by Neil Bauman, Ph.D.
November 6, 2016
A man explained,
I was on Citalopram for 2 years and had no noticeable side effects—no tinnitus. I’ve never had tinnitus other than in my younger days for a few hours after going to a nightclub!
Three months ago I thought I was ready to come off. Having discussed with my doctor, I did this slowly over 3 weeks. At the end I developed tinnitus and a strange “brain zap”.
I can only describe this as a pulse that races inside from the top of the head to the neck, maybe down one arm, maybe both or maybe down the spine as well.
I also got extremely and undeservedly irritable when I came off, so I went back on slowly building the dose back up. As soon as I started taking it again, the symptoms went.
Due to other problems, my doctor has switched me to another SSRI. Again, I gradually reduced the dose and now tinnitus and brain zaps are back. Also very irritable/angry for the first few days after stopping.
The tinnitus is mild and only really noticeable when sitting quietly. The brain zaps are intermittent but constant. Not debilitating but very aggravating.
This is not looking good. What has this drug done to me?
When you try to come off Citalopram too fast you open yourself up to all sorts of side effects including “irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache” among other things. (1)
Besides your tinnitus, you are specifically experiencing three of the above-mentioned side effects, namely irritability, agitation and paresthesias (abnormal sensations typically tingling or pricking) such as the electric shock sensations you are experiencing that you describe as “brain zaps”.
These are all indications that you tapered off the Citalopram much too fast. This stems from the fact that you thought you were doing a slow taper over 3 weeks. However, in actual fact, you did a very fast taper. A slow taper would take you somewhere between a year and 4 years to complete.
You are also fortunate that you only got tinnitus when you tried to get off the Citalopram. A good number of people get tinnitus soon after they start taking this drug. And for many of them, their loud tinnitus never goes away. I have received more anecdotal reports of side effects (mostly of tinnitus) from people taking Citalopram than for almost any other drug. That’s how common tinnitus is from taking Citalopram.
The Royal College of Psychiatrists recommends that you reduce slowly. Unfortunately, their idea of slowly is this: “if treatment has lasted less than 8 weeks, stopping over 1-2 weeks should be OK. after 6-8 months treatment, taper off over 6-8 weeks. Be prepared to stop the reduction or increase your dose again if needed.” (2)
To be sure, this taper speed works for numbers of people.
Many people seem to be able to taper off psychiatric medications in a couple of weeks or even cold-turkey with minor withdrawal symptoms perhaps for a month or so. Doctors therefore expect everyone can do this. However, a minority suffer severe symptoms for much longer. (3)
It seems that most doctors don’t appreciate the need for a greater margin of safety in reducing the risk of side effects by gradually reducing the dosage. Thus, they usually advise tapers that are much too fast. (2)
However, there are numbers of people like you that cannot follow this fast taper without problems such as you have been experiencing. You need to do a much slower taper that can take a year or more to complete. When you do this, you (hopefully) can finally get off Citalopram without experiencing the negative side effects that faster tapers cause.
The problem is, no one knows in advance how their nervous systems will respond to any speed of taper until they try it—and then it can be too late. Thus, a wiser approach is to do a slow taper in the first place than to try to put your nervous system back together again after you have wrecked it by too fast a taper. (3) “It’s a Humpty-Dumpty situation. Once your nervous system falls off that wall, there’s not much that can be done to put it together again.” (3)
A good rule of thumb is to taper your dose by 10% per month. This 10% rule holds for Celexa, as well as for other psychiatric drugs. (2)
This 10% taper is a “harm reduction” approach to going off psychiatric drugs. This conservative approach causes the least harm to the greatest number of people. Unfortunately, a few people will still experience side effects, even at this slow rate.
“If you are very sensitive to dosage reductions, you may have to reduce by very, very small amounts, less than 10% per month, or hold for even longer than a month at a time.” (3) For example, you may need to do a 5% taper, or take longer intervals between each step—such as 6 weeks instead of 4 weeks per step. Do whatever works for you so that your don’t experience side effects as you taper off this drug.
Note that you reduce your dose by 10% per month, calculated on the last dosage you took, not the initial dosage. (2)
Here is the wrong way—a straight taper off the initial dose. For example, say you were on a high dose of 40 mg per day. A straight 10% taper would be to reduce your dose by 4 mg each month—and after 10 months you’d be off the drug. This is too fast a taper and you will likely find that negative side effects will crop up.
The right way to do a 10% taper is to taper 10% off the last dose you took. For example, again say you were on a dose of 40 mg per day. To do a 10% taper you’d do the same as the above for the first month. 10% of 40 is 4 mg. So for the first month you’d take 40 – 4 = 36 mg/day. Then for the second month, you’d reduce this by 10% of the 36 mg. So the second month you’d take 36 – 3.6 mg = 32.4 mg/day. For the third month you’d reduce this by 10% and thus take 32.4 – 3.24 mg = 29.16 mg/day and so on.
Here is the 10% taper for daily doses of 40, 20, 15 and 10 mg.
| 10% Reducing Taper | |||||
| 40 mg pill | 20 mg pill | 15 mg pill | 10 mg pill | ||
| Dose (mg) | Dose (mg) | Dose (mg) | Dose (mg) | Drink (ml) | Pour out (ml) |
| 40.0 | 20.0 | 15.0 | 10.0 | 100.0 | 0.0 |
| 36.0 | 18.0 | 13.5 | 9.0 | 90.0 | 10.0 |
| 32.4 | 16.2 | 12.2 | 8.1 | 81.0 | 19.0 |
| 29.2 | 14.6 | 10.9 | 7.3 | 72.9 | 27.1 |
| 26.2 | 13.1 | 9.8 | 6.6 | 65.6 | 34.4 |
| 23.6 | 11.8 | 8.9 | 5.9 | 59.0 | 41.0 |
| 21.3 | 10.6 | 8.0 | 5.3 | 53.1 | 46.9 |
| 19.1 | 9.6 | 7.2 | 4.8 | 47.8 | 52.2 |
| 17.2 | 8.6 | 6.5 | 4.3 | 43.0 | 57.0 |
| 15.5 | 7.7 | 5.8 | 3.9 | 38.7 | 61.3 |
| 13.9 | 7.0 | 5.2 | 3.5 | 34.9 | 65.1 |
| 12.6 | 6.3 | 4.7 | 3.1 | 31.4 | 68.6 |
| 11.3 | 5.6 | 4.2 | 2.8 | 28.2 | 71.8 |
| 10.2 | 5.1 | 3.8 | 2.5 | 25.4 | 74.6 |
| 9.2 | 4.6 | 3.4 | 2.3 | 22.9 | 77.1 |
| 8.2 | 4.1 | 3.1 | 2.1 | 20.6 | 79.4 |
| 7.4 | 3.7 | 2.8 | 1.9 | 18.5 | 81.5 |
| 6.7 | 3.3 | 2.5 | 1.7 | 16.7 | 83.3 |
| 6.0 | 3.0 | 2.3 | 1.5 | 15.0 | 85.0 |
| 5.4 | 2.7 | 2.0 | 1.4 | 13.5 | 86.5 |
| 4.9 | 2.4 | 1.8 | 1.2 | 12.2 | 87.8 |
| 4.4 | 2.2 | 1.6 | 1.1 | 10.9 | 89.1 |
| 3.9 | 2.0 | 1.5 | 1.0 | 9.8 | 90.2 |
| 3.5 | 1.8 | 1.3 | 0.9 | 8.9 | 91.1 |
| 3.2 | 1.6 | 1.2 | 0.8 | 8.0 | 92.0 |
| 2.9 | 1.4 | 1.1 | 0.7 | 7.2 | 92.8 |
| 2.6 | 1.3 | 1.0 | 0.6 | 6.5 | 93.5 |
| 2.3 | 1.2 | 0.9 | 0.6 | 5.8 | 94.2 |
| 2.1 | 1.0 | 0.8 | 0.5 | 5.2 | 94.8 |
| 1.9 | 0.9 | 0.7 | 0.5 | 4.7 | 95.3 |
| 1.7 | 0.8 | 0.6 | 0.4 | 4.2 | 95.8 |
| 1.5 | 0.8 | 0.6 | 0.4 | 3.8 | 96.2 |
| 1.4 | 0.7 | 0.5 | 0.3 | 3.4 | 96.6 |
| 1.2 | 0.6 | 0.5 | 0.3 | 3.1 | 96.9 |
| 1.1 | 0.6 | 0.4 | 0.3 | 2.8 | 97.2 |
| 1.0 | 0.5 | 0.4 | 0.3 | 2.5 | 97.5 |
| 0.9 | 0.5 | 0.3 | 0.2 | 2.3 | 97.7 |
| 0.8 | 0.4 | 0.3 | 0.2 | 2.0 | 98.0 |
| 0.7 | 0.4 | 0.3 | 0.2 | 1.8 | 98.2 |
| 0.7 | 0.3 | 0.2 | 0.2 | 1.6 | 98.4 |
| 0.6 | 0.3 | 0.2 | 0.1 | 1.5 | 98.5 |
| 0.5 | 0.3 | 0.2 | 0.1 | 1.3 | 98.7 |
| 0.5 | 0.2 | 0.2 | 0.1 | 1.2 | 98.8 |
| 0.4 | 0.2 | 0.2 | 0.1 | 1.1 | 98.9 |
| 0.4 | 0.2 | 0.1 | 0.1 | 1.0 | 99.0 |
| 0.3 | 0.2 | 0.1 | 0.1 | 0.9 | 99.1 |
| 0.3 | 0.2 | 0.1 | 0.1 | 0.8 | 99.2 |
| 0.3 | 0.1 | 0.1 | 0.1 | 0.7 | 99.3 |
| 0.3 | 0.1 | 0.1 | 0.1 | 0.6 | 99.4 |
| 0.2 | 0.1 | 0.1 | 0.1 | 0.6 | 99.4 |
Tapering like this—10% on the reducing balance—will go on forever with ever smaller quantities. Thus, at some point you need to simply “jump off”. However, don’t “jump off” too soon. As you get to a smaller and smaller dose, you must taper extra slow, not faster. (3) This has to do with the percentage of receptors in your brain that the Citalopram is occupying. So just go extra slow in the taper at the end before you finally “jump off”.
If you find this protocol too slow, you can always speed things up by making the 10% reductions more often—for example, every 3 weeks or 2 weeks or even every week—whatever interval works for you. However, if you get any withdrawal symptoms, this is your nervous system’s way of telling you that you are tapering too fast and you need to switch to a slower taper. (3)
Thus, if you used the above taper rate, it would take you 4 years of slow (monthly) taper to finally get off the drug. If you used a fast taper (weekly), using the same table, it would take you one year to get off the drug.
Now for some practical considerations. Since Citalopram comes in 40, 20 and 10 mg tablets, how do you precisely measure a “funny” dose such as 29.16 mg?
What you do is use the various strengths of the tablets combined with a liquid form of Citalopram. (You could also split the tablets, but this can be quite inaccurate unless you have sensitive scales to accurately measure each piece.)
For example, in the above case of a dose of 29.16 mg, you could take a 20 mg tablet and the equivalent of 9.16 mg of the liquid form of Citalopram for that particular dose.
Note that in the US, the liquid oral solution comes in 10 mg/5 mL (2 mg/mL). (2) So in this case you want to take (9.16 x 5)/10 = 4.58 ml of the liquid Citalopram plus a 20 mg tablet.
To measure tiny precise amounts of the liquid form of Citalopram, you need an oral syringe. You can learn more about oral syringes and how to use them here.
If you’d rather do a straight taper over 300 days at the rate of 1% taper every 3 days, you can use the following table.
