Reducing citalopram from 20mg to 10mg? (3 Possibilities)

In this blog post, we are going to answer the question, “What to expect when reducing citalopram from 20mg to 10mg?”. Citalopram is an antidepressant which is used to treat a variety of mental health conditions. 

The dose of this antidepressant is reduced at times and this blog will cover why that happens and what one should expect when the dose is reduced. 

What to expect when reducing citalopram from 20mg to 10mg? 

When your citalopram is reduced from 20mg to 10mg, you can expect:

• Better tolerability 
• Lesser side effects 
• Safe withdrawal 

Better tolerability 

The aim to achieve better tolerability of citalopram is one of the reasons why the dose is reduced. It is recommended to start your treatment from the lowest effective dose in order to ensure safety and Tolerability of citalopram. 

However, you can not stay on the lower dose as it is not usually sufficient enough to counteract the symptoms of your mental health condition. So the dose is eventually increased. This increased dose may not be tolerated by some of the people. 

Experts suggest that some people suffer from unusual side effects when their dose is escalated for the first time. Make sure you immediately report to your healthcare provider if you exhibit any sign of an allergic reaction or any unusual side effect when your dose is increased. 

Lesser side effects 

Your healthcare provider may reduce your citalopram dose from 20mg to 10mg if you suffer from increased side effects. This is because when a person is new to antidepressants, there is no way to predict how his or her body will react to these meds. 

Antidepressants increase the amount of excitatory neurotransmitters to counteract the symptoms of depression. Now this excessive neuronal activity makes people respond in different ways.

If your doctor notices that you’re presented with more side effects at a higher dose, he or she tones it down to give your body more time to adjust to this med at a lower dose. 

This effect is also seen when the dose is increased from 10 mg to 20 mg, after a week or two of the treatment. Some people develop unusual and new side effects when their dose is increased for the first time. 

This results in shifting back to the 10 mg dose, to help provide some relief from the side effects. 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. 

Celexa (Citalopram) is also associated with some serious side effects, which may 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.

Safe withdrawal 

The biggest reason behind dose reduction is citalopram withdrawal. When it’s time to stop using this antidepressant, your doctor slowly starts to taper down your dose every 2 to 3 weeks. 

This time duration depends on a lot of factors including the duration of your treatment with citalopram, the dose from which you’re starting to taper off and the fact that how well you can do with decreased dose of citalopram. 

You probably already know that the treatment with antidepressants can range from a few months to several years. It totally depends on the mental health condition of the one taking it. 

For people who have spent years taking citalopram, it could take up to a few years to successfully taper it off. It is not recommended to stop using citalopram abruptly. 

Abrupt withdrawal of citalopram leads to withdrawal or discontinuation syndrome. When you start taking antidepressant, it increases the amount of serotonin in your body. 

Over time, your body gets used to this increased amount of serotonin. When you suddenly stop using it, it creates an unannounced serotonin deficiency, to which your body reacts in a negative way. You may suffer from the following symptoms:

• Muscle cramps
• Gastrointestinal side effects 
• Headaches
• Emotional stress or constant crying
• Inability to concentrate or think clearly 
• Forgetfulness 
• Awkward behaviour 
• Dizziness and lightheadedness
• Chills
• Feeling suffocated with excessive sweating 
• Insomnia or somnolence 

Why dose tapering is considered crucial to ensure safe withdrawal of citalopram? 

Dose tapering is an important technique for the withdrawal of antidepressants, in a safe and effective manner. Antidepressants are known to produce dependence. 

As we know, SSRIs increase the availability of serotonin. So, if you abruptly stop taking it, your receptors which are dependent on it will start to have a major impact of serotonin deficiency. 

They literally start craving it and as you have stopped taking the medication, they remain deficient in excess serotonin. This leads to withdrawal symptoms. 

This is why dose tapering is important. It is a safe and effective method to withdraw SSRIs. Your healthcare provider simply just reduces the dose of your antidepressant. 

It enables you to start taking medicine in lesser quantities without completely depriving your receptors of serotonin. Half of the dose keeps decreasing gradually over the period of 7 to 8 days. 

After spending a week or two, the med is on its lowest possible dose and now it is considered safe for you to stop using it.

