Can you switch from 10mg citalopram to 50mg sertraline?

This blog post will answer the question, “Can you switch from 10mg citalopram to 50mg sertraline?”. Citalopram is an antidepressant which is used to treat a variety of mental health conditions. Sertraline, on the other hand, is also an antidepressant. 

This blog will cover why you should, if at all, switch from citalopram to sertraline. We  will also discuss the reasons which lead to the discontinuation of citalopram. 

Can you switch from 10mg citalopram to 50mg sertraline?

Yes, you can switch from 10mg citalopram to 50mg sertraline if your healthcare provider suggests you switch. It is not recommended to switch, stop or change the dose of your antidepressant without your doctor’s approval. 

Both citalopram and sertraline belong to the same class of antidepressants, that is selective serotonin reuptake inhibitors (SSRIs). These drugs inhibit the reuptake of serotonin from the synaptic cleft (space between a neuron and its target cell). 

When the neurons release serotonin, oftentimes there’s some leftover within the synaptic cleft that is retaken by transporters. Citalopram and sertraline basically inhibit these serotonin transporters (SERT) and increase the availability of active serotonin in the body. 

Serotonin is a neurotransmitter (a chemical) released by our brain which is responsible for modulating mood, cognition, reward, learning, memory, and various other psychological processes. 

Both of these meds are approved by the Food and Drug Administration (FDA) to be used in the treatment of mild to severe episodes of depression, including major depressive disorder (MDD). They are used for other mental health conditions as well. These include:

• Generalised anxiety disorder (GAD) 
• Eating disorders
• Dementia
• Panic attacks 
• Post traumatic stress disorder (PTSD) 
• Obsessive compulsive disorder (OCD) 
• Social anxiety disorder or social phobia
• Premenstrual dysphoric disorder (PMDD)

Both of these drugs are either approved or used off-label for the treatment of above-mentioned illnesses. Off-label use indicates that the drug does possess some beneficial effects against the disease but is not approved by the FDA yet. 

Why switching from citalopram to sertraline can be a good idea? 

It is not easy to switch antidepressants. Infact, they should be switched only when necessary. Your doctor might recommend another antidepressant for one of the following reasons:

Citalopram intolerance 

Intolerance is the biggest issue with antidepressants and citalopram may become extremely difficult for some people to bear. It can not only cause an allergic reaction, but also cause side effects that become extremely difficult to manage. Some mental health conditions require years and years of treatment, but is it possible if your antidepressant doesn’t suit you? No. It is impossible to live with a medicine that you can’t tolerate well. Intolerable side effects of citalopram include:

• Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 
• Auditory or visual hallucinations 
• Nose bleeds
• Severe headache
• Arrhythmia or abnormal heartbeats
• Impaired memory and concentration 
• Convulsions 
• Swelling or tenderness in different parts of the body.

The above mentioned side effects can make your journey with citalopram unbearable and it can lead to the discontinuation of treatment with this antidepressant. This is why citalopram is often switched to sertraline. Now, one thing to bear in mind is that it’s not necessary that sertraline will work 100% for you. You may or may not tolerate it well. 

Inadequate therapeutic response 

If your citalopram, or any other antidepressant you might use, is not living up to the expectations and it fails to provide relief from depression symptoms, your doctor might think of increasing the dose of the same antidepressant. 

However, it’s not wise to blame the drug right away and jump to conclusions. Sometimes, it’s the dose that’s not working out for you. If citalopram fails to give an adequate therapeutic response even at high doses (even highest), now it’s time to switch.

Your doctor will prescribe another antidepressant and follow proper switching strategy. 

Note: Dose escalation is a tricky process and should be done only by your doctor. You are not authorised to reduce or escalate your dose on your own. Make sure you ask your healthcare provider if you think your dose is too high or too low.

Drug interactions

If your citalopram is interfering with the effects or metabolism of some other medicines that you are taking along with it, it’s best to switch to another antidepressant, like sertraline, that’s safe to use with your other prescribed medications. 

Side effects of citalopram

If your citalopram is producing side effects which are not going away, even after 3 to 4 weeks of your treatment, you might need to change it. Your antidepressant should be well tolerated as you have to live with it everyday, for several months or even longer. 

Common side effects of citalopram include:

• Nausea 
• Vomiting 
• Diarrhoea or Constipation 
• Acid reflux or heartburn 
• Abdominal pain 
• Loss of appetite 
• Weight gain or loss 
• Excessive sweating or night sweating (nocturnal/night hyperhidrosis) 
• Frequent urination 
• Polydipsia or excessive thirst
• Tremors 
• Muscle twitching and pain
• Drowsiness 
• Dizziness 
• Excessive tiredness or fatigue 
• Insomnia or inability to fall asleep 
• Xerostomia or dry mouth 
• Dysmenorrhea or heavy periods
• Flu like symptoms including irritation in eyes and runny nose
• Loss of libido in both male and females. Males may suffer from inability to release, while females may suffer from inability to have a climactic experience. 

What are the important points to keep in mind when you switch your antidepressant? 

There are few things you need to understand before you switch from citalopram to sertraline. These include:

Your new antidepressant might take a few weeks to work

The new drug will not start working overnight. Your body will take its time to adapt to sertraline. Be patient. Don’t lose hope or think that no antidepressant is working for you. Just give it a few weeks, be consistent and maintain a healthy lifestyle. 

