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Thread: Weaning off citalopram

  1. #1

    Weaning off citalopram

    I have been on citalopram 20mg for around 11 years. My depression has gone. I do feel general anxiety but i feel i handle it well. I am doing online cbt at the moment. I had a medication review today and discusting with the doctor about lowering my dose. He suggested having 20mg one night then 10mg another night and so on. I was worried this is quite a drop quicker. He suggested 20mg for 3 nights then 10mg for one night then 20mg for 3 nights and so on. Do you think this sounds sensible? I dont want to rush things and feel ill again. Thank you

  2. #2
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    Re: Weaning off citalopram

    Quote Originally Posted by happybunny13 View Post
    I am doing online cbt at the moment.
    Good! To many feel great after a course of antidepressants and decide to quit without having any tools to handle the occasional bad day, or days when they occur and then begin to relapse.

    He suggested 20mg for 3 nights then 10mg for one night then 20mg for 3 nights and so on. Do you think this sounds sensible?
    No. I see what he is trying to do, use the relatively long citalopram half-life to affect a small dose decrease via skipping doses, but the interval back at 20mg is too long. Anyway, I've never been convinced this is the best method anyway. Roller-coasting the dose eventually ends up in roller-coasting anxiety. The only time it could be necessary is for ADs only made in slow-release formulations and even then there are other options for all except duloxetine.

    The trick with weaning off is to do it by small steps at intervals of no earlier than 5 times the half-life of the med, which for citalopram is 8 days. It takes that long for plasma levels to stabilize to a steady-state after a dose decrease (or increase). Cutting back the dose faster may increase the severity of any withdrawal symptoms, but delaying the drop won't significantly reduce them no matter how long the wait. However, there is more to this than chemistry and biology. Psychology is at least as important, some would argue even more important because an anxious mind is very capable of producing far worse symptoms than mere biology, so I suggest waiting a few extra days to build confidence ahead of the next reduction.

    Imho, the best option for citalopram is to drop the dose by 5mg every 10-14 days. This means you will probably need a prescription for either 10mg tablets to cut in half (pill cutters sold by all good pharmacies are more accurate than breaking tablets and much less bloody, ime, than knives), or for citalopram in liquid form, as the shape of many 20mg tablets makes quartering them accurately difficult even with pill cutters.

  3. #3
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    Re: Weaning off citalopram

    Quote Originally Posted by happybunny13 View Post
    i dont think any amount of antidepressents will ever get rid of it completely.
    There probably is an AD that would got a long way to stopping your GAD in its tracks. The problem being it might take quite a while to narrow it down.

    So id like to get down to the lowest mg i can which still allows me to live with a managable level of anxiety.
    While being on the lowest possible dose sounds like a good idea, it may in fact backfire spectacularly. It is important to understand how ADs work. The meds themselves have no intrinsic anti anxiety/depression affect in the way say aspirin and benzodiazepines do. Anxiety and depression are symptoms of the physical loss of brain cells in a region of the two hippocampi caused by high brain stress hormone levels, mostly cortisol. Essentially, this is a form of auto immune disorder. Antidepressants - and also therapy, plus to a lesser degree exercise and Omega-3/fish oil supplements - turbo charge the growth of new cells (neurogenesis). They, and the stronger interconnects they forge produce the therapeutic response, not the AD directly.

    The problem with taking sub/borderline therapeutic doses is neurogenesis may be interrupted whenever the antidepressant plasma levels drop below the amount needed to sustain it which could then lead to the second issue, the growing evidence antidepressants become progressively less effective every time they are stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Amsterdam JD, 2009; Leykin Y, 2007). This applies whether returning to a previously taken antidepressant or a different one. Taking a sub/borderline therapeutic dose for months may create a similar situation as stopping and restarting it as plasma levels sometimes drop below that required to sustain neurogenesis. While the interruptions may only be of short duration, they will probably occur much more frequently. For citalopram I'd be wary of dropping below 20mg/day. You might get away with 15mg, but there is no way of knowing if it sustains neurogenesis continually.

  4. #4

    Re: Weaning off citalopram

    Thank you for your reply and knowledge. I feel i just want to be off them some time in the future. I know the longer i am on them the harder it is going to be to get off of them. Every year passes is another year on antidepressents. They have helped me but sometimes i wonder the side effects dont help my anxiety. They make me feel kind of Dreamy not in the moment.

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    Re: Weaning off citalopram

    Quote Originally Posted by happybunny13 View Post
    Every year passes is another year on antidepressents. They have helped me but sometimes i wonder
    There is little evidence that taking ADs for decades does any harm, and some that they can reduce the risk of dementia and heart attacks, even some Cancers. I've been taking ADs pretty much continually for over 30 years.

    the side effects dont help my anxiety. They make me feel kind of Dreamy not in the moment.
    Switching to another SSRI may diminish this side-effect. If that's something you want to pursue then I suggest trying escitalopram. They are virtually the same drug, escitalopram is just a more refined version of citalopram, but there can be differences in the side-effects experienced. Because of the close chemistry there are usually no issues when switching to equivalent doses of one to the other.

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