When the reason behind stopping your citalopram is to switch to another antidepressant, make sure you properly follow the instructions of your healthcare professional. 

In some practices, the dose of the first drug is lowered down while the new drug is started, also from the lowest effective dose. At this time period, you’re supposed to take two antidepressants, as you’re tapering one down and starting another. 

Experts believe that this time period could be a bit confusing for some people and they sometimes take more than they should. Make sure to stay on the lowest doses while you’re taking two antidepressants, because high doses can increase the risk of serotonin syndrome. 

It is a condition associated with too much serotonin in your system, which binds excessively to all of its receptors present throughout the body. The increased serotonergic activity causes a number of symptoms which include:

• Excessive sweating 
• Restlessness and fatigue
• Headache, which often feels like your head is pounding
• Changes in blood pressure and/or temperature
• Nausea
• Vomiting
• Diarrhoea
• Bradycardia
• Tremors
• Muscle twitching and muscle pain
• Shivering and goosebumps

Make sure you carefully take the prescribed dose and protect yourself from getting unwanted side effects. 

How long do these withdrawal symptoms last?

Different factors affect the duration of your withdrawal symptoms. One of these factors include the half-life of the drug. Drugs with longer half lives produce withdrawal symptoms for a longer period of time. Half life of citalopram is 30-35 hours. 

Most people experience the first symptoms of withdrawal within one to three days after their last dose. Even if you taper off, you may still experience some symptoms. 

During days four to five, the symptoms may become more intense, depending on the dose you were on and the duration of your therapy. Some people experience dizziness, nausea, shakiness and fever. 

Your symptoms will gradually start to fade away in a week or two. It, too, depends on how your body reacts to this withdrawal. 

It is extremely important to follow your taper schedule vigilantly. It may take longer than you think it should, but it’s important to go slowly, so your brain has enough time to adjust the lowered doses. 

Within a few weeks, it will be safe to stop using your citalopram. Don’t mess up your taper schedule, if you wish to prevent discontinuation syndrome. 

Conclusion 

In this blog, we have discussed what to expect when reducing citalopram from 20 mg to 10 mg. One of the reasons behind dose reduction is the occurrence of side effects on high doses. This results in reduction of dose. 

Most people are subjected to unusual effects when their dose is increased after 2 to 3 weeks of treatment. This could also result in reducing citalopram back to the lower doses to give your body more time to adjust to the medicine before trying to increase your dose again. 

The biggest reason behind dose reduction is citalopram withdrawal. When it’s time to stop using this antidepressant, your doctor slowly starts to taper down your dose every 2 to 3 weeks. 

This practice is crucial to avoid withdrawal or discontinuation syndrome, which is associated with many disturbing symptoms of its own. Make sure you properly follow your doctor’s taper schedule in order to ensure safe withdrawal of citalopram. 

FAQs: reducing citalopram from 20mg to 10mg

How do I reduce citalopram 20 mg?

Your healthcare provider will gradually start taper with 20 mg citalopram if it’s time for you to stop using this antidepressant. It is not recommended to stop using citalopram abruptly or without your doctor’s approval. 

Does 10mg of citalopram do anything?

10mg citalopram is used to treat depression, obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), generalised anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and premenstrual dysphoric disorder (PMDD). 

Can I go from 20mg to 10mg citalopram?

Yes, you can go from 20mg to 10mg if your doctor prescribes it. The dose is reduced because of one of the following reasons:

• Citalopram intolerability 
• Unwanted side effects 
• Citalopram withdrawal 

What is the best way to reduce citalopram?

The best way to reduce citalopram is dose tapering. When it’s time for you to discontinue the treatment with this antidepressant, your healthcare provider will suggest a proper taper schedule in order to ensure safe withdrawal. 

What are the side effects of citalopram 10mg?

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 

How long does citalopram 10mg take to work?

Citalopram may take upto 4 to 6 weeks to start producing noticeable therapeutic results. However, this time duration can vary from person to person. Some people may start to notice differences much earlier than the others. 

References 

• James M. Ferguson, M.D. – SSRI Antidepressant Medications: Adverse Effects and Tolerability https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/
• 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