What to expect when increasing citalopram dose from 20 to 40?

In this blog post, we are going to answer the question, “What to expect when increasing citalopram dose from 20 to 40?”. Citalopram is an antidepressant which is used to treat a variety of mental health conditions. 

In usual practice, the treatment is started with the lowest effective dose. However, the dose is gradually increased to achieve better therapeutic outcomes. This blog will cover what one should expect when citalopram dose is increased. 

What to expect when increasing citalopram dose from 20 to 40? 

When your citalopram dose is increased from 20 mg to 40 mg, you can expect a better therapeutic outcome. The higher dose aims to target your depression more effectively. Doctors do not increase the dose if your current dose provides sufficient therapeutic response. 

In usual practice, the treatment with citalopram is started from the lowest effective dose. This is because it is impossible for the healthcare providers to determine how a newly diagnosed person will respond to the antidepressants. 

Lower doses are easy to manage, especially in case of an allergic reaction, the symptoms associated with it are much less intense as compared to the symptoms of an allergic reaction on a higher dose. Such patients also recover earlier from unusual effects. 

Better therapeutic response is not the only thing that comes with a high dose. You can also experience side effects more pronounced than your previous dose. We all know, no medicine is pure from side effects. 

As now your dose has been increased, you might find an increase in your side effects as well. Antidepressants take time to settle in your body. Give it a few weeks and let your body adjust to the new increased dose. After a few weeks, your symptoms will begin to subside. 

The most common side effect experienced on dose escalation is mood instability. You may feel good one day but extremely depressed the next. It’s just your body trying to adapt to the higher dose. 

What is the clinical significance of citalopram?

Citalopram is used for the treatment of following mental health conditions:

Depression 

Citalopram is used in the treatment of mild to major depression disorder (MDD). It is a state of mind which is concerned with disturbing thoughts, especially about one’s self. 

It is associated with symptoms like hopelessness, tearfulness and emptiness. Depression is caused by the deficiency of excitatory neurotransmitters. 

Citalopram increases the amount of active serotonin to help relieve the symptoms of depression. Serotonin is an excitatory neurotransmitter responsible for modulating mood, cognition, reward, learning, memory, and various other psychological processes. 

Generalised anxiety disorder (GAD) 

Citalopram is also used to treat generalised anxiety disorder. As the name implies, this mental health condition is associated with general worry or anxiety about pretty much everything without having any logical reason. 

People suffering from GAD worry about small matters related to family, friends, relationships, study, work, health, wealth etc. 

Obsessive compulsive disorder (OCD)

Citalopram is used to treat symptoms of OCD. It is a condition characterised by troublesome thoughts that won’t go away, no matter what you do, and a weird urge to do things over and over again. 

Panic attacks 

Overtime, Citalopram has proven to be a suitable treatment option for treating panic attacks. They are sudden, uncontrollable attacks of fear and worry. A patient might unwillingly exaggerate a certain condition and gets frightened, often to the point where he gets attacked by seizures. 

Social anxiety disorder (SAD) 

Citalopram is also used to treat social anxiety disorder. It is a condition in which the patient fears facing crowds or social gatherings, and doesn’t really know how to react among people. 

Post traumatic stress disorder (PTSD)

Citalopram can also be used to treat the symptoms associated with PTSD. It is concerned with extreme psychological symptoms that develop after a disturbing incident, such as death of a loved one or a horrific accident.

Premenstrual dysphoric disorder (PMDD) 

Citalopram is also used to treat premenstrual dysphoric disorder, including symptoms like mood swings, irritability, bloating, and breast tenderness.

What are the recommended doses of Citalopram?

Citalopram is recommended in the following doses:

Depression

For adults: The treatment is usually started from 20 mg/day, taken usually at morning or whatever time is suggested by your healthcare provider. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For elderly people: The treatment usually starts from 10 mg/day. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For children: Dose is suggested by the doctor according to the condition and body weight.

Generalised anxiety disorder (GAD) 

For adults: The treatment is usually started from 20 mg/day, taken usually at morning or whatever time is suggested by your healthcare provider. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For elderly people: The treatment usually starts from 10 mg/day. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For children: Dose is suggested by the doctor according to the condition and body weight.

Obsessive compulsive disorder (OCD) 

For adults: The treatment is usually started from 20 mg/day, taken usually at morning or whatever time is suggested by your healthcare provider. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For elderly people: The treatment usually starts from 10 mg/day. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For children: Dose is suggested by the doctor according to the condition and body weight.

Panic attacks 

For adults: The treatment is usually started from 10 mg/day, taken usually at morning or whatever time is suggested by your healthcare provider. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For elderly people: The treatment usually starts from 10 mg/day. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For children: Dose is suggested by the doctor according to the condition and body weight.

Post traumatic stress disorder (PTSD) 

For adults: The treatment is usually started from 20 mg/day, taken usually at morning or whatever time is suggested by your healthcare provider. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For elderly people: The treatment usually starts from 10 mg/day. However, the dose can be adjusted by the healthcare provider if needed and should not exceed 40 mg/day. 

For children: Dose is suggested by the doctor according to the condition and body weight.

What are the side effects of Citalopram?

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. 

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.

Conclusion 

In this blog, we discussed what one should expect when the doctor increases the citalopram dose from 20mg to 40mg. In usual practice, higher dose is preferred to achieve better therapeutic response. It is a good option for people who tolerate citalopram well but their dose is too low.

When the dose is increased, side effects can get a bit pronounced too, but they remain till your body adjusts to the new increased dose. After that, you begin to settle down on your new dose and hopefully start achieving better outcomes. 

Make sure you only increase your dose if your doctor suggests you. It is not your job to do that on your own. Ensure the proper use and stick to your doctor’s recommendations. Adopt a healthy lifestyle and surely everything will go just fine. 

FAQs: increasing citalopram dose from 20 to 40 

What are the increasing citalopram doses from 20 to 40 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 

How long does an increased dose of citalopram take to work? 

The increased dose may take a week or two to enhance mood stability and help relieve the symptoms associated with your mental health condition. However, increased side effects are also expected and are extremely common when the dose is escalated. 

Several studies also suggest that dose escalation may cause side effects which were not present on the lower dose. Make sure you report your side effects to your healthcare provider and avoid non-adherence. 

What should you expect when your citalopram dose is increased from 20mg to 40mg? 

When your citalopram dose is increased from 10 mg to 20 mg, you can expect a better therapeutic outcome. The higher dose aims to target your depression more effectively. Doctors do not increase the dose if your current dose provides sufficient therapeutic response. You can also experience side effects more pronounced than your previous dose. 

How long does it take for an increase in Celexa to work?

It usually takes 2-3 weeks to start noticing your increased celexa dose. Experts believe that people start exhibiting new side effects when their dose is escalated for the first time. However, these side effects begin to fade away once your body is adjusted to the new increased dose. 

What is the difference between 20mg and 40mg citalopram?

The only difference between 10mg and 20mg citalopram is the amount of active ingredient. They both are used to treat the same mental health conditions.

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