| Taper Dose –1% taper every 3 days | ||||
| Day | 10 mg | 15 mg | 20 mg | 40 mg |
| 1 | 10.00 | 15.00 | 20.00 | 40.00 |
| 4 | 9.90 | 14.85 | 19.80 | 39.60 |
| 7 | 9.80 | 14.70 | 19.60 | 39.20 |
| 10 | 9.70 | 14.55 | 19.40 | 38.80 |
| 13 | 9.60 | 14.40 | 19.20 | 38.40 |
| 16 | 9.50 | 14.25 | 19.00 | 38.00 |
| 19 | 9.40 | 14.10 | 18.80 | 37.60 |
| 22 | 9.30 | 13.95 | 18.60 | 37.20 |
| 25 | 9.20 | 13.80 | 18.40 | 36.80 |
| 28 | 9.10 | 13.65 | 18.20 | 36.40 |
| 31 | 9.00 | 13.50 | 18.00 | 36.00 |
| 34 | 8.90 | 13.35 | 17.80 | 35.60 |
| 37 | 8.80 | 13.20 | 17.60 | 35.20 |
| 40 | 8.70 | 13.05 | 17.40 | 34.80 |
| 43 | 8.60 | 12.90 | 17.20 | 34.40 |
| 46 | 8.50 | 12.75 | 17.00 | 34.00 |
| 49 | 8.40 | 12.60 | 16.80 | 33.60 |
| 52 | 8.30 | 12.45 | 16.60 | 33.20 |
| 55 | 8.20 | 12.30 | 16.40 | 32.80 |
| 58 | 8.10 | 12.15 | 16.20 | 32.40 |
| 61 | 8.00 | 12.00 | 16.00 | 32.00 |
| 64 | 7.90 | 11.85 | 15.80 | 31.60 |
| 67 | 7.80 | 11.70 | 15.60 | 31.20 |
| 70 | 7.70 | 11.55 | 15.40 | 30.80 |
| 73 | 7.60 | 11.40 | 15.20 | 30.40 |
| 76 | 7.50 | 11.25 | 15.00 | 30.00 |
| 79 | 7.40 | 11.10 | 14.80 | 29.60 |
| 82 | 7.30 | 10.95 | 14.60 | 29.20 |
| 85 | 7.20 | 10.80 | 14.40 | 28.80 |
| 88 | 7.10 | 10.65 | 14.20 | 28.40 |
| 91 | 7.00 | 10.50 | 14.00 | 28.00 |
| 94 | 6.90 | 10.35 | 13.80 | 27.60 |
| 97 | 6.80 | 10.20 | 13.60 | 27.20 |
| 100 | 6.70 | 10.05 | 13.40 | 26.80 |
| 103 | 6.60 | 9.90 | 13.20 | 26.40 |
| 106 | 6.50 | 9.75 | 13.00 | 26.00 |
| 109 | 6.40 | 9.60 | 12.80 | 25.60 |
| 112 | 6.30 | 9.45 | 12.60 | 25.20 |
| 115 | 6.20 | 9.30 | 12.40 | 24.80 |
| 118 | 6.10 | 9.15 | 12.20 | 24.40 |
| 121 | 6.00 | 9.00 | 12.00 | 24.00 |
| 124 | 5.90 | 8.85 | 11.80 | 23.60 |
| 127 | 5.80 | 8.70 | 11.60 | 23.20 |
| 130 | 5.70 | 8.55 | 11.40 | 22.80 |
| 133 | 5.60 | 8.40 | 11.20 | 22.40 |
| 136 | 5.50 | 8.25 | 11.00 | 22.00 |
| 139 | 5.40 | 8.10 | 10.80 | 21.60 |
| 142 | 5.30 | 7.95 | 10.60 | 21.20 |
| 145 | 5.20 | 7.80 | 10.40 | 20.80 |
| 148 | 5.10 | 7.65 | 10.20 | 20.40 |
| 151 | 5.00 | 7.50 | 10.00 | 20.00 |
| 154 | 4.90 | 7.35 | 9.80 | 19.60 |
| 157 | 4.80 | 7.20 | 9.60 | 19.20 |
| 160 | 4.70 | 7.05 | 9.40 | 18.80 |
| 163 | 4.60 | 6.90 | 9.20 | 18.40 |
| 166 | 4.50 | 6.75 | 9.00 | 18.00 |
| 169 | 4.40 | 6.60 | 8.80 | 17.60 |
| 172 | 4.30 | 6.45 | 8.60 | 17.20 |
| 175 | 4.20 | 6.30 | 8.40 | 16.80 |
| 178 | 4.10 | 6.15 | 8.20 | 16.40 |
| 181 | 4.00 | 6.00 | 8.00 | 16.00 |
| 184 | 3.90 | 5.85 | 7.80 | 15.60 |
| 187 | 3.80 | 5.70 | 7.60 | 15.20 |
| 190 | 3.70 | 5.55 | 7.40 | 14.80 |
| 193 | 3.60 | 5.40 | 7.20 | 14.40 |
| 196 | 3.50 | 5.25 | 7.00 | 14.00 |
| 199 | 3.40 | 5.10 | 6.80 | 13.60 |
| 202 | 3.30 | 4.95 | 6.60 | 13.20 |
| 205 | 3.20 | 4.80 | 6.40 | 12.80 |
| 208 | 3.10 | 4.65 | 6.20 | 12.40 |
| 211 | 3.00 | 4.50 | 6.00 | 12.00 |
| 214 | 2.90 | 4.35 | 5.80 | 11.60 |
| 217 | 2.80 | 4.20 | 5.60 | 11.20 |
| 220 | 2.70 | 4.05 | 5.40 | 10.80 |
| 223 | 2.60 | 3.90 | 5.20 | 10.40 |
| 226 | 2.50 | 3.75 | 5.00 | 10.00 |
| 229 | 2.40 | 3.60 | 4.80 | 9.60 |
| 232 | 2.30 | 3.45 | 4.60 | 9.20 |
| 235 | 2.20 | 3.30 | 4.40 | 8.80 |
| 238 | 2.10 | 3.15 | 4.20 | 8.40 |
| 241 | 2.00 | 3.00 | 4.00 | 8.00 |
| 244 | 1.90 | 2.85 | 3.80 | 7.60 |
| 247 | 1.80 | 2.70 | 3.60 | 7.20 |
| 250 | 1.70 | 2.55 | 3.40 | 6.80 |
| 253 | 1.60 | 2.40 | 3.20 | 6.40 |
| 256 | 1.50 | 2.25 | 3.00 | 6.00 |
| 259 | 1.40 | 2.10 | 2.80 | 5.60 |
| 262 | 1.30 | 1.95 | 2.60 | 5.20 |
| 265 | 1.20 | 1.80 | 2.40 | 4.80 |
| 268 | 1.10 | 1.65 | 2.20 | 4.40 |
| 271 | 1.00 | 1.50 | 2.00 | 4.00 |
| 274 | 0.90 | 1.35 | 1.80 | 3.60 |
| 277 | 0.80 | 1.20 | 1.60 | 3.20 |
| 280 | 0.70 | 1.05 | 1.40 | 2.80 |
| 283 | 0.60 | 0.90 | 1.20 | 2.40 |
| 286 | 0.50 | 0.75 | 1.00 | 2.00 |
| 289 | 0.40 | 0.60 | 0.80 | 1.60 |
| 292 | 0.30 | 0.45 | 0.60 | 1.20 |
| 295 | 0.20 | 0.30 | 0.40 | 0.80 |
| 298 | 0.10 | 0.15 | 0.20 | 0.40 |
As you can see in retrospect, it is much better if you use natural means (diet, counseling, etc.) to deal with mental/emotional health issues and stay away from SSRIs and other mind-altering drugs. Then you don’t have to worry about all the horrible side effects when you try to get off these drugs.
____________
(1) Citalopram Tablets.
I went to a psychiatris and was told Citalopram may no longer be working on me since I have been taking it for eight years. I am taking 40 mg. Can I cut it to 20 mg as a tapering it off? She wanted to put me on another medication. I want to get of the medication and since it probably does not work is this tapering to fast?
Hi Cynthia:
When you say that the Citalopram isn’t working for you, all you are really saying it isn’t having the positive effects you wanted. But it is still in your body doing bad things. Therefore, you still need to taper off it at a slow rate.
Since you were on it for 8 years, I’d err on the side of caution and do a 10% taper per month on the reducing balance as outlined in this article. Jumping from 40 mg to 20 mg is much too fast a taper in my opinion if you want to avoid all negative side effects as you come off it.
You’d do well to carefully read my article again, before you decide to do a quick taper.
Cordially,
Neil
Hello Neil,
My name is Brian..I’ve only been on Citalopram for 5 weeks and want to come off because of all the negative weaning reactions I’ve read..I started feeling better after week 4,but then I dropped from 10mgs to 5mgs and intrusive thoughts,anxiety and body quivers came back along with the gas..Should I stay on 10mg longer to get rid of depression then wean or do it now and find a more natural way to deal with depression and anxiety..I don’t want to go through life needing antidepressants
Hi Brian:
If you start getting side effects, then you know you are tapering off too fast. Going from 10 mg to 5 mg is a 50% taper. That is much too fast. You should be tapering off at a 10% rate based on the descending balance. So you should probably go back to the 10 mg and wait for your body to stabilize then do a slower taper.
At the same time, since you want a more natural way to control your depression, you might want to consider St. John’s Wort. Studies have shown it to be as effective as prescription anti-depressants, yet it very few side effects–sun sensitivity is one.
You could taper UP on St. John’s Wort as you taper DOWN on the Citalopram.
If you choose to get it, just be sure it says on the bottle “standardized” and then says what it is standardized to. You want something that says, “standardized to 0.3% (or up to 0.7%) hypericin” which is the active ingredient.
Cordially,
Neil
Hello Doctor,
I’m on Prestiq for depression & have Tinnitus. Is there a link between between them?
Can you recommend the best drug to take for Tinnitus? My GP put me on Verapamil, but from reading this site it looks like Verapamil causes Tinnitus! I’m confused & lost.
Thank you,
Janine
Hi Janine:
Hundreds of people on Desvenlafaxine (Pristiq) have reported tinnitus as a side effect. So there is a good chance that it caused your tinnitus also.
The FDA has not approved ANY drug for reducing tinnitus. So I wouldn’t go the drug route to treat tinnitus. Besides, more than 550 drugs are listed as causing tinnitus. So that should tell you right there that you are barking up the wrong tree if you think taking drugs will get rid of your tinnitus.
Verapamil is an antihypertensive drug. Why would you take that for tinnitus? I don’t see any connection.
If I were depressed, I certainly wouldn’t take drugs to treat it. Rather, I’d use a number of natural ways. One of them would be to take St. John’s Wort.
If you need an anti-depressant, I’d suggest you look at the herbal St. John’s Wort. It is not ototoxic, is available without a prescription at many drug stores, health food stores or On-line.
A number of studies have shown that it works as well as, or better, than prescription drugs for mild to moderate cases of depression.
If you choose to get it, just be sure it says on the bottle “standardized” and then says what it is standardized to. You want something that says, “standardized to 0.3% (or up to 0.7%) hypericin” which is the active ingredient.
Cordially,
Neil
Hello,
I was put on Citalopram 10mg and started to have horrible side effects, including burning skin. I had taken 7 doses, and decided to discontinue. It has been two full days without taking the medication. Is it truly necessary to taper this low dose after only a weeks worth of taking it? Or will it be okay to continue not taking it at all, as I’ve done the previous two days? Thank you so much!
Hi Alyssa:
Since you haven’t had any problems after two days, and since you only took it for 1 week, and since you were on a low dose, I’d think you could get away with just staying off it now and hopefully not experience any bad withdrawal side effects.
I think that’s what I’d do if I were in your shoes.
Cordially,
Neil
Hi Mr Bauman. I was taking 10 mg Celexa for about 1 year and started taking half’s then stopped cold turkey. Third day experienced vomiting, Suicidal impulse , panic attack within one day! I went to the natural outlet vitamin store and got 5HTP, and L Tyrosine and took it asap… with an hour I was mentally better. Still vomited for the next three days.. but overall much better. From that moment I started walking everyday and taking my vitamins and felt like my old self. Fast forward three months. I’ve been experiencing shiver like headache and feeling and severe anxiety! Could the Celexa still be affecting me? If so what should I do
Hi Sierra:
Stopping cold turkey like that wasn’t the wisest thing you’ve ever done. But taking the 5HTP, etc with the exercise was a good thing. I’d keep it up. You are, aren’t you?
As far as I know, Celexa can affect you for many months so you can expect good days and not so good days (or weeks or whatever). But in the long run, things should slowly get better and you’ll have more and more good days and fewer bad days. And the bad days won’t be as bad as they once were.
I’d keep on doing what you are doing. And maybe check that your vitamin D3 levels are up in the optimal range between 60 and 80 ng/ml. Most doctors think if you are above 20 ng/ml that is fine–but its not. You need to be much higher for optimum health and to get your life back on track.
Cordially,
Neil
I am taking one day 10 anothet day 5 i took this for 1month and half now im starting to go fon on 5 is it ok im on celexa since last june pls cannu get bk to me thanku
Hi Matina:
When you taper off a drug, you want to do a continuous taper downwards–not an up and down method like you are doing.
Assuming you are taking 2 5 mg pills a day, you would be better off to split one 5 mg pill in quarters for example and starting at 10 mg per day, then go to 1 3/4 pills, then to 1.5 pills, then to 1 1/4 pills, then 1 pill, then 3/4 pill, then 1/2 pill, then 1/4 pill then off the drug–that idea. The taper is always downward, not up and down on alternating days.
Cordially,
Neil
I’ve been on 20mg citalopram for 4 years. My doctor’s told me to drop to 10mg for 3 weeks, then stop. This resulted in my getting headaches, tinnitus, electric shocks and the most horrendous anxiety. I ended up going to 10mg 8 months ago, Iv just started 5mg 2 weeks ago. I plan on staying on 5mg for 6 weeks total, but then what do I do? My dic said just stop! I don’t think that’s right?
Hi Melanie:
Your doctor’s tapering advice was FAR too fast as you unfortunately discovered when you began experiencing all the withdrawal side effects. A safe taper rate is not 50% twice over 6 weeks, but 10% per month on a descending balance. At that rate, you need about a year to safely stop taking this drug without side effects.
You are still doing a 50% taper and that is likely too fast. It’s easy to tell–if you get withdrawal side effects, you are tapering too fast. If not, it appears that that rate is ok for you.
If that works for you, then take 2.5 mg for another 6 weeks, then 1.25 mg for another 6 weeks and you’re off. But I don’t recommend tapering that fast. The slower you go, the less chance of having withdrawal side effects, but the choice of how fast you taper is up to you.
Cordially,
Neil
Hi Dr. Bauman,
If I may ask for your opinion.
I have been on Citalopram for 22 months.
My doctor has recommended a dose drop from 40MG Citalopram, to 30MG the following evening, then 40MG the next and do that for a few weeks, then to 30MG for a few weeks, then onto 20MG, 30MG the next and so on.
Do you think this is equivalent to the 10% drop approach you recommend?
I am in the UK, I am not sure if we can get liquid Cilaopram and I am concerned about trying to accurately cut the 10MG tablets.
I do seem sensitive to any changes with it, even time changes appear to effect me. I had tinnitus already although it has increased in severity during my time on the drug.
Thank you so very much.
Regards,
Stephanie.
Hi Stephanie:
That would be varying the dose by 25% each week for the first two weeks–that’s faster than the 10% taper. Then the next two weeks would be varying the dose between 30 and 20 which would be a 33% change, then the following two weeks would be varying between 20 and 10 which would be a 50% change.
I’d say that is risky–much too fast to be sure of not getting withdrawal side effects.
This is especially so since you say you are sensitive to any dosage changes.
It would be better to cut the 10 mg tablets even if you aren’t exactly accurate, it would average out every two days (so if you made the split 60/40 instead of 50/50, one day you’d get the 6 mg dose and the next day the 4 mg dose). This would still be a much smaller change per day than swinging 10 mg each day.
If you did that you’t reduce your dose to 35 mg for a week, then 30 for a week, then 25 for a week, then 20, then 15, then 10, then 5. That would take a total of 7 weeks to reduce to zero. That could still be much too fast. With a 10% taper you’d take about 40 weeks. Below are the dosages for each week for a 10% taper starting at at dose of 40 mg and reducing it 10% for 40 weeks. This would be a much safer taper.
40.00
36.00
32.40
29.16
26.24
23.62
21.26
19.13
17.22
15.50
13.95
12.55
11.30
10.17
9.15
8.24
7.41
6.67
6.00
5.40
4.86
4.38
3.94
3.55
3.19
2.87
2.58
2.33
2.09
1.88
1.70
1.53
1.37
1.24
1.11
1.00
0.90
0.81
0.73
0.66
You have to decide a jumping off point where you stop as this can go on forever. Probably at 40 weeks is a good jumping off point.
You don’t have to be precise to 2 decimal places like I have shown above, but try to get reasonably close to this by splitting tablets. It will still be much better than alternating 10 mg per week.
If you find that you experience NO side effects you could go faster. However, if you begin to experience side effects stay at that level until the side effects go away, then continue on the tape again. It doesn’t matter how long it takes. The thing is to get off safely.
Cordially,
Neil
Hi Neil,
Thank you so much for your reply.
I truly appreciate it.
Regards,
Stephanie.
How do go from say 40 to 36 then 32 etc. Is there a 36 etc mg pill
Hi Stephen:
If you have pills and want to break them into small pieces (which is almost impossible to do), the way to do this is to get a mortar and pestle and grind a whole pill into dust, then dissolve it in exactly 100 ml of water. Get yourself a 100 ml beaker that is marked for each individual ml. (It will be a tall thin beaker.) Just dump the ground pill dust into the beaker, fill it to the 100 ml line with water, put your hand over the top and shake it until it dissolves.
Now all you have to do is pour out the part you don’t need and drink the rest. That way you can essentially split a pill into 100 parts (each 1 ml represents a 1% reduction).
Here is a table to show you how to do this starting with a 40 mg dose and using a 10% reducing taper.
