final Doses

Do not stop at 20 mg and then discontinue abruptly. The hyperbolic relationship between SSRI doses and serotonin transporter occupancy means that stopping from even "low" therapeutic doses causes a large drop in receptor effects, triggering withdrawal symptoms. 3

• Taper down to doses much lower than the 20 mg minimum therapeutic dose - potentially as low as 2.5-5 mg or even lower before complete cessation 3
• Once you reach the smallest available tablet (10 mg), you can either:
  • Cut tablets into smaller pieces (quarters = 2.5 mg)
  • Switch to taking 10 mg every other day for 1-2 weeks before stopping 5
  • Extend the interval between doses before complete discontinuation 2

Timeline Expectations

• Plan for a minimum of 6-12 months for the complete taper, possibly longer depending on your duration of use and tolerance 2
• The goal is durability of the taper, not speed 2
• Pauses in the taper are acceptable and often necessary when withdrawal symptoms emerge 2

Monitoring and Managing Withdrawal Symptoms

• Common withdrawal symptoms include: anxiety, dizziness, sensory disturbances, tremor, insomnia, sweating, headache, nausea, and confusion 2, 6
• These symptoms often occur in the final stages of tapering and should not automatically be interpreted as depression relapse 6
• Follow up at least monthly during the taper, with more frequent contact during difficult phases 2

When Withdrawal Symptoms Occur

• If intolerable symptoms develop, return to the previous dose that was tolerated, then resume tapering at a slower rate 1
• The taper rate must be determined by your tolerance, not a rigid schedule 2

Special Populations

• Patients over 60 years: The FDA recommends a maximum dose of 20 mg/day, so start your taper from this lower dose if applicable 1
• Patients with hepatic impairment or taking CYP2C19 inhibitors: Same 20 mg maximum applies 1

Critical Pitfalls to Avoid

• Never discontinue abruptly - this is equivalent to suddenly stopping blood pressure or diabetes medications and can cause severe withdrawal 2
• Never taper too quickly - research shows even 10% reductions every 3 days resulted in only 24% of patients successfully completing withdrawal 2
• Don't assume withdrawal symptoms are depression relapse - they are often direct medication withdrawal effects that will resolve with slower tapering 6, 3

Evidence on Relapse Risk

• A 2021 randomized trial found that patients who discontinued antidepressants had a 56% relapse rate at 52 weeks versus 39% who maintained therapy, but this study used relatively rapid discontinuation protocols 4
• Slower, hyperbolic tapering over months to years may minimize relapse risk by allowing neuroadaptations time to resolve 3, 7