You may suffer from side effects 

Sertraline may produce some unwanted side effects at first, but as your body gets used to it, they will begin to subside. So don’t think that your new med doesn’t suit you, it’s just your body adapting to it. Hang in there! 

Common side effects of sertraline include:

• Loss of appetite
• Tiredness
• Feeling angry or agitated
• Weight gain
• Inability to digest food
• Nausea
• Diarrhoea
• Loss of libido
• Sweating/Night sweats
• Tremors or shaking
• Insomnia
• Decreased sex drive
• Impotence
• Inability to release

You may experience withdrawal symptoms

In case of completely washing out the citalopram, you might face withdrawal symptoms. The best way is to taper down citalopram slowly while starting sertraline from the lowest effective dose. 

This can be done because both of these meds belong to the same class of antidepressants, that is selective serotonin reuptake inhibitors (SSRIs). 

How to determine the best switching strategy? 

When we specifically talk about citalopram and sertraline, they both belong to the same class of antidepressants so they can be switched easily. 

The best switching strategy is determined according to the severity of your symptoms and the reason which led to the discontinuation of the first drug. Common switching strategies include:

• Direct switch: Here, you stop one antidepressant and directly switch to another. This strategy is only applicable if you’re switching to a drug which belongs to the same class of antidepressants.

• Cross taper: Here, you taper off one antidepressant while gradually increasing the dose of the next one, over a few weeks period. 

• Taper and switch right away: Here, you gradually taper off your current drug. As soon as you have completely stopped the first drug, you start taking the next one. 

• Taper and switch, after washing out the first drug completely: Here, you gradually taper off the first drug and wait a couple of weeks, usually 1-6 weeks, for your body to completely wash out the drug from your system, even traces.

In case of switching from citalopram to sertraline, you can try either direct switch or cross taper. It is not recommended to cross taper if citalopram is causing terrible side effects. 

Such people are already suffering from enough side effects and discomfort, it is not suitable to start another antidepressant with citalopram, no matter how low the dose is. Your healthcare provider will closely study your condition and determine the best switching strategy for you.

Conclusion 

In this blog post, we have discussed switching from 10mg citalopram to 50mg sertraline. Both citalopram and sertraline belong to the same class of antidepressants, that is selective serotonin reuptake inhibitors (SSRIs). 

It is easy to switch from one antidepressant to another which belongs to the same class. Your doctor may recommend switching to another antidepressant, if the current one doesn’t work best for you. It usually takes a few trials to determine which antidepressant works best for you. 

Just stick to your doctor’s advice and do not deviate from it. Make sure you don’t stop or start using any medication without your doctor’s approval.

FAQs: 10mg citalopram to 50mg sertraline

Can I change from citalopram to sertraline?

Yes, you can switch from citalopram to sertraline if your healthcare provider suggests you switch. It is not recommended to switch, stop or change the dose of your antidepressant without your doctor’s approval. Both citalopram and sertraline belong to the same class of antidepressants, that is selective serotonin reuptake inhibitors (SSRIs). 

Is 50 mg sertraline enough for anxiety?

Sertraline 50mg per day is considered as the starting dose for most of the patients. According to study, it is tolerated well. The strong dose of sertraline is 200mg. If you don’t do well on 50mg, your doctor may reduce your dose to help your body adjust to the med and then will increase the dose again.

Does 10mg of citalopram do anything?

10 mg citalopram is used for the treatment of depression, generalised anxiety disorder (GAD), post traumatic stress disorder (PTSD), panic attacks, eating disorder and premenstrual dysphoric disorder (PMDD).

Is citalopram better tolerated than sertraline?

Both citalopram and sertraline belong to the same class of antidepressants, that is selective serotonin reuptake inhibitors (SSRIs) and works by inhibiting the reuptake of serotonin. Several studies have indicated that citalopram and escitalopram can be considered the safest SSRIs and can be tolerated better than sertraline, paroxetine and fluoxetine. 

Can you just switch from citalopram to sertraline?

The best switching strategy is recommended by your doctor. In usual practice, direct switch is preferred only after a short duration of treatment with citalopram and it doesn’t seem to work that well for you. 

If you are switching after months or years of taking citalopram, it is not recommended to just stop and switch. You need to taper celexa down and start sertraline from the lowest effective dose. 

How do you know when to switch antidepressants?

Your healthcare provider may switch your antidepressant if your current antidepressant:

• Doesn’t suit you
• Cause side effects 
• Fails to provide adequate therapeutic response. 

References

• Antidepressant switching guidelines (1998) https://www.nps.org.au/assets/Products/Guidelines-switching-antidepressants_A3.pdf 
• Nicholas Keks, Director and Adjunct professor, Judy Hope, Deputy director and Senior lecturer, and Simone Keogh, Psychiatrist and senior fellow – Switching and stopping antidepressants https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919171/
• Nazila Sharbaf – Citalopram https://pubmed.ncbi.nlm.nih.gov/29489221/
• Sertraline 50 mg Tablets – Lupin Healthcare (UK) Ltd https://www.medicines.org.uk/emc/product/7162/smpc#gref
• C Lindsay DeVane et al. Clin Pharmacokinet. 2002. – Clinical pharmacokinetics of sertraline https://pubmed.ncbi.nlm.nih.gov/12452737/
• Celexa – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-8603/celexa-oral/details
• Citalopram (Oral Route) https://www.mayoclinic.org/drugs-supplements/citalopram-oral-route/description/drg-20062980