Dose Pour Out Drink
(mg) (ml) (ml)
40.0 / 0.0 / 100.0
36.0 / 10.0 / 90.0
32.4 / 19.0 / 81.0
29.2 / 27.1 / 72.9
26.2 / 34.4 / 65.6
23.6 / 41.0 / 59.0
21.3 / 46.9 / 53.1
19.1 / 52.2 / 47.8
17.2 / 57.0 / 43.0
15.5 / 61.3 / 38.7
13.9 / 65.1 / 34.9
12.6 / 68.6 / 31.4
11.3 / 71.8 / 28.2
10.2 / 74.6 / 25.4
9.2 / 77.1 / 22.9
8.2 / 79.4 / 20.6
7.4 / 81.5 / 18.5
6.7 / 83.3 / 16.7
6.0 / 85.0 / 15.0
5.4 / 86.5 / 13.5
4.9 / 87.8 / 12.2
4.4 / 89.1 / 10.9
3.9 / 90.2 / 9.8
3.5 / 91.1 / 8.9
3.2 / 92.0 / 8.0
2.9 / 92.8 / 7.2
2.6 / 93.5 / 6.5
2.3 / 94.2 / 5.8
2.1 / 94.8 / 5.2
1.9 / 95.3 / 4.7
1.7 / 95.8 / 4.2
1.5 / 96.2 / 3.8
1.4 / 96.6 / 3.4
1.2 / 96.9 / 3.1
1.1 / 97.2 / 2.8
1.0 / 97.5 / 2.5
0.9 / 97.7 / 2.3
0.8 / 98.0 / 2.0
0.7 / 98.2 / 1.8
0.7 / 98.4 / 1.6
0.6 / 98.5 / 1.5
0.5 / 98.7 / 1.3
0.5 / 98.8 / 1.2
0.4 / 98.9 / 1.1
0.4 / 99.0 / 1.0
0.3 / 99.1 / 0.9
0.3 / 99.2 / 0.8
0.3 / 99.3 / 0.7
0.3 / 99.4 / 0.6
0.2 / 99.4 / 0.6
Note: this only works with hard pills, not with gels or capsules.
You can use this to taper off a drug and any speed. For example, each step could represent 1 day (50 day taper) or 1 week (roughly a one year taper) or 1 month (roughly a 4 year taper), or any other speed you want to try.
If the taper is too fast, slow it down so that side effects don’t appear.
Cordially,
Neil
Hi Neil been taking Celexa for 16 months now only 10 mg right before I go to bed. Been having really bad Tinnitus , headaches, foggy brain and zero energy and all I want to do is sleep. I just came off of gabepentin after 20 months of 3600 mg. It’s been a month since my last pill. I really want to discountinue Celexa but coming off gabapentin was awful. The Celexa is now making me feel ill and not sure how to taper off a medicine that is making me feel sick. Please advise and thank you
Hi Dan:
I fear you came off the Gabapentin MUCH too fast. I would have tapered off the Gabapentin over a period of several months to a year–slow enough that no withdrawal side effects showed up.
I’d normally say do the 10% taper on the descending balance. But you want to get off it as soon as possible so you could try doing it faster, but if you notice any withdrawal side effects appearing, then you know at that point you have to slow down the taper.
You’ll see the 10% taper figures in my reply of Jan 5, 2019 under this article.
Cordially,
Neil
Hello Dr,
I have been on Celexa now for about two years. I have done great. I just realized that I dont laugh, or cry or really be happy. So, I decided to taper off. I wish I read your article first. I was on 40mg, I went from 40 to 20 and then 20 to 10 and 10 to 5 in all of two or three months. I am now in withdrawal mode! So, can I go back to 20 or 10mg then do your method?
Hi Kathy:
You have two points to consider. First, how long has it been since you last too any Celexa. The more time that has gone by, the less likely you’d want to take it again as you have likely gone through the worst of the withdrawal symptoms. If you can stand it and your withdrawal symptoms are not too severe, you might just want to “tough it out”.
Second, there is no guarantee that going back on the Celexa will make much difference unless you go back on the full dose. You can try a lesser dose and see. If not, you’ll have to go back on the full dose and then do the slow taper.
Cordially,
Neil
Hi my name is Amber and I had been on Zoloft. Now the course of time is what follows, I had been on 50mg for 3 wks and reduced to 25mg for almost 2 wks. Was doing a modified taper of taking 1/4 off of each week I had been on the drug so as follows, it was 3/4 week one, 1/2 week 2 and 1/4 week three and done. I have only gone as far as 3/4 right now but had adjusted it to 0.067 at the time. And had been on that since the 24th. So I am only on 18mg of Zoloft right now. How should I taper properly to get off of this because I was going to proceed with the modified taper to take it down to half. I am very sensitive to this medication and would like to know what step I should take to proceed
Hi Amber:
I’m probably getting to answering your question too late, but here goes anyway.
Sertraline (Zoloft) has a reasonably long half-life of 26 hours or so. This means you can do a relatively smooth taper. The speed you go is determined by how you feel. If you don’t experience any withdrawal effects, you can go faster. If you begin to experience withdrawal effects, you are tapering a bit too fast.
A “safe” taper is about 10% per step. A step could take 1 week, or 2 weeks or a month (whatever your body requires). So if you are sensitive to Zoloft and withdrawal effects are appearing–I’d halt the taper until the side effects go away, then I’d continue at a slower rate. Sometimes, its the last step or two that you have to make very small changes–rather than just stopping “cold turkey” at a level you think is small enough to stop. In other words too many people make the mistake of making the last step bigger than what their body needs.
You basically can’t taper too slow, but you can easily taker too fast.
Cordially,
Neil
Hello cynthia, my name is hugo, ive been on meds for almost 8yrs now. The last 6 yrs ive been on citalopram,
But it seems to not be causing any effect. My doctor suggested i go on 30 mg but i denied it. I believe these drugs mess your life up but the doctors dont seem to care in discussing the yrue side effects or even to look at other alternatives before starting these meds. They get rich and the pharmaceutical companys get richer. My main question to you is if you have already came off the meds completely and if so, how did you do it?
I feel a tremendous emptyness as if i had no one in the world. I have nightmares and i get very little sleep. I also have alot of cry spells for no reason.
Thank you
I dont know if i can post on here, but worth a try. I stopped taking 20mg citalopram, 2mg abilify, and 1 mg klonopin cold turkey all at the same time a month ago. And i feel dysfunctional but im functioning barely. Its gotten better over the last few days, its been rough but im done with that shit. You feel nothing while on them and have severe withdrawals when u quit. Ima troop it out and hope for the best. My job, family, and every relationship depends on it. Withdrawals are bad though. Cold sweats at random times, insomnia, memory blanks(cant remember shi**.),
Shakes , mood swings like insanely. Everybody is wondering whats goin on. But i dont wanna tell em. I hope its almost over withdrawal wise. But we will see
Hi. Im taking citalopram over 20 years 20mg a day. I had lots if guts issues that have not been treated in the same time. Hence i had to stay on this medication. However i have taken control finally of my candida problem. And i beleive i dont need this antidepressant as my brain became so clear. I can think first time in this last 10 years. I have tried to quit before fixing my guts and it always ende with relapse. Now i feel and beleive to solved guts health i could cut it out of my life forever. I started to take only 10 mg a day and still feeling great and better then ever. When can i start adding 5http and what dose to replace the 10 mg citalopram?
Hi Kinga:
Cutting your dose in half is awfully fast. I’d taper off the Citalopram at the rate of 10% or less per month on a reducing basis. It could take you a year or more to get off the Citalopram.
I am no expert on reducing off one drug and taking another to replace it. I’d ask your doctor or knowledgeable health care professional how to do get off the Citalopram while beginning taking 5-HTP to replace it.
Cordially,
Neil
I take 10mg citalopram and have for 8 plus years. I have gained 50 pounds and my dr says it’s the citalopram causing the weight gain. I want to come off and do the st joins wart approach. I have read about the reducing at a slow pace. But can I add the St. John’s wort as I’m tapering off? If so how?
Hi Natalie:
Good question. I don’t know how these two will interact. Theoretically, I’d say that as you taper down on the Citalopram, you’d taper up on the St. John’s Wort if you think you need it. (Maybe you won’t even need it, or maybe only sporadically.)
The problem is that St. John’s Wort comes in capsules so you can’t just cut one up or dissolve it in water.
I’d do the slow 10% taper on the Citalopram and maybe once you are half way down, you could take the St. John’s Wort if you find you need it at that point–but that is just my gut feeling. I really don’t know how to do this. Preferably, you’d taper right down on the Citalopram and then see whether you need the St. John’s Wort at that point. And hopefully, you won’t need it, but if you need it, then you’d start taking it. That way you wouldn’t be interacting with two drugs at the same time.
Cordially,
Neil
I’ve been on Celexa for 5 years, Lexapro before that. I take 40mg/day and my attn span is lacking, constantly fatigued, tired a lot and I’m addict sober for 2 years. I want to taper and get off the Celexa altogether. Is there a medication I can take shirt term to lessen the negative withdraw? Any suggestions? I read your article, very helpful. Need help!
Hi Joey:
I don’t understand why you’d need another drug to “lessen the negative withdraw”. If you do the slow taper suggested in this article, you won’t have any withdrawal symptoms. If you do, as the article explains, you are tapering too fast and you just need to slow down the taper until the withdrawal symptoms go away. Remember, this slow taper is going to take you more than a year. It is not something you do in a month or two.
Cordially,
Neil
Do you think I can come off of 20 mg of citropram after 12 years without side effects. I believe antidepressants are so bad for people. Why is it that people can come off of narcotic drugs easier then antidepressants
Hi Sherry:
Yes, I think you can get off Citalopram without side effects IF you use a very slow taper and listen to your body. If side effects start to appear, then slow down the taper even more.
Cordially,
Neil
I have been on Fluoxetine for 15 years. My dose was 15mg/day. (I would have to cut a 10 mg pill in 1/2 to achieve the 15 mg dose per day. each day I took 1 1/2 pills) Then in April of 2017 Medicare switched me to Citalopram. My dose is 10 mg/day. I was very concerned about switching over but my Dr. said it should be no problem since both of these medications are in the same “family”. In May, 2017 I started experiencing excess gas, with lots of “gut upset”. I was then told by a Naturopath that I had parasites. Since then I have switched to a different Naturopathic group and their testing suggests that I still have parasites, SIBO, suppressed Immune system and my gut does not absorb fats. Whether or not this has been caused by being on an anti-depressant for 15 years is not clear. At any rate my question is how do I taper off of the Citalopram? Or do I switch back to the fluoxetine to accomplish the getting off of this drug? I sincerely want to be off of this medication. Thanks in advance for your advice.
Sincerely, Peggy
Hi Peggy:
Fluoxetine (Prozac) is an SSRI drug. Citalopram (Celexa) is also one of the SSRI drugs. As your doctor pointed out, they are both in the same class of drugs and thus, you can expect them to have many of the same side effects.
However, I’ve received far more anecdotal reports about ototoxic side effects resulting from taking Citalopram than for taking Fluoxetine. Therefore, if it were me, I think I’d ask my doctor if it is ok to put me back on Fluoxetine and then slowly taper off it, rather than try to taper off the Citalopram.
Note: a slow taper would be something in the order of 10% per month on the descending balance. Thus it would take you more than a year to get off it. Tapering too fast leads to all sorts of problems. You would do well to read my article on tapering off Citalopram for much more information on how to do this. You can read it at http://hearinglosshelp.com/blog/tapering-off-citalopram-safely-without-side-effects/
Cordially,
Neil
I was on a daily 40 mg dose of citalopram for like 15 years. Last spring I started tapering it off by 5 mg/month. The very last dose was on Oct. 25. During the past months I can’t say I had any noted sympotoms. But after the last dose I started having less sleeping hours while I used to sleep too much in the past years. In the past couple of nights it’s complete insomnia in addtion to digestive distubances, nausea and chills in my body. Insomnia is the worst for me. Will these last, improve or worsen? Shall I go back to a low dose, a single dose Prozac.. Is there something that can make me sleep? 5-HTP!!
Hi Sam:
Usually side effects occur when you taper off a drug too fast. In your case tapering over eight months seems to be a reasonably slow taper. However, some people need to taper even slower, especially with that last 5 mg. It might have been better to taper that one at 4 mg for one month, then three then two and then one before finally stopping it.
Do you think your insomnia and other symptoms are related to your taking Citalopram, or could they be from some other cause? You might want to run this by your doctor and see what he says.
I’m no expert on this since I’m not a medical doctor, but you might want to go back on the 5 mg dose and see if your symptoms go away. If they do, then you know that your symptoms are related to taking Citalopram and tapering off too fast. If that’s the case, perhaps you want to stay on Citalopram for another month and then start reducing the dose by 1 mg a month or even slower until you can finally quit the Citalopram and not have any side effects, or at least no side effects that you can’t easily deal with.
Cordially,
Neil
No.. I said insomnia and other symptoms showed up after discontinuation not while on the drug.
It is strange, I feel tired but not sleepy!
I would have stayed on Citalopram for ever, but on different occasions the drug prevented me from taking other medications that with aging become very much needed like NSAIDs because of drug interactions.
I have not been particularly active but today I started fast walking for 30 minutes. Can this be the answer for what I have or is it just a helping factor?
Sincerely,
Sam
Hi Sam:
You misunderstood what I was trying to say since I worded it poorly. I should have said, “Do you think your symptoms are the result of your having taken Citalopram in the past and just showed up after you tapered off it or not?”
Not all side effects of drugs show up while you are taking them. Unfortunately, some don’t show up until after you stop taking them. Thus, you may not correlate them with drug use.
Getting more exercise is always a step in the right direction. It can make you healthily tired so that you can sleep better. if it works for you, go for.
Cordially,
Neil
Hello Dr.,
I cold turkeyed off of citalopram three months ago and im having a lot of agitation, empty hopless feeling. Feeling of deep sadness and no joy in the things i onced enjoyed. I know cold turkey was the worst thing to do but its done. and after reading all the negative sid2 effects and damage to the nervouse system i feel so scared. How can i repair the damage? where do i go from here?
Hi Ayan:
Unfortunately, I’m no expert on how to fix these kinds of things However I do have some suggestions.
One, you could go back on the Celexa and then after you are stabilized on it again, then slowly taper off it.
Two, begin taking the herbal St. John’s Wort to replace the Celexa. It is not ototoxic, is available without a prescription at many drug stores, health food stores or On-line.
A number of studies have shown that it works as well as, or better, than prescription drugs for mild to moderate cases of depression.
If you choose to get it, just be sure it says on the bottle “standardized” and then give what it is standardized to. You want something that says, “standardized to 0.3% (or up to 0.7%) hypericin” which is the active ingredient.
Three, take the amino acids l-tryptophan or 5-htp to help your body replace the serotonin you need. Some people find prefer l-tryptophan over 5-HTP. Most people respond better to 5-HTP. This is because 5-HTP skips a step in the conversion process to create serotonin. Leading practitioners in nutritional therapy try 5-HTP with people first, just don’t stop if 5-HTP doesn’t do the trick for you.
L-tryptophan is an amino acid that the brain uses naturally to create Serotonin. It does this by utilizing Vitamin B-3 to convert Tryptophan into 5-HTP, which is used in conjunction with Vitamin B-6 to convert into serotonin.
You would do well to research how to get yourself back on track again. One good website I found is at https://dominatedepression.com/how-i-got-off-antidepressants/
I wish you well.
