Reducing citalopram advice

[DulwichHamlet]

Just wondering if anyone has any advice for dealing with reducing citalopram?

Had an appt yesterday and my GP wants to bring me off citalopram over the next few weeks in order to move me onto another medication (venlafaxine). I've been taking 20mg daily for the past few years; my doc has suggested I go to 20 mg one day then 10mg the next for the next 7-10 days, followed by 10mg each day for 7-10 days after that, before going onto 10mg every other day for the final 7-10 days.

I live with a good friend who's going away for a week and she's suggested maybe I should wait until she's back before I start reducing my dose, just in case it makes me feel awful. On the one hand I don't want to be feeling awful while I'm in the house by myself for a week, on the other hand I'm quite keen to start moving toward trying the new medication as soon as I can as citalopram seems to have lost all effectiveness.

[Victory2016]

Regardless of how you taper you are probably going to endure some withdrawal symptoms. I don't agree with the every other day tapering. I would personally would want to go to 15, 10 and then 5 staying at each dose for 7-10 days.

I guess the question is why do you need to taper? Can't you just switch right over to the new med?

[DulwichHamlet]

Regardless of how you taper you are probably going to endure some withdrawal symptoms. I don't agree with the every other day tapering. I would personally would want to go to 15, 10 and then 5 staying at each dose for 7-10 days.

I guess the question is why do you need to taper? Can't you just switch right over to the new med?

Thanks for the reply. At the moment I'm thinking that if past experience is anything to go by it'll probably be a week or so before I start feeling any difference from adjusting the dose anyway so I'll probably start the tapering now in the interests of getting things moving.

I'd imagine the GP's gone for it that way because I'm in the UK and it's easier/quicker for pharmacies to dispense the 20mg/10mg tablets than 5mg ones.

I wondered about the tapering as well but the GP said that a) I've been on Citalopram for so many years that it would be safer to taper and b) the new med, venlafaxine, is a different class of medication and the official guidelines are that citalopram should be tapered off first.

[MyNameIsTerry]

Here are the official guidelines:

http://www.gpnotebook.co.uk/simplepage.cfm?ID=1651179592

Your GP should be stopping Cit one day and introducing Ven at a slightly lower dose than normal. This is because Ven has such a short half life. Ven reaches steady state in your blood plasma in 3 days whereas Cit takes about a week.

Your GP is approaching this as if you are withdrawing totally rather than switching.

I don't know what guidelines your GP thinks they are following but the one I have posted can be seen being issued by many local NHS trusts as well as in national guidelines.

Even with a total withdrawal, this "rocking" style isn't supported by Rpsych either. And I agree with Victory, I don't agree with it. The professionals, including MIND, advocate tapering with pill cutting. This is fine with Cit. Sadly there is no official NHS guideline on this so GP's may not want to stick their neck out but that scoreline down the middle of the pill denotes the manufacturer saying you can split it because the med is homogenised. Germany do it, so do many HMO's in the US.

It would probably be easy enough to find your local trust guidelines via Google, I've seen many of them online stating to use the above guidelines.

They won't prescribe you the 5mg because the drug companies have set the price much higher than the other doses. They don't want to sell that dosage.

Whilst Ven is a different class, it only works as a SSRI until you reach it's norepinephrine threshold of 150mg. So, the official guidelines allow for an overlap of Serotonin treatment that can help to make the process easier. When you hot the threshold, different side effects can come into play as I learned with my SNRI, Duloxetine, which kicks in at 60mg. The difference with mine is that 60mg is the starting dose (taper to it by starting on 30mg if GAD first) whereas with Ven it can be used as a SSRI as you may not need to go that high.

Keep your Ven doses at strict times and don't miss a dose if you are taking the standard release because missing a dose can mean almost a cold turkey by the time the next one comes around. The Ven XL/MR gets around this as it's a sustained release version but it costs a bit more.

[DulwichHamlet]

Thanks for the detailed response and for the link. Had a look on that site (which I seem to remember my GP using when I saw her) and their recommendation for going from Cit to Ven is: "withdraw and then start venlafaxine at 37.5 mg per day. Increase very slowly" which to me looks to be what my GP is doing, unless I've misunderstood some of the terms. I don't know whether she's planning on starting me on the ven while I'm still on the 10mg or what, I guess I'll see when my next appt comes up, in three weeks' time. I had big problems with side effects when she increased my citalopram dosage before, which has now been decreased, so maybe she's being cautious because of that.

I did say to my GP that as I've got like 2 months' worth of citalopram I could just cut some of them in half for the 10mg rather than getting 10mg prescribed but she wasn't keen on that and said I should go with the prepackaged 10mg tablets.

My main issues seem to be with OCD and GAD - I feel depressed too, but I feel reasonably confident in saying the depression is a product of the other two things. I was a little surprised at being prescribed venlafaxine, as it doesn't seem to be mentioned much in the official guidelines for OCD but it seems like people with OCD quite commonly get prescribed ven if googling is anything to go by. It seems like clonipramine is what's normally recommended if SSRIs aren't working but I'm trusting my GP knows what she's doing.

[DulwichHamlet]

So it's just under a week since I started reducing... feeling pretty awful. I went out at the weekend and drank and I'm really regretting it now, felt anxious and low all day yesterday and feeling the same today. Really not looking forward to another 2 weeks of this before I can start the new stuff.

[DulwichHamlet]

Another day feeling really anxious today. Does anyone think it's worth asking to see my doctor again? I'm not suicidal or anything but I'm feeling very low and anxious and I'm kind of scared of dealing with the next 2 weeks like this.