From the FDA Drug Label
If adverse reactions are bothersome, a decrease in dose to 20 mg/day can be considered 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
The time it takes to adjust to a dose decrease of citalopram is not explicitly stated in the drug label. However, it is recommended to decrease the dose gradually rather than abruptly, and to monitor for symptoms. If intolerable symptoms occur, the previously prescribed dose may be resumed and the dose decreased at a more gradual rate 1.
From the Research
Adjusting to a dose decrease of citalopram typically takes about 2-4 weeks for most people. When reducing citalopram dosage, it's essential to do so gradually under medical supervision to minimize withdrawal symptoms. For example, decreasing from 20mg to 10mg daily might be done over several weeks rather than all at once. During this adjustment period, you may experience temporary symptoms such as mild dizziness, irritability, headaches, or sleep disturbances as your body adapts to the lower dose. These symptoms are usually most noticeable in the first 1-2 weeks and gradually improve. The adjustment timeline varies between individuals based on factors like how long you've been taking citalopram, your original dose, how quickly you're tapering, and your individual body chemistry.
Key Considerations
- The most recent and highest quality study on antidepressant discontinuation syndrome suggests that down-titration cannot exclude the chance of ADS, but it is nonetheless warranted in the clinical setting, especially for short half-life and sedative compounds such as paroxetine 2.
- Integrative management with concurrent pharmacotherapy and psychotherapy may minimize the eventual unpleasant effects arising within the discontinuation process.
- Patient-tailored interventions and education should be part of the discontinuation strategy.
Recommendations
- If you're experiencing significant discomfort during the dose reduction, contact your healthcare provider, as they may recommend a more gradual taper schedule.
- The adjustment period reflects the time needed for your brain chemistry to rebalance with the changed serotonin levels from the lower medication dose.
- Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive 3.