Cordially,
Neil
Hi, I am currently on 10mg a day of citalopram and have been taking it for a year. I originally needed the drug because of a really tough year but my circumstances have improved greatly. I want to start tapering myself off and wanted to know if dropping down to 5mg would be too much and if I should try 7.25 first? I have spoken to a few doctors as I think my doctor pushes them on me. One doctor said he thinks I have only been on a low dosage so I have a good chance of starting with a 50% drop.
Thanks
C
Hi Clarissa:
Personally, I’d go slower in the taper, rather than faster. But in any case, here is an easy way to tell. If you taper too fast, you may begin experiencing side effects. If that happens go back to the previous dose and then taper slower from that point such that no side effects appear.
If you experience minor side effects, stop the taper at that point and wait until they go away, then continue the taper.
I’m glad you’re getting off this drug–just do it safely.
Cordially,
Neil
I’m on 40mg citalopram that I’ve been on for about 5 years.
How feasible is it with the half life of citalopram to taper by initially taking 40mg every 2nd day, and if that is viable what would my next move be?
Hi Pete:
Since you have been on Citalopram for 5 years, personally, I’d follow the 10% per month taper as outlined in this article. I think a 50% reduction is much too fast.
However, if you choose to do a faster taper, if you notice any beginning signs of unwanted side effects, I’d immediately go back to the previous level and then do a slower taper from that point on.
Cordially,
Neil
I’ve been on 20 mg of citalopram for two weeks then up to 40 mg for 4 weeks so 6 weeks all together i was wondering how long it might take to wean off if i cut the 40 in half and go back to 20mg a day for 5 days then down to 10 mg for 5 days then quit should that be enough time not to have withdrawals
Hi Nick:
How fast you can taper off a drug depends a lot on whether you have built up a tolerance for that drug or not. The longer you are on a drug, the more likely you have built up this tolerance for it, and thus the greater side effects if you try to go off it.
If you choose a relatively fast taper as you are suggesting, just watch for side effects. If none appear, then probably the taper is fine. If side effects begin to appear, this indicates that the taper is too fast. If this happens, either increase your dose to the last level you were at and then taper more slowly. Alternately, if the side effects are not to bad, you could stay at that level until the side effects disappear, then continue on your taper, but ideally at a slower rate.
I’d urge you to do a slower taper, rather than a fast taper like you are thinking of since some side effects may prove to be permanent once they appear. Thus the trick is to do a slow enough taper so none appear.
Cordially,
Neil
Hey,
I’ve been taking citalopram for almost 2 years now, and i wish to discontinue it soon.
i read your tips about the right way of doing so, but unfortunately in my country there is no oral solution available.
I am taking a dose of 20 mg, how should i tapper it down? i know the tablet can be cut in 1/2, but i am not sure about smaller doses than that.
thank you,
Rose.
Hi Rose:
You want to do a SLOW taper.
If you have built up a tolerance to Citalopram, you have to taper off very slowly or you can cause new and worse side effects. A common problem is tapering off too fast, and like you said, it is hard to cut pills to smaller and smaller sizes. Getting smaller pills is one solution but even so, that will mean you taper by 25% or more with each size of pill reduction. This is MUCH too fast in many cases. I’ve heard from too many people that followed their doctors recommendations and tapered off too fast.
A much better way, according to Dr. Heather Ashton, is to taper off slowly over a period of 300 days. This means you would reduce your dose by 1/3 of a percent per day. That way you can almost guarantee you will not make things worse as you wean your body off this drug.
“How do you do that,” you ask? One way to precisely reduce the dose is to get yourself a mortar and pestle and a tall 100 ml beaker marked off in ml. Use the mortar and pestle to crush the pill to a fine powder, then fill the beaker with exactly 100 mL of water and dissolve the powdered pill in it and stir it well. Now, the first day, pour out 1 mL of the solution and drink the rest. Do this for three days. Now you have reduced your dose by 1%. On the fourth through sixth days pour out 2 mL of the solution and drink the rest. Thus, every three days you pour out one more milliliter of the solution and drink what remains until finally on the 298th day to 300th day you are pouring out 99 mL and drinking 1 mL. After that you are free from the drug!
Cordially,
Neil
Thank you very much for the informative reply!!
I was on 5 mg of citalopram for three months and decided to start tapering off. I have taken the tapering slowly and now I am on 2.5 mg and have been for a couple of weeks. My question is at what point do I get off the citalooram altogether? I never went above 5 mg but once I get down to let’s say 2 mg at that point do I stop? I’m very sensitive to any medication. I’m not sure if What I have been feeling are side effects or with drawl symptoms or something else. That’s why I want to get off this drug but I want to do it slowly. Thank you
Hi Mark:
The conventional wisdom is to taper by 10% of the descending dose. You can go faster if you want–but if you start to see withdrawal symptoms, then go back to the previous dose and do a slower taper, or hold the level until the symptoms go away.
Since you are sensitive to drugs, I’d err on the side of a slower taper rather than a faster one to keep withdrawal symptoms at bay. I’d get down to 1 mg or less before you try stopping it altogether. You can try and see what happens and go back on if you get withdrawal symptoms. As you taper off, you should experience fewer and fewer side effects, so if things start getting worse, I’d say they’d be withdrawal symptoms instead–and you need to slow down the taper.
Cordially,
Neil
I’ve been on citalopram for almost 6 months, I was put on it because of my anxiety attack. For the last 4 months I’ve put on a lot of weight and have not had any more anxiety attacks. I would like to stop taken it. But probably freak out from all the side effects.
I have been on 20 mg for a year and want to come off of it. How should I do it?
Hi Hillary:
Follow the instructions in this article. Is there something you don’t understand in this article?
Cordially,
Neil
Hi, I have been on Celexa 20 mg for 28 years. 1-7-18 I cut it in half to 10 mg. 28 days later to a quarter. I don’t feel right and have some terrible weepy days. Was this too fast? I didn’t know about the 10% taper. What should I do now? Thank you!
Hi An:
Since you were one Celexa for 28 years, I’d say you tapered MUCH too fast. You may need a very slow taper than takes a year or more to complete, although you may do it faster.
You may find the 10% taper is even too fast for you.
I’d do a slower taker–1% every 3 days. This would take you 300 days to taper off. And at any point, if you feel the side effects emerging, then you stay at that level for a few days or weeks until they go away, then you continue on your taper. There is no rush. Take your time and do it right.
Since you are experiencing problems now, I’d go back to the level where you didn’t experience problems and then slowly taper down from there.
Cordially,
Neil
I have been on 40mg of celexa a day for over 5 years. My doctor wants to switch me to something that is better for my fibromyalgia pain. I went from 40mg to 30mg Saturday, this afternoon Monday I’m shaky, nateous, migraine, anxiety, and some other stuff. Is this from the drop in medication? I’m supposed to drop 10mg every 2 weeks for 8 weeks them start the new meds. I can’t handle this.
Hi Katrena:
Personally, I think what your doctor is suggesting is a much too fast a taper. The proof is that you are “going to pieces”. You should perhaps go back to your full dose, an then once things stabilize, begin a 10% per month taper on the descending balance. This will take you a year or so. Even that could be too fast. If it is, stop the taper when side effects appear and stay at that level until things normalize, then start the taper again. That’s what I’d do if I were you.
Also, if you are going to be taking a similar drug in the future, I think you could start on a small dose and taper up on it at the same time as you taper down on the existing drug. You’d need to taper up at about the same rate as you are tapering down so you never get a drug overdose. This is another possibility–but you’d need to run it by your doctor.
Cordially,
Neil
I have been on 20mg Celexa for about 3 years due to anxiety and depression. I am tired of being in a constant fog and want to go a more natural route. I want to start taking 5htp in replace of Celexa and am looking for some type of taper schedule where I can incorporate the two. I’m wondering if I should completely taper first and start the 5htp or can I take a low dose of Celexa with the 5htp? Or do you suggest a different route?
Hi Charissa:
I’m no expert on this, but it seems to me that if you can taper right off the Celexa, then you do’t need it, and can get on with your life. However, if you DO need something, then it seems logical that you should taper up on the 5-HTP at the same time as you taper down on the Celexa. You just want to be careful that you don’t overdose by tapering up on the 5-HTP faster than you taper down on the Celexa. (It sure wouldn’t hurt to run this by your doctor and see what he says.)
Cordially,
Neil
I was on Celexa 10 mg for approximately 5 weeks, then Celexa 20 mg for the past 8 weeks (for social anxiety). I have been experiencing some of the posted side effects for Celexa and I want off. My Dr. is o vacation and for privacy issues I refused to explain the side effects to the Dr. on call. I know you have to taper and I have read you article. I only have 20mg tablets and 10 mg tablets to work with.
Hi Pam:
Depending on how much dependence you your body has built up to the Celexa, determines, to a large extent, how fast you can taper off this drug. Since you have not been on it long term, you might want to see if you can taper off the Celexa relatively fast– in other words, not do the slow 300 day taper.
If you split the 20 mg tablets in half, and split some of the 10 mg tablets in half, then you could reduce the dose to 15 mg for a week or two. If you feel fine at that point, then reduce the dose to 10 mg for another week or two, and if all is still going well, then reduce the dose to 5 mg (half a 10 mg tablet) for another week or two. At that point if everything is still going well maybe you can just get off then.
If this is too fast at taper for you, you can always stay at whatever point you got to until everything feels okay, then continue the taper. If you need to, and you have a pill cutter, you could split the pills into quarters and do an even slower taper and go down by 2 1/2 mg per week or two, rather than 5 mg.
Run this by your doctor and see if he thinks this will work for you.
Cordially.
Neil
Neil- thank you so much for all your advice and careful responses to everyone’s individual concerns. I am about to start a taper from 10mg Citalopram (6 intolerable weeks of side effects) and am hugely motivated and supported by all your guidance here, as the task previously felt extremely daunting.
I am on 1 20mg tab of cetalapram a day
Can I tapper of buy taking 6.5 tabs per week for 4 weeks then drop a nother 1/2 tab on a different day for 4 weeks and so on till I am taking 10 mg per day …and then do the same thing skip one day per week for 4 weeks then a bother day ….ect in total it would take me 56 weeks to come right off .
You thought please
Simon
Hi Simon:
You shouldn’t by “choppy” in how you reduce. You should take the same amount each day–but over time reduce the daily dose.
So if you can split the pills into quarters, one way you could reduce is to take 3 quarters for a month (or whatever interval you choose), then reduce it to 2 quarters, then to 1 quarter.
This may be much too fast a reduction–25% that first time, then 33% the second time and 50% the third time. I recommend a much slower gradual taper–reducing 1% every 3 days–not a whopping 25% jump at a time.
However, you know your own body–so if you want to try the above and see whether side effects pop up. If they don’t, then maybe you can reduce that fast. But if side effects crop up, then you know you have to slow things down to a rate such that they don’t bother you.
Cordially,
Neil
Hi
I have been on 10mg for 10 days then Dr uped it to 15mg for 8 days then after that he put me on 20 MG for 4 weeks had depression and anxiety
the depression went on the 20 MG but anxiety got worse so he put me on 30 MG . That’s 10mg ×3 for 7 weeks anxiety got worse on the last 4 days so we went down to 25mg was that to fast dropping 5 MG ?
Hi Barbara:
If side effects appear when you reduce the dose, then you know you are tapering too fast. However, your side effects seem to be getting worse with taking the drug. So maybe it is not the right drug for you. Did you know that Citalopram CAUSES depression (and likely anxiety) in numbers of people? Personally, if I were you, I’d get completely off that drug as fast as is safely possible–but of course, that decision is yours to make.
Cordially,
Neil
Hi, I see you seem to know a lot about tapering off drugs, i’ve been on clonazepam 15 years i’m now on 4mg per day, what would recomend my taper should be ? i do know that SLOW is the key here, i have been told by my doc to go off 1half mg per month hthen at the end take .5 mg for three weeks
what do you think
Thanks Jim
Hi Jim:
That might work, but it is a bit faster than I’d like to see. You could try it and if side effects show up, then you know you are tapering too fast and need to slow down.
The recommend taper is 10% per month on the DESCENDING balance–not a straight taper. I explain this in the above article.
Cordially,
Neil
hello, one thing I did in the beginning was very dumb, I got off two mg in about three weeks and I paid for it, horrible effects my heart was bumping so hard I thought I was going to die, I also have tinnitus and I know it’s something to do with the fillers in most of these generic brands
the one thing I’m trying to do is get a white in color pill mg pill, the one I know I can get is made by actavis witch is now owned by TEVA, would you know of a brand of clonazepam generic without all the dies and bad fillers, I only know of two that’s accord and the actavis
I’m using the brand but can’t afford it $500.00 for 100 pills, any advice would be most helpful
Hi Jim:
Tapering off Clonazepam can also give you tinnitus. How do you know its the fillers that are causing your tinnitus and not the Clonazepam itself. Hundreds of people have reported getting tinnitus from taking Clonazepam.
Sorry, I can’t help you with the ins and outs of which pills have fillers and which ones. I don’t keep track of such things, although I’ve heard that for some drugs, the fillers are far from inert like you would think they would be and can also cause side effects.
Cordially,
Neil
Hi Dr. Neal, ok the reason i know that it’s the brand I’m on right now is I’ve been taking TEVA brand 4 mg for 18 years and no side effects, no (extra) ringing I’m going to have this for the rest of my life I understand this, and have had it 30 years, after all the brands I’ve used with something called aluminum lake #6 IE: aluminum oxide, or just pick a number. in other words for me and my ear ringing with all my research what it has shown me is most anything with these dies and fillers cause more noise in my ears. I also have no doubt that you know what your talking about as per tapering off and that clonazepam causes tinnitus, I just have to try to find the best pill that is white in color without all the extra ingredients I’m not at all sure but the actavis and accord brands seem to be the only two available to me in my small town. you seem to me to be a good man and knowledgeable in these areas and I thank you for taking the time to listen and reply sorry for this post being so long I will get through this, if there is anything you may add please let me know, peace be with you Jim
Hello – I have been on 20 mg of Citalopram for about 10 years. I have gained weight and have some other issues so I decided to try another drug. My doctor prescribed Wellbutrin 150 mg a day. I switched immediately from the citalopram to the Wellbutrin. I have felt terrible on the Wellbrutron. But i have not had the celexa (Citalopram) for a month now. The doctor told me to start tapering the wellbutrin down to every other day for three or 4 doses and start back on the citalpram. My question is, I would like to get off of all of it. I will start the taper with the Wellbutrin, but since I havent had the Citalopram in a month, should I start that back at a lower dose than the 20 mg and then taper off or go right back to the 20 mg and reduce slowly? Thank you so much for the information.
I have been taking 40mg citalopram for about 3 years, but they don’t seem to be working well for me anymore. My GP has decided to change my medication to sertraline and advised me to take 20mg citalopram every day for two weeks before changing to sertraline. I was supposed to have an appointment with my GP to collect my new medication after 2 weeks, but appointment had to be cancelled, so it means I have to take 20mg citalopram for three weeks instead of just two weeks. I’m into the third week of 20mg citalopram and my appointment is in 5 days, but I’m now feeling agitated, weepy, anxious and getting extremely angry for no reason. Can you advise me please?
Hi Joanne:
I think what is happening is that you are having side effects from reducing your Citalopram MUCH too quickly. You do not just suddenly drop the dose 50% and not expect to have some serious side effects pop up. A much safer way is to reduce the dose by 10% on the reducing balance. You would reduce the dose weekly, by-weekly or monthly, depending on how you feel. So to reduce your dose by 50% should take a minimum of 7 weeks at weekly reductions and as long as 7 months if you used monthly reductions.
I know this answer is late–I get swamped as I’m sure you appreciate–but how are things going now. I think you’ll be on the Sertraline by now.
Cordially,
Neil
Hello, I’ve been on citalopram 10mg for about 6-8 months and want to taper off. What would be the best way to do it?
Thank you
Hi Mariel:
I’d definitely taper slower, rather than faster. It’s more important if you have built up a dependence/tolerance to the Citalopram than if not. I’d suggest a 10% taper on the descending balance. This could be per week, per two weeks or per month depending on how you feel. If no side effects show up, you can taper faster, and if you start to feel “off” in any way, then slow down the taper.
Cordially,
Neil
I am so thankful for having come across this information. I have been on SSRI’s for 17 years, celexa specifically for the last 7 to 8. The past few years i ve noticed that the celexa is no longer working for my anxiety so i ve decided to tapper off. My doctor only wanted to give me an additional med to add to the celexa which i refused to do. Tappering off proved to be very difficult for me. I’ve cut back from 20 mg to 10mg with no problem but when i went from 10 mg to 5 mg, i became suicidal, super anxious, depressed, major side effects, not sleeping…etc. It lasted a good 3 weeks. Now i see that it was from tapering off too fast, but at the time, i had no idea what was wrong with me. Thank you for your tapering off schedule. Now on 5 mg, I will need to find a way to cut those all ready tiny pill pieces even smaller. I don’t think that liquid celexa is available where I’m from. Just wanted to voice my appreciation. I have hope now of being able to come off these meds.
Hi Daniele:
If you have pills and want to break them into small pieces (which is almost impossible to do accurately), the way to do this is to get a mortar and pestle and grind a whole pill into dust, then dissolve it in exactly 100 ml of water. You’ll also need a 100 ml beaker that is marked for each individual ml. (It will be a tall thin beaker.) Dump the ground pill dust into the beaker, fill it to the 100 ml line with water, put your hand over the top and shake it until it all dissolves.
Now all you have to do is pour out what you don’t need and drink the rest. That way you can essentially split a pill into 100 parts (each 1 ml represents 1% reduction).
So, for example, if you wanted to taper from 5 mg in 1 mg steps. You crush a whole 5 mg pill. Then, since you want to reduce by 1 mg each day/week (or whatever your taper time is), you’d pour out 20 ml (1/5 of 5 mg = 20% = 20 ml) and drink the remaining 80 ml. When you want to reduce the taper further, you’d pour out 40 ml (2/5 of 5 mg = 40% = 40 ml) and drink the rest, and so on.
This way, you could make a precise taper of 1% a time if you wanted to.
This works for hard tablets, but not for gel pills or capsules.
Cordially,
Neil
Hi Dr. Neal, I have been on 10mg Citalopram for 10 days now. I want to taper off this med so I can go to natural route. Thinking about few options such as 5-HTP, St. John’s Wort, Safranal, Vitamin B Complex.
Can you kindly some suggestions to make the transition as less painful as possible?
Thank you !
Zulf
Hi Zulf:
Since you have been on a low dose and only for a short time, you probably haven’t built up much of a dependence on the Citalopram, so you probably could taper quite quickly. I think what I’d do in your situation is cut the dose in half and at the same time begin taking a “half-dose” of 5-HTP or St. Johns Wort (assuming you are depressed). If/when you have no side effects, then switch completely over. I don’t see that you can’t also at the same time take Safranal (although I have no experience with it) and up your Vitamin B intake.
If that is too fast, maybe do it by quarters instead of halves.
Cordially,
Neil
I’m on citalopram in the UK and never went above 20mg in the three years I’ve taken it. My initial dose was 10mg and my doctor doubled that. My first cut was back to 10mg, then I had a pill every alternate day. I certainly noticed the difference as the no pill day was clearer with no floaty head. I then went to 5mg every day, with my doctors approval. Now I’m on 2.5mg daily. That’s the lowest dose possible with quarter tablets. Personally I find that the inaccuracy of a pill cutter helps you to randomise the dose thus triggering the body back into a normal state.
A life event coincided with my 2.5mg reduction and I found that dealing with that rationally put me back into a better emotional state. That’s when you find you’ve learnt how to cope without the masking affect of an antidepressant. I hope to cease altogether in a short while. I had tinnitus already so noticed no difference.
Now for the bad news. The only true fix is to remove whatever caused the depressive state. In my case it was toxic people providing a continuum of abuse. The last offender is out of my life and I’m feeling better for it. At first it was tough and their hostility hurt. But when I discovered that I’d been constantly excusing abuse by blaming myself for it I suddenly found myself turning a corner. So the bad news is that no antidepressant will ever cure your issues or any holistic remedy. You hit the ground because your body cut out when it all got too much to cope with. It really is absolute hell to get that low. And the cause may be hidden deep from view. That’s why therapy is so essential. It’s the only rational way forward because you learn why you got depressed and build life skills to cope with further events.
Good luck to everyone trying to get off this drug. When you get a breakdown you couldn’t care less about what you’re given just as long as it stops the head spinning. Citalopram is said to be the safest of the SSRI class. But it does have side effects. I particularly love the fluorescent blue figures dancing on my balcony at night when the serotonin hits a high point. They’re my friends now. That’s the only way to deal with some side effects.
Hi Bryan:
As I’ve said for years, the way to treat depression isn’t drugs, but counseling to find the root of your depression and deal with it. Then you can get better and won’t need antidepressant drugs. Your story illustrates this point. But doctors are too quick to put you on drugs rather than get you a counselor that can really help you.
Cordially,
Neil
Good morning Dr Neil,
I was on 5 mg escitalopram for anxiety and it made me so tired I couldn’t function at work. It totally helped my anxiety but I can’t believe that such a small dose made me so tired. So my doctor switched me to 10mg citalopram. It also has helped my anxiety but now after being on it 2 months I am feeling the same overwhelming brain fog every day. I don’t know what to do the. I am 60 years old and I have a high-pressure job and I love it I can’t take this brain fog. So right now I’m trying to take it in the morning to see if taking at night is the reason I have such a brain fog. I do want to taper off of it but I’m not sure I can handle my anxiety at work.. Being in such a low dose and only been on it 2 months, 2 months on the escitalopram prior to that, do you think that changing to the morning will help that brain fog and maybe taking it every other day?
Hi Mary:
I don’t know the answer to your questions about when to take the drugs. Sorry.
But what I’d like to know is why you are so anxious. Personally, I’d seek out a competent counselor to help me deal with the underlying cause of my anxiety–then I wouldn’t have to take drugs. Drugs only hide the symptoms, but do nothing to deal with the cause–which is where you should be focusing your efforts.
Cordially,
Neil
I have been taking Cilift 20mg for 15 years. I am always tired, have little energy and no sex drive at all. I get irritable quite easily. For the last few months I have been getting a strange feeling in my head, almost like my brain resets or I have had a 1 or 2 second memory loss. Should I be tapering off or increasing my dosage?
Hi Debbie:
As far as I’m concerned, no one should be on Citalopram (Cilift) for more than a couple of weeks or so. 15 years is FAR too long. This is because the benzodiazepine drugs such as Citalopram can cause dependence which makes it very difficult to get off them. Furthermore, the longer you take them the less effective them become, until they don’t help at all and then they start causing worse and worse symptoms.
I think this is where you are today. Thus, increasing the dose ultimately won’t help you–just make things worse. And now trying to get off them is going to be even more difficult–but as I see it–it is the only way to get your life back.
The trick is to taper off this drug VERY slowly–something in the order of 1% every three days or even slower if the side effects get worse.
Cordially,
Neil
Hello Neil. Thank you for your reply. I am starting the taper of 1% from today. Kind regards, Debbie
Hi Dr. Neil
I was on 10mg of celexa corn 8 months post partum. I tapered for about 8 weeks and felt fine during the taper. 3 months later I experienced and onset of dizziness and lightheadedness that has been constant. I have been tested for every other possible cause of dizziness, which all came back negative. A neurologist suggested that I experienced delayed withdrawal from SSRI. It has been 6 months of symptoms with minor improvement. Please advise. Thanks you!
Hi Lauren:
Did you take any drugs other than Celexa? Were you on any drugs 3 months later when you began to experience the dizziness, etc.?
It’s possible that you have delayed withdrawal problems, but I’ve not had any experience with that so can’t help you there.
Cordially,
Neil
Thanks so much for responding. I did not take any additional medications. I had the same exact dizziness when I initially stopped for 3 days after 6 weeks of taper. The dizziness went away after resuming the medication. I continued to taper another 6 weeks and felt fine initially. I have always been extremely sensitive to medications and was told that my body metabolizes medications slowly which could have caused the delay once I stopped the medication. In your experience with patients who complain of dizziness. How long does this typically last even when it begins right away? Thank you for your time.
Hi Lauren:
I can’t answer your question as I’ve not had people complain about dizziness lingering. It’s basically been tinnitus that is the problem. I sometimes suggest to them that they go back on the drug at whatever level they need to, and wait until their tinnitus goes away, then begin a SLOW taper of something in the order of 1/3 of 1% a day. That means the taper takes 300 days. But for some people even that is too fast and they have to slow it down even more.
Since you felt fine, you can’t use your feelings as your guide to how fast you should taper. But you could go back on the drug at a level that gets rid of the dizziness then taper much slower than you did before and see if that helps you.
Cordially,
Neil
Dear Dr. Neil,
Although my OBGYN told me it’s safe to take 10mg citalopram during pregnancy, I want to get off the drug before trying to get pregnant. If I taper in the manner you suggest (starting today), in 12 months: January 2020, I will still be on the drug. I’ll be down to 2.54mg from 10mg, but still on the drug. This would be fine, but I’m turning 40 soon, so time is ticking away fertility-wise. What would you suggest? Thank you so much for your thoughts and advice on this.
Sincerely,
Sonny
Hi Sonny:
I agree with you that getting off drugs before getting pregnant is a great idea. It makes sure your baby doesn’t start off life drugged.
I know you want to do as fast a taper as possible, so you could try a faster taper. As a rule of thumb, the longer you have been on a drug, the slower the taper needs to be. Ditto if you have built up any degree of dependence on the drug.
Unless you are particularly sensitive to this drug, you could try a faster taper–but watch for any side effects developing–and if any start to develop, then stop the taper at that point and wait until the side effects go away, then continue the taper–possibly at a slower rate.
I’m not sure where you got your figures from, but a 10% taper starting at 10 mg would give the following figures.
Dose (mg)
10.0
9.0
8.1
7.3
6.6
5.9
5.3
4.8
4.3
3.9
3.5
3.1
2.8
2.5
2.3
2.1
1.9
1.7
1.5
1.4
1.2
1.1
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
You could taper at 10% a week at the above rate and if that is ok, you could try to speed things up and taper at say every 5 days or whatever works for you until you get to a low value that you think is low enough so you can “jump off”.
If the above is too fast, you can slow the taper to every two weeks or any number of day in between (or even slower if you have to). Only you know your own body and how fast you can safely taper. If you are undecided at any point, err on the side of caution and slow the taper.
Cordially,
Neil
How do I get off of 15mg of Remeron/mirtazipine? My dr said cut it in half to 7.5 for 2 weeks then get off and 5 days into the reduced dose I was irritated every other day and then I started feeling this weird tingly feeling in my head/maybe brain, not sure exactly where and I had a panic attack that last an hour.. so day 6 I went back on 15mg. I want to completely get off. I’ve been on the frug for 2 months, why is it so hard to get off and being on it I don’t feel any better. I want to try to reduce to 10% but I feel like I’ll still have symptoms 🙄 but I guess I have to ride it out?? I’m taking cbd oil, magnesium, b complex, fish oils and vitamin d3, what else can I take to make this process easier?
I don’t want to take a year to get off when I’ve only been on it for two months.. that’s ridiculous and torture…
Hi Jay:
If you are getting weird feelings and side effects while tapering off the Remeron, then you know you are tapering too fast. So all you have to do is slow down your taper.
It’s the nature of psychotropic drugs–easy to get on and then you get hooked (they make changes in your brain) and then you find it is most difficult to get off and the drug may even make you feel worse, not better. That is why I say don’t take them in the first place. There are other natural means to deal with depression besides prescription drugs–but your doctors won’t tell you that.
Now to address you issue. So you don’t want to wait a year to get completely off–then don’t. Do a faster taper, but if side effects start appearing, slow it down. Stop the taper at that point and stay at that level on the drug until the side effects disappear, then continue on your taper–probably at a slower pace.
You can always quit “cold turkey”, but by doing so, you risk even more/worse side effects that may prove to be permanent, so I’d never recommend that.
What is your blood level of Vitamin D3. Doctors think it is fine if it is around 20 to 30, but that is grossly low. You want your blood levels to be between 60 and 80 ng/ml. That means you likely need to be taking D3 at higher doses that most people take–from 10,000 to 50,000 IU per day. But the way to determine how much you need to take is by your blood levels of D3.
Dr Mercola says, “the level you’re aiming for is between 60 and 80 ng/mL, with 40 ng/mL being the low cutoff point for sufficiency to prevent a wide range of diseases.”
Cordially,
Neil
I have been on 10mg celexa for a little over 2 years now I want to get off it I don’t think I need it anymore, how do I taper off of 10mg @ bedtime?
Hi Betty:
Read my answer to Sonny for Jan 5, 2019. This is a 10% taper on the reducing amount. Do it as slow as needed. I’d start out doing it by the week and modify it if it is too fast or too slow.
Cordially,
Neil
I started citi generic for celexa 20 mg for1 week then drop to 10mg could not toleorate the 20 mg have been on 10mg for 5 weeks how do i taper off. I have 20 & 10mg to worlk with. Thanks
Hi Angie:
Citalopram (Celexa) is an SSRI. You don’t want to quit “cold turkey”. You want to taper off over a period of at least 2 months since you haven’t been on it too long. However, even that speed of taper could be too fast. How to do it is explained in the article near the bottom and in some of my replies under this article. You need to re-read these again to learn ways to do it.
Cordially,
Neil
Hi Dr Bauman,
I have a real dilemma. I hope you can help.
I have been on Celexa 15mg for 20 years! I want to get off this medication, but no one seems able to tell me how! Can you please help me? I have Celexa 10mg tabs, so I take 1 1/2 tabs at bedtime. Please help me to get off this medication.
Hi Sue:
If you’ve been on Celexa for 20 years, you need to get off very slowly–this could easily take a year or more. A 10% taper on the descending balance is normally a good place to start. The intervals between the reduced taper doses can be a month, 3 weeks, 2 weeks, 1 week, or longer or shorter. The taper time is dictated by going slow enough so that no side effects show up. So if you are doing a taper every 2 weeks and side effects begin to show up, you know you need to go slower–you could try every 3 weeks or every month or whatever interval works for you.
Here are the dosages for each taper interval starting at your dosage of 15 mg.
15.0
13.5
12.2
10.9
9.8
8.9
8.0
7.2
6.5
5.8
5.2
4.7
4.2
3.8
3.4
3.1
2.8
2.5
2.3
2.0
1.8
1.6
1.5
1.3
1.2
1.1
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
Cordially,
Neil
Hi.
I have stopped taking my dose and am experiencing lots of the symptoms mentioned.
If I am able to persevere is it safe and how long before I start to feel better?
Many thanks.
I was on for years weaned myself down to 10mg then stopped about week ago….
Hi Ian:
How are you feeling now? It’s about a month later. It’s not the best to stop suddenly–even at 10 mg. But once you have stopped, it’s probably better to just persevere through the side effects if you can. How long it takes obviously varies from person to person, but it can take from 1 month to several months or longer to get back to normal.
Cordially,
Neil
Dr. Bauman,
I was put on citalopram to treat GAD. I know you have recommended St. John’s Wort for depression, but does it also work for anxiety? I would like to get off the SSRI, but I’m afraid my anxiety will worsen. Is there anything else you would recommend?
Hi Jamie:
St. John’s Wort is good for depression. I wouldn’t take it for anxiety. For anxiety I’d take a herbal such as Valerian to help calm you down. There are other herbals you could also try.
You may also be low in the “B” vitamins and in Vitamin D3. These are two other things you might want to check out.
Cordially,
Neil
Hi doctor I have been taking citalopram 40mg for about 7 years going up from 10mg 20mg and 30.g. I was fine until I hit 40mg . I developed psoriasis only a little while after going up to 40mg. The psoriasis is now very severe . After having done a fair bit of research I am convinced this drug triggered the psoriasis. I think it’s time to come off this drug anyway as my phyciatrist was concerned about the length of time I’ve been on it and ordered an ECG which thankfully was fine. I am 57 years old and want to reduce safely . What are your thoughts please. Thankyou
Hi Angela:
I agree that it would be a good idea to get off the citalopram. Since you have been on it for so long, in order to safely withdraw without negative side effects showing up, I do a very slow taper. A slow taper would take approximately a year.
A good way to start would be to reduce your dose by 10% on the remaining balance each period. The period could be a week or two weeks or three weeks or a month depending on how fast your body lets you taper without getting side effects.
Since you are taking 40 mg now, see my reply of November 6, 2018 to Stephanie for the correct tapering dose per period.
Cordially,
Neil
I’ve been on 10mg Citalopram for at least 10 yrs. I tried quitting by not taking them for about 10 days. I then started feeling very agitated & depressed. I called the dr who prescribed that to ask if this was withdrawal I was having. He told me “no”, it was just my body telling me that I needed the drug. He said to keep taking them. I’m at a lost with what to do.
Hi Mary:
If you have been on Citalopram for 10 years, you almost certainly have built up a dependence on this drug, and stopping this drug cold turkey is not wise as it brings on withdrawal symptoms.
Your doctor is correct in that since you have built up this dependence, you need this drug because your body has quit making it own supply of what it needs. That is why you need to taper off it very slowly–taking around a year to do so. A 10% taper on the descending balance is a good way to go. The taper interval could be every month, or every two weeks or every week depending on how fast you can taper without withdrawal side effects showing up.
I disagree with your doctor that your body NEEDS this drug. If that were true, then everyone should be on it, and that is obviously ridiculous. The way I see it, you NEED to get off it and let your body heal itself naturally.
What you do is up to you, but that is what I’d do if I were in your shoes.
Cordially,
Neil
Thank you! I agree with you. Him saying that it’s my body telling me I need the drug to didn’t make sense to me. When I was “withdrawing”, it was awful b/c all my old feelings were coming back. Thanks for your opinion.
Hi Neil.
Thank you for taking the time to write such an informative article, it has helped me greatly with my situation. I have been on citalopram 30mg for nearly 12 years or more. During that time I have made three suicide attempts. The last a year ago. I asked my doctor to change my meds in January as I felt if they were working I wouldn’t have done this. I have been changed to Rameron 30mg, weaned off cipramil over 4 Weeks, it has been hell. I spoke to doctor about night body jerks, electric head sensations irritability and horrendous hunger. He said ‘oh I must have weaned you too quick’ and he dosen’t know what the body jerks are. Your article has helped explain a few things and thank you for that. I think I will stay on the rameron though as it is helping me sleep.
Any advice?
Hi Mary:
I already replied to you. See my reply after your original inquiry.
Cordially,
Neil
Dear Neil,
First of all, thank you for your time and knowledge.
I have never had anxiety up to roughly a month ago when I lost someone in my family and I couldn’t deal with it hence I developed this issue.
My doctor has prescribed 10mg of Citalopram and I have been on it for roughly 7 weeks now, and I would really like to come off of it. I have tried not taking it for 4 days and felt agitated, depressed and my chest was hurting….nothing so severe I couldn’t handle but I got a bit concerned so I started taking it again. I believe I was tapering off too fast. If I decided to, would it be safe to just come off of it and hold out until the symptomps fade? I don’t want to poison my body any longer.
My other question is regarding anxiety itself. Can it cause vertigo? I have been suffering from it on and off and had a head CT and an MRI scan done but all the results were normal. I have even had my ears looked at and there was nothing wrong,
only tannitis but I always had it.
Thank you for your reply.
Brigitta
Hi Brigitta:
You don’t want to come off Citalopram too fast if you have built up a dependence on it. Rather than quitting cold turkey, it would be better to taper off it, even if done rather rapidly.
For example, you could take the 10 mg pill and break it in quarters and take 3/4 for a week or so. If no side effects crop up, then take a half for a week or so and again if no side effects crop up, the next week take 1/4 for a week and then stop.
If side effects begin to show up, slow down the taper–say wait two weeks before dropping to the next level.
That would get you off it in 1 month, or longer if needed. You could always stop cold turkey and hold out–but that is not the best idea because sometimes bad things occur and become permanent–so better to have some degree of taper.
I’ve not heard of anxiety causing vertigo by itself. When did the vertigo start in relation to losing your family member? And it regards to starting the Citalopram?
Citalopram can certainly cause vertigo and does so in numbers of people, but if the vertigo was before you began the Citalopram, you can’t blame it on this drug.
Vertigo can be caused by your upper neck being out of proper alignment. If your anxiety tightened up your neck even more, it could have thus indirectly brought on the vertigo.
What you can do is go to an upper cervical spine chiropractor and have him check that your C1 and C2 vertebrae are in proper alignment. Just one treatment can alleviate the vertigo, although you may have to go back several times if the treatment doesn’t “hold”.
You can find these special kind of chiropractors by going to http://www.upcspine.com/ and clicking on “practitioners” to find one near you.
Cordially,
Neil
Hi,
I have been on citalopram for 16years and really want to come off , could I crush it in 100ml and reduce by 1% each 7 days by taking out 1ml each day for 1 week , very slowly .
Thankyou
Hi Linda:
Yes, that’s one method that should work. You can adjust the interval time up or down depending whether you begin to experience any side effects or not. If in doubt, slower is always better.
Cordially,
Neil
Hi Neil,
Thank you for the information. I will definitely check in with a chiropractor.
My vertigo came on a month later after the news and I felt really stressed.
During those months my upper back along with my whole body was aching.
I have started cutting the 10mg pill into halves just as a test to see how my body reacts and I have been taking it like this for more than a week (just after I have written to you) and my vertigo went away and I have felt like normal again. I guess it is a good sign.
How long do you think I should keep on with taking half of the pill?
With regards to the vertigo I feel like that as the pill doesn’t have as much effect on my mood and it doesn’t mask emotions as before I started to realize that whenever I felt stressed the vertigo started even though it was mild, nothing like before. This is why I’m thinking that stress and anxiety can be the root cause of my vertigo.
Thank you
Brigitta
Hi Brigitta:
If your vertigo went away after reducing the dose of Citalopram to 5 mg, that may indicate that the Citalopram was the culprit. (Hundreds of people have reported getting vertigo from Citalopram–so you’d not be alone in this.)
Since you have not been on it all that long, you may find a faster taper works for you. If you don’t experience any side effects after a couple of weeks, then you could cut the half in half and do that for another couple of weeks, and if you still don’t have any side effects, then maybe you could stop taking it altogether. If side effects appear, then slow down the taper at that point.
Cordially,
Neil
Hi Neil. Thank you for posting this — it is exactly what I’ve been looking for. I had NO idea citalopram was linked to tinnitus! I’ve been taking 20 mg daily for 12.5 years now and I’m trying to taper off very slowly. I’ve tried twice in the past and failed because the side effects were so harsh, but that was likely because I was doing it too fast. I’m down to 15 mg at this point and I’ve definitely noticed some hypomanic behavior in myself. Is that more indicative of bipolar depression? I’ve scheduled with a local psychiatrist to help me with this process. Thanks!
Jared
Hi Jared:
How fast did you taper from 20 to 15 mg? If you just did that “cold turkey”, that could be the reason. You should do a 10% taper on the reducing balance, or the 1% taper ever three days or so. Slow and steady is the secret to getting off this drug. If side effects begin to show up, then you know you need to slow down the taper. However, if things are going well, you can speed up the taper intervals.
Cordially,
Neil
Thanks Neil. Yes I did do that 20 mg to 15 mg change all at once. I currently have 20 mg pills and could only manage to cut them into fourths, but apparently there are smaller doses I can get ahold of to taper off more slowly than that 🙂
I’ve been on 20 mg of citalopram for 9 weeks, along with 25 mg of trazodone for sleep. My anxiety keeps getting worse and my dr. told me to cut it in half. After reading your article, I feel like I need to cut it by 10%
Hi Amanda:
It’s always better to go slower if you want to give yourself the best chances to avoid the risks of developing withdrawal side effects. But everyone is different as to what speed the taper could take.
You could cut it in half like your doctor said, but if side effects begin to appear you know it was too fast and you could then go back to the full dose and start doing a 10% taper. Or cut the pill in quarters and reduce by 25% for a couple of weeks, then another 25% in 2 or more weeks. See what works for you. Obviously, you want to get the dose down as fast as possible–but consistent with not causing yourself more problems.
Cordially,
Neil
Dear Neil,
After taking citalopram 10-20mg on and off for a decade, I stopped a few months ago (tapering much too fast I now realize) and, after an initial period when I felt fine, I descended into horrible depression and anxiety. I also noticed a weak ringing in my ears. After reading this site, I worry about developing more serious tinnitus, so I reinstated the drug at 2.5mg to minimize ototoxic side effects. Since then, I feel the ringing is the same or slightly worse (but of course I also now focus on it).
I would like to stabilize at 2.5mg, and then later taper very very very slowly if at all. Is this a viable strategy? Am I putting my ears at risk by doing this? Should I discontinue the drug again, or switch to escitalopram (which you indicate is less ototoxic)? Any advice would be appreciated.
Best, Christian
Hi Chris:
The first thing to consider is that you have been off the Citalopram for a few months. You got bad depression and anxiety (as I would expect from too fast a taper). What is your mental state now? If you have the depression and anxiety under control, going back on the Citalopram may be counterproductive and I’d probably stick it out as the worst should be past.
However, if you still have bad depression and anxiety, I’d probably go on the 2.5 mg dose and stabilize then do a very slow taper (but I’d certainly aim to ultimately get off this drug).
I don’t think you are risking your ears any more than you have in the past.
I wouldn’t switch to Escitalopram as my latest figures show it to be about the same ototoxicity as Citalopram if not a bit more ototoxic.
As for your tinnitus, personally, since it doesn’t seem to be too loud and intrusive, I’d just learn to ignore it by focusing on other things and let it fade into the background. Just think of it as a useless external background sound like traffic noise or whatever you normally can hear but totally ignore. Treat your tinnitus exactly the same–because that is all it is–a unimportant background sound–and not even worth listening to or worrying about.
Cordially,
Neil
Dear Neil,
Thank you so much for the prompt reply! My mental state is not too good – I still have bad anxiety, but mostly this anxiety revolves around the tinnitus. I am now on day 4 of the 2.5mg dose and I feel it is getting gradually worse, interfering with my sleep. Do you think that I could be having an ototoxic reaction to this small dose even though I used to do fine with 10-20mg? Or is it more likely my anxiety fueling the tinnitus, which might suggest even increasing the dose to get over the anxiety?
Best
Christian
Hi Chris:
I think you are in a catch-22 situation where your anxiety is fueling your tinnitus, and then your louder tinnitus is fueling your anxiety. So you need to get both under control. If you want to try and drug it into submission, that is up to you. You may want to increase your dose back to were it was, get stabilized and then do a very slow taper.
But during this time, you need to root out the fundamental cause of your anxiety and deal with it so it no longer is an issue. So you need to work on your tinnitus too. Reading my book, “Take Control of Your Tinnitus” would be a good step in the right direction then implement tinnitus strategies that work for you. You can get this book at http://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/ .
Cordially,
Neil
I have been on Citalopram for about 2.5 years 20mg. About two weeks ago I dropped this to 10mg. I am not sure if I am having any side effects. When would I expect to start to see them would it have been before now?
Hi Kevin:
Sometimes you can get away with a 50% reduction like you did without any obvious side effects, but you are taking a risk. To begin a taper, you may not see any side effects for awhile. I’m trying to remember how long it could be–can’t put my finger on the paper I want–but I think it could be up to 2 months. So if you don’t see any side effects by then, you’re ready to continue the taper and get off this drug eventually.
I do not recommend tapering so fast–certainly not in the future for sure. Slower is better, especially as the dose reduces–which is opposite to what you might think seems logical. A safe taper rate is more like 10% a time on the reducing balance.
Cordially,
Neil
Dear Dr. Neil: Thank you for providing this wonderful forum, and for your great expertise. My question is: I have been on 10 mg of Citalopram for 15 years. I note on your 10% taper chart that there is an option for liquid Citalopram. I’m wondering if I could switch to all-liquid and begin my tapering that way, without having to mix both pills and liquid. Thank you so much.
Hi Maeve:
Sure, if you have access to liquid Citalopram–you can use it from the get go. There should be no difference between the liquid or tablet form.
However, don’t get mixed up between mg and ml. Mg is a solid measure while ml is a liquid measure. Now here’s the tricky part. Note that in the US it is my understanding that the liquid oral solution is concentrated such that 10 mg = 5 mL (2 mg/mL). So in this case you want to take the dosage shown in the mg taper column and divide it by 2. So, for example, if the taper shows 10.0, 9.0, 8.1, 7.3 mg as the proper taper dosage, you would divide these numbers by 2 to get the correct amount in ml–namely 5.0, 4.5, 4.05, 3.65 ml equivalent, etc.
Cordially,
Neil
Hi Neil, thank you for this post which I just happened to stumbled upon…I am 43 y/o and a nurse and after the birth of my 3rd child 16 years ago I found myself very overwhelmed with raising kids and working 12 hour night shifts at the hospital. Hormones became out of wack after I stopped breastfeeding and PMS became worse than ever. I ended up on 50mg of Zoloft then after fews years switched to Celexa due to sexual side effects of Zoloft. Excuse the long back story…I have been on Celexa 10 mg (20mg zonked me so stayed at 10mg) for approx 10 years and on a rare day forget to take a dose by mistake and I feel extremely anxious, overwhelmed,headache, brain zaps, irtitable, angry, tinnitus, poor concentration.Nonetheless I know I am sensitive to withdrawl. Ultimately hoping you can send me the taper schedule for both the 10mg/10% taper per month and the 10mg taper of 1% every 3 day schedule for someone like me. Thank you, Sincerely Rosa Laura
Hi Rosa Laura:
I have created two tables in the article. The first one is for the descending balance taper (which I’d recommend in your case) and the second one is for a straight taper of 1% every 3 days so the total taper time is 300 days.
Each table has the dose amounts in mg for 10, 15, 20 and 40 mg doses.
That should help you. If you have any problems, let me know.
Cordially,
Neil
Hello Niel, thank you so much for all this information. I would like to tapper off by the method you mentionned of disolving the pills in 100ml of water and slowly reduce the amounts. I saw that in july 2018 you explained the method and posted the amounts to drop/drink starting from a 40mg dose of citalopram. Could you please tell me the amounts starting from 20mg? I have been taking that amount for three years and have recently been unsuccessful at tapering off over three weeks reduction as my doctor suggested.
Thank you so much,
Barb
Hi Barb:
In the first table in this article the first 4 columnsare headed 40 mg, 20 mg, 15 mg and 10 mg. This shows you the amount you take each time based on your initial dose. The last two columns show you how much you drink and how much you throw away. The amounts you drink and throw away are the same for all four columns since these are all based on the same 10% reducing balance–it just that you start with a different dose.
So for 20 mg, just dissolve a 20 mg pill in 100 ml of water. You drink and throw out the same amount no matter what the dosage is. It’s just that if you start at 40 mg you will have a 100 ml concentration twice as strong as if you started with the 20 mg dose, etc.
Cordially,
Neil
Oh, sorry I hadn’ noticed the 20, 15 and 10 columns!!
Thank you so much for your fast reply, I hope it will work this time.
Kind regards
Hi Doctor Neil,
I am 61 years old and have been on and off anti-depressants for over 20 years. After reading about how terrible they can be, I decided I was ready to try life without them. I tapered off (certainly too quickly) 20 mg of Celexa about three years ago. It was awful. My poor brain became barely functional. Basic cognitive skills were severely impacted. I still remember writing 12 cheques for my landlord at work and it being a monumental task for my brain. I stayed off the Celexa for about two years and spiralled into a deep depression full of suicidal thoughts. I simply was not coping well and went back onto the drug – 20 mg again. I responded well and became able to enjoy life again so all seemed well. I rationalised to myself that my father had struggled with depression and that it was genetic and I simply need assistance. On top of this, I was drinking way to much wine on a daily basis.
Several months ago I was diagnosed with thrombocytopenia (39,000 platelet count). I immediately researched and decided that alcohol must be the culprit. I stopped drinking (82 days sober) and hoped the platelet count would return to normal. No such luck, three months after stopping drinking, the platelet count dropped 3000 to 36,000. There is no cirrhosis of the liver but there are fatty deposits.
Apparently there is a body of research that suggests there is a link between Celexa (and other SSRIs) and thrombocytopenia. My internist wants me off the Celexa asap. He referred me back to my GP. My GP who told me to cut the dosage in half, from 20 mg to 10 mg a day. That was about 10 days ago. I am feeling very tired and the brain fog is creeping in.
Additionally, I have had terrible morning headaches for several months which my GP has attributed to degenerative discs of the neck. Sleeping with a contoured pillow had lessened the severity of the headaches from a 5 out of ten every morning to a 2 out of ten. The headaches go away after two cups of coffee. Don’t know if this is related.
Given my particular circumstance, where I have already started to taper off (incorrectly albeit) and the thrombo cytopenia) I am wondering if you have any recommendations about stopping Celexa under these circumstances and if you know about Celexa and Thrombocytopenia. I am scheduled for more blood work in three weeks, but obviously I will still be on the Celexa. Any advice would be appreciated. I am so confused.
Thanks
Hi Andrea:
I have no knowledge of thrombocytopenia in relationship to Celexa. That is not my area of expertise. I can tell you about Celexa and ears though.
Since you have to get off Celexa and don’t have time to taper down properly (gotta get those platelets up), what I’d suggest is you switch to a totally different antidepressant–the herbal St. John’s Wort. It is not ototoxic, is available without a prescription at many drug stores, health food stores or On-line.
A number of studies have shown that it works as well as, or better, than prescription drugs for mild to moderate cases of depression.
If you choose to get it, just be sure it says on the bottle “standardized” and then give what it is standardized to. You want something that says, “standardized to 0.3% (or up to 0.7%) hypericin” which is the active ingredient.
What I’m suggesting below you need to run by your doctor to be sure it will work ok for you.
Start taking St. John’s Wort at “full strength” along with your Celexa to get the St. John’s Wort (hypericin) built up in your blood. Then after a week or so, start tapering off the Celexa again–hopefully you can do a very rapid taper since the St. John’s Wort is replacing it so it shouldn’t be like a withdrawal so much as just transferring from one drug to another.
Have your doctor check to be sure hypericin doesn’t cause thrombocytopenia as I know nothing about that.
I’ve not heard of people switching suddenly from an SSRI to St. John’s Wort, but I don’t see any reason it shouldn’t work–just like transferring from one SSRI to another. The trick is to get the right dose of St. John’s Wort during the switching process. So you need your doctor to monitor you until you normalize on the SJW and your platelet count starts climbing again.
See what your doctor thinks of the above.
Cordially,
Neil
Thank you Dr. Neil,
You have given me something to explore. I greatly appreciate your time and guidance. I will arm myself with more info and talk to my GP. I like the idea of a natural alternative and will research if there is any contraindication to taking hypericin with low platelets. I would be pleased to keep you posted as things evolve if you are interested.
Many thanks again and kind regards,
Andrea
Hi Andrea:
I’m always interested, so please keep me informed how it goes with you in getting off the Citalopram.
Cordially,
Neil
Hi, I’ve been on citalopram for 7 years but am very scared of the possible bradycardia side effects of increased QT length intervals after my mother recently passed away with heart problems so CVD is genetically in my family history. I want to taper off as soon as possible and replace with 5HTP and natural supplements like co enzyme Q10 etc. I started this week by reducing front 40mg to 20mg daily. I am no more tired and weak than before so no clear withdrawal symptoms. Can I safely continue like this for a month, then next month down to 10mg and the next month stop?
Hi Trevor:
Everyone’s body is different, so you may be able to taper down more quickly than normal. That would be a quick taper–reducing by 50% each month, but it may be doable. Personally, I’d go slower, but if you want to try it, I’d wait two months for the next taper and see whether side effects show up. Sometimes they don’t show up right away, so waiting that extra month will give them times to show up if they are going to. If no withdrawal side effects show up after two months, then go to the next level and stay on it for two months, etc. That would be a safer taper–but still mighty big jumps (50%). The recommended taper is 10% per month on the descending balance.
If side effects show up within two months, then you know you are tapering too fast, and instead of dropping to 10 mg, you should go in smaller increments from then on.
Cordially,
Neil
Dr. Neil,
Thank you for what you do! I am so tired of having chemicals in my body! I want to go natural! Everything natural! I am tapering off Celexa now, I actually went from 40mg to 20mg and took 20 for a while, then down to 10mg and then just stopped and I have been horrible. I was not aware of side effects or withdrawals with this drug! So, I am back up to 20 and hope to taper off soon!
I have taken Celexa about 10 days. My doctor thinks the nausea I’ve been experiencing was anxiety. I started slowly at 10 mg for about 5 days then bumped up to 20 mg for a couple of days, had some not so good thoughts so decided to cut back to 10 mg then 4th or half of a half. Stopped now for 3 days and side effects are YUCK!!!! This stuff is no joke. For the 3 days have felt funny ( not so funny) in my head and my stomach is bothering me. Any advice??
Hi Janis:
Since you have tapered off and three days have gone by, you may be past the worst of the withdrawal side effects. Thus, the better part of valor may be to tough it out until they all go away and hope it doesn’t take too long.
I don’t think going back on the Celexa is a good idea as you’d just be prolonging the agony as I see it.
I wish you well.
Cordially,
Neil
Dr. Neil
I started taking citalopram 20mg for 3.5 weeks, I started having bad headaches so doctor dropped me to 10mg by simply cutting the pill in half. I have been taking 10mg for almost a week now and eventually want to come off. Since I’ve been on such a short time how should my taper look? Take 10mg for 2-3 weeks, then cut the pill again and take 5mg for 2-3 weeks? Thank you.
Hi Ben:
If you don’t have any ototoxic side effects showing up and if you have not developed any dependence on the Citalopram, you could try what you suggested. If, at the end of 3 weeks, you don’t feel any ototoxic side effects, then try the quarter pill for 2 or 3 weeks. If side effects begin to appear, slow down the taper for a bit.
Cordially,
Neil
Hi Dr-
I have been taking Citalopram for about 5 years off and on, most recently for he last year and a half. I was on 40 mg last year and dropped down to 20 mg. At that time I regrettably tried to go off completely, which was a devastating mistake. I quickly went right back in at 20mg. I experienced horrendous and almost debilitating withdrawal symptoms. After about a month or so they went away. It has been a year of being back on at 20 mg with no problems. Until recently I’ve stated to feel the same withdrawal symptoms, slight fogginess, tingling, shivers, nausea, burning sensation on skin all over, sweats. This has all come on over the past few days, yet I’m still taking my rx as prescribed. I’m perplexed at why I would have these same symptoms when I’m still taking my medication. I’m actually ready to start the taper process and then this started. Could I be possibly building up an immunity to the drug? I’m not sure what to do but I don’t want to go through what I went through last year with the withdrawal symptoms. It was absolutely awful. Any help you can provide would be appreciated. Thank you!
Hi Shawntel:
Over time numbers of people build up a tolerance to Citalopram, so it does less and less good. The typical doctor just raises the dose and that works for a while, then the same thing happens again (and again). Finally, you feel terrible and need to get off but you are hooked. So you don’t want to go that route.
You are already down to 20 mg. What I’d do is start a slow taper, as I’ve laid out in this article. You could start with a 10% taper on the reducing balance and hold each step for 1 month or as long as you need to in order to let your body adjust to the new level, then continue to the next step.
You will likely have withdrawal symptoms, but hopefully they will be manageable–which is the purpose of the slow taper.
I wish you well as you get off this nasty drug.
Cordially,
Neil
I am trying to stop taking 20mg. of citalopram; (over 10 yrs.)and have advised my RX. I have read all your responses and can only hope the gradual reduction will work for me. Thankyou
Hi David:
A slow reduction (10% taper on the reducing balance is a good one to try) should work for you. Just be sure you don’t go too fast. So set the taper steps far enough apart to suit your body’s reaction to the reduced dose. It could be monthly, or every 3 weeks, or it may have to be even slower than that. How long it takes you to taper off a drug is not important. The important thing is that you slowly progress towards your goal at a speed that doesn’t cause you any major/severe withdrawal reactions.
I wish you well as you taper.
Cordially,
Neil
Hi
I have been on citoloprom (20 mg then 10)for 2years
I have temperd it by using 10 every other day then 10 twice a week and now i have stopped
I dont have access to liquid forms so i can cut of the dosage daily
I have tried before to cutt if off however after maybe several months as there is a difficulty in my life the anxoety and depression symptoms come back and i was forced to start again
This time i stopped using 10mg once a week
I am having littke depresion symtoms should i cntibue the 10mg once a week?or stop and wait for the depression to get over?
Hi Mary:
You’ve done well to taper down to get off Citalopram.
If you still have some problems with depression from time to time, I’d suggest you might want to look into the herbal St. John’s Wort. Note: St. John’s Wort is an anti-depressant, not an anti-anxiety herbal.
St. John’s Wort is not ototoxic, is available without a prescription at many drug stores, health food stores or On-line. Furthermore it does not create dependence.
A number of studies have shown that it works as well as, or better, than prescription drugs for mild to moderate cases of depression.
If you choose to get it, just be sure it says on the bottle “standardized” and then give what it is standardized to. You want something that says, “standardized to 0.3% (or up to 0.7%) hypericin” which is the active ingredient.
Cordially,
Neil
Hello Dr. Neil, my mother was put on Celexa 8-9 years ago starting at 10 mg, then 20 mg 7 years ago, then 40 mg about a year ago. Before reading this article I took her down to 30 mg about 2 weeks ago (11/17/19). She doesn’t report any withdrawal symptoms but as you mention it is still early. Would it be okay to start your 10% taper schedule from a base of 30 mg, perhaps in 2 more weeks? Could be a coincidence, but her health has been inversely related to dose of Celexa. Since starting it she developed Afib then HF. Her weight increased significantly after going up to 40 mg. Primary doctor hasn’t responded with a taper schedule. He also never tested her for sleep apnea despite family history and her age/weight, I had to push for it. I think her new CPAP machine will improve her health much more than this drug.
Hi John:
Your plan sounds reasonable to me, but remember I’m not a medical doctor. If withdrawal side effects begin to show up, then pause the taper at that point and give her body a chance to get used to that level before continuing the taper.
I wouldn’t be at all surprised that her health went down as the drug dose went up. I’ve heard from numbers of people who found their health improved as they got off the drugs their doctors were prescribing.
Cordially,
Neil
Thank you Dr. Bauman. I encourage other readers to review your article and to look into other guidelines out there that also warn against the use of Celexa especially at higher doses. It was shocking to me that her Cardiologists had little knowledge of the Federal guideline put out strongly discouraging doses above 20 mg for seniors 60 and up. You have to do your own research and don’t assume your providers know everything.
I have not taken citrapam for 7 months, trying to cope with my anxiety and panic attacks, but is it alright to go back on it now.
Hi Lynda:
That’s up to you and your doctor. If you get back on Citalopram, you’ll just have the same problems all over again. Personally, I’d find a holistic doctor that can help you deal with your anxiety and panic attacks using natural means, rather than drugs.
Cordially,
Neil
Hi Doc..Been on 10mg Celexa 13 years..after a bad time at work went from 10mg Celexa to 15mg for only 3 days but ended up getting bad side effects ..is it ok to go back to my 10mg without expecting any side effects after only 3 days on 15mg
Hi Goffir:
I’d hope you could drop back without anymore side effects showing up. If it were me, I’d just do it and see what happens. Hopefully, the new side effects you have will go away in a week or so.
Cordially,
Neil
Hi dr Batman
I’ve been on citolapram for 10 years 30mg,I’ve reduced it to 20mg then 10mg I’m experiencing tinnitus which I didn’t know what it was until I read your reply’s to people’s answers. I’ve been having fast heart rate pins and needles diarrhoea and very sad thoughts,but I had all of these symptoms before I started reducing my tables because I thought it might be side effects from the citolpram I do have an appointment to see my GP in 2 weeks time shall I just carry on with the 10mg until I see the GP ?
Hi Julie:
The longer you are on a Benzo, the less effective it typically becomes and the more side effects surface. So you want to get off it as soon as you can. You didn’t say how fast you tapered–or if you just jumped from 30 to 20 to 10. If you can stand it, I think I’d then drop to 5 mg for two or more weeks and see how you feel, then you may choose to stop it altogether, or continue to taper. Everyone is different so you have to listen to your body for the right speed of taper for you.
Cordially,
Neil
Hi Dr i been on10 mg citalopram for 22 days i have side effects i won’t to stop dr dr gave me 30 peels I have 8 peels left what do you think how I should stop taking them i want to take something natural
Hi Tony:
If I was in your shoes and I only had 8 pills left, I think I’d try to taper off them by cutting them into quarters and then taking 3 quarters for 6 days, 2 quarters for 5 days and 1 quarter for 4 days. That’s would still be a relatively fast taper, but it would get you off the pills with what you have.
Cordially,
Neil
Thank you very much and what do you think when to start the natural pills ,do I start right away when I finish this ,ore I have to wait little bit, I bot this (Myco Botanical
Stress Decompress) what do you think ,thank you .
Hi Tony:
Typically, herbals are not as “strong” and harsh on your body like prescription drugs are. So while you are tapering down on the Citalopram, probably you’d be safe to start taking the herbals. You could take 1 a day until you reach the 1/4 pill taper of the Citalopram, then start taking two a day like they say. I think that is what I’d do in your shoes. Herbals may take a while to build up in your system. Wouldn’t hurt to check with your doctor or pharmacist though.
Cordially,
Neil
Dr Bauman I’ve been on Citalopram well over 10 years. The GP put me on it for hot flashes at 20 mg per day. After a couple of years, I decided I’d rather not take a full 20 mg so I started cutting the pills in half and it seemed to be somewhat effective for my hot flashes, and I dont remember having any withdrawal symptoms. I feel it’s not working so well anymore. And I’ve noticed when I miss a dose at 10 mg. I am not caring for the feeling I have so I told my GP I want to get off it. He said to take 1/2 of the 10 mg and I did this a few days ago and I’m noticing that I’m feeling like my nerves are very sensitive, ringing in my ears and feeling like I could have a panic attack and just a jittery feeling in general, so I went back to the 10 mg and found your site with how to taper off.
Very helpful info. I’m wondering now, have I done damage to my nerves by being on this drug for so long ? And also hoping I didn’t do any damage the 1 week that I went from 10 to 5mg.
What are you thoughts on my last comments?
Knowing how long I’ve been on this dose, how much time do you think I should try towards reducing my dosage? Thank you
Hi Rhonda:
Quite often when you take a Benzodiazepine such as Citalopram, the longer you are on it, the lest well it works, but when you try to get off it side effects kick in. So you want to get off it, but you have to do it slowly.
No doubt, you’ve changed how your brain works by being on this drug for so long. Now you need your brain to change back as much as you can make it change. Since this takes time for your brain to rebuild connections, don’t try to do anything too fast. Dropping by 50% is MUCH too fast. A safe taper rate is as you know is 10% on the descending balance–with typically a month on each step of the taper.
You can’t worry about what damage may have been done–what’s done is done and you’ll have to live with it–but the slow taper will help ensure that no further damage is done. Only time will tell if you have some degree of permanent neurological/psychological damage. But even that can be treated to some degree if it occurs.
Cordially,
Neil
Hi Dr Neil i was on Lorazepam 1mg
for couple weeks then swich to citalopram for a month now I have to pills left and I called the doctor i told him I still have episodes of depression but I’m more quiet but I want to temper out because I have electric shock on my top left side of my head ,and body aik allover me ,what do you think why is that ,the doctor said to get reed of that ill give 20mg citalopram for two weeks, what do you think ,if you are in my shoes what you will do and is it ok switching from 10mg to 20mg ,and will be ok to temper out after thet
Hi Niko:
I can’t answer your questions. I’m not a medical doctor. That is something you need to discuss with your doctor.
Cordially,
Neil
Thank you for your reply. I would like to know if you have anything you recommend I could take that would be all natural to help against the fight of withdrawals during the time of my tapering off of Citalopram?
Hi Rhonda:
You shouldn’t have any withdrawal symptoms of any consequence IF you do a very slow taper. If withdrawal symptoms show up, that means you are tapering too fast.
Cordially,
Neil
One last question. My GP prescribed a liquid solution of Citalopram and his directions are 4.5 ml for 5 days, 4 ml for 5 days, 3.5 ml for 5 days, 3 ml for 5 days , 2.5 ml for 5 days, 2 ml for 5 days 1.5 ml for 5 days, 1 ml for 5 days, .5 ml for 5 days. this is obviously not a 10% taper. This will last 45 days and I worry that it will not be long enough taper, especially since I’ve been on this for over 10 years, so how many ml would you suggest I take for how many days and how many ml is a 10% drop if I’m on 10 mg currently. (I’m not good at math and don’t know how to figure this out). I’d like to try and get off this without having to take 4 years! Can you help me figure a schedule with ml?
thank you
Hi Rhonda:
I agree with you that your doctor’s taper schedule of 45 days is probably much too fast since you have been on the drug for 10 years. A slow taper would take more than 300 days. His taper is about 7 TIMES too fast for safely “guaranteeing” no withdrawal side effects.
To do a 10% taper on the reducing balance, here are the figures in ml. You are on a 10 mg/day dose now which is equivalent to 5 ml/day. So, below are corresponding amounts in ml. You stay on the dose for 1 month each (but if you don’t find any side effects showing up and you want to go faster–you can try staying on each dose for 3 weeks or 2 weeks–whatever works for you. But if side effects start to show up go back to the monthly taper. It will take longer, but is safer.
As the above article states, you will need to get yourself an oral syringe to measure these small amounts.
ml/day.
4.5
4.1
3.7
3.3
3.0
2.7
2.4
2.1
2.0
1.8
1.6
1.4
1.3
1.1
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
Cordially,
Neil
Thank you Dr Neil i hade one more question how do you think I can teper out after two weeks, by the n ill be left with 15 more pills of 20 mg so u took 10mg for a month and now ill be taking 20mg for two weeks thank you and God bless you
Hi Niko:
I’m not sure I understand your situation. You have 15 pills left of 20 mg each and you want to taper off them. If so, I’d cut them in quarters and take 3 quarters for 10 days, then 2 quarters for 10 days and then 1 quarter for 10 days. That’s a pretty fast taper, but its the best you can do with 15 pills.
Cordially,
Neil
Dr Bauman,
Thank you so much for the help. I appreciate your help with figuring out how to negotiate my dosages.
Dr. Bauman,
My doctor recently upped my Celexa dosage from 20 to 40 mg. I took it for three months with no issue. On my first refill, I screwed up and starting taking my old 20 mg prescription. I believe it was about a month before I realized and went back to the 40 mg. Around that time I started having some bad tingling and numbness in legs and arms, and when I try to sleep it spreads to my entire body. Feels like I’m shaking, but no visible shakes. Any advice?
Hi Ned:
Since you had no problems going from 20 to 40 mg for 3 months, I assume your tingling/numbness is from reducing the dose by 50%–withdrawal symptoms. You’ve increased the dose back to 40 mg, so that SHOULD have taken care of these symptoms, but in some cases I think the persist for a long time once you have them.
I’m not a medical doctor so don’t know all the ins and outs of this. You need to talk to your doctor about this and see what can be done.
Cordially,
Neil
‘Once your nervous system falls off that wall, there’s not much that can be done to put it together again.’
Hi Neil, could you please eloborate on this? I lived in a extremely heightened state of anxiety for years, do you think my nervous system will never be healthy again?
Hi Roy:
It seems that sometimes your brain changes permanently and doctors don’t know how to change it back again. But that doesn’t mean there is no hope and no help. Since I wrote that article, I’ve run across something that may change all that. What I’d do is, assuming you are in the USA, go to one of Dr. Amen’s clinics and have a SPECT brain scan. These clinics have been doing a wonderful job of “fixing” people’s brains again. You can what they do on their website at https://www.amenclinics.com/ . Snoop around it and read up on the sections in “The Science” and elsewhere and see how they have helped others–and can likely also help you.
Cordially,
Neil
Dr Neil i took citalopram10mg for one month then 20 mg for 2more months now the 4th month i have 30 pills of 20 mg citalopram and i start tempering off i cut the 20mg in 4 pieces i and i took 3 pieces for almost one week ,which is 15mg [its been 6 days now ] then for next week will be cut on half will be 10 mg then for one more week will one half of the half which is 5mg and for one more week ill take 2,5 mg then ill stop what do you think is this good temper or
how will you temper this 30 pills of 20mg citalopram thank you .
Hi Niko:
That is probably as good a taper as you can do with the 30 pills you have to work with. If it’s too fast, you’ll have to slow down–but renew your prescription so you have more pills to work with.
Cordially,
Neil
Dr Neil thank you very much for your respond ,is it ok to take l-tryptophan , b coplex fish oil and magnezium will im tempering out and what else do you recomand ,thank you and stay save .
Hi Niko:
Yes, I don’t see any problems with taking the above while you taper off the Citalopram.
If you are not already taking vitamin D3, that would be a good vitamin to add to the above.
Cordially,
Neil
Hi Dr Bauman, I wanted to let you know your recommendation for tapering with the liquid citalopram has been working perfectly. From an original starting point of 10 mg, I have been able to get 8.2 mg (4.1 ml liquid Citalopram) without any side effects and I’ve been able to do it in a little less time than you recommended, still a long road to go though, but I did have another question.
I cannot afford to continue on such a long course of tapering with the liquid citalopram, so I will have to start crushing my pills. With that said, I know I’ve read in previous posts how you recommend crushing and dissolving the tablets in 100 ml of water. So if I dissolve a 10 mg tablet in 100 ml of water and continue the 10% taper, what am I looking at for a schedule of how much of the 100 ml I would take if I’m starting at my current level of 8.2 mg?
Thank you, you are a godsend with your helpful information on this issue.
Hi Rhonda:
Go to the 10% Taper Chart in the above article and just follow along using the 10 mg column (4th column) and the 5th and 6th columns telling you how much to drink.
Just start on line 4 the 7.3 mg dose for your next taper, and then continue down the column until you are finally off this drug.
Cordially,
Neil
Thank you, I thought I might be able to use that schedule, but I wanted to know from you first before I just assumed it would work for me. I’m very cautious about this drug now, knowing what it has done to my body.
I’m so disappointed in traditional Drs and how the easy way out is to prescribe drugs that cause more problems than they fix.
Thank you for all the great advise you give on this matter as I can see it’s helping many people..my situation: I’ve been on 10mg Citalopram for about 10 years and I decided to taper off and do without..without giving to many details I know from all the side effects I’ve had on my third week that I tapered to fast ..I’ve gone back to taking 10mg to Stabilise myself and follow your advise of a very very very slow taper..is there any idea how long it’ll take me to get back to being stable and get rid of the side effects of tapering to fast..I was at 2.1/2 weeks before I went back on to 10mg
Hi Goffir:
I think it depends largely on how much dependence you have built up for the Citalopram. I wouldn’t be surprised if it took you at least 2 or 3 months to get back to “normal” so you can begin your slow taper. But it could be much longer, or shorter. Only time will tell.
Cordially,
Neil
Hi Neil I
Really can use ure advice on tapering off of 10mg of pill citalopram for 9months I’ve been on it when u say cut it in quarters the 10mg that’s 4pieces wright and I would take 3of the 4 pieces wright also and for how long should I take the 3pieces for in tapering off. Need help thanks in advance neil
Hi Reese:
How long you take 3 of the 4 pieces depends on whether you experience withdrawal symptoms. The idea is that it might take a month or so between steps, but listen to your body. You might be able to do it faster, or you might need more time than a month, but a month would be a good starting point to see how it works for you.
Cordially,
Neil
I have been on celexa for 13 years, I have tried multiple taper this being my third taper. I did this on my own because I am not sure where to find a MD. I started by slowly tapering 20mg daily 6 days a week and 15 mg the 7th and did this for 4 to 6 weeksn and them tapered another 5 mg that same day and once 10mg I started tapering another day ect. After 1 and 1/2 years I am still having variable sleep issues as my only main side effect of withdrawl, so recently changed meds to morning time for about a week but had such bad fatigue i went back to nights this week but my sleep has been horrible. I would take any advice to help minimize sleep disturbances . I am currently on 10mg 5 days a week and 20 mg on 2 days. Should I got up a little in my meds till symptoms improve or hold out and see if it does. I have hydroxizine and belsorma for sleep but doesnt always work. I thought of adding 5-HTP but dont know the dose and do not want to withdrawls from that if it will be just as bad?
Hi Amanda:
You really don’t want to go “backwards” once you have succeeded in tapering down. If you can, personally, I’d see if I could tough it out and stay at that level until all withdrawal symptoms go away before tapering more.
For your information, it is not the best to vary the dose 10 mg one day and 20 the next. This largely negates the effects of trying to taper off a drug. You want a smooth taper–always going down.
You can do this by splitting pills in half or quarters by getting a pill splitter. Or you could dissolve the pill in 100 ml of water then pour out the 1 ml and drink the 99 ml. Then the next day (or 2 or 3) do the same but pour out 2 ml and drink the remaining 98 and continue doing this until you are pouring out the 99 and drinking the final 1 mg. Then you are off the drug. This could take between 100 and 300 days depending if you stay at each level for one day or 3 days. I’d suggest the 3 day level as the safer way, but if your body allows it go faster at 2 or 1 day intervals.
Cordially,
Neil
I have been on Citalopram 40mg for many years. It does seem to have helped in terms of depression. I have had loud ringing in my ears for a long time; I can even make out two or three tones at the same time, and I never knew it might be connected until I read this article. I wanted to try getting off this drug, just because I’d rather not take any drug, and my doctor said to reduce my dosage by 50% for at least a month. I asked if that was a gradual enough taper, and she assured me it was. I have been taking that 20mg dosage for six weeks now, and have not experienced any bad effects. Ear ringing has not changed, nor has anything else. Now I find out from your article that was too sudden (though maybe I got lucky and no harm was caused). The question is: how should I proceed from this point?
Hi Kathy:
Hah! Your doctor sure is ignorant about tapering off Benzodiazepines. A slow taper is 10% a month on the descending balance–and that would take about a year. That is a “safe” taper. Yes, you can taper faster if you haven’t built up a dependence on the drug and depending on your body–everyone is different.
Some people can stand quite a big drop at the beginning, but if they continue all of a sudden, they can get hit with withdrawal side effects. Thus it is better to go slower and avoid any side effects.
If I were in your shoes, I’d just start the slow taper from where you are now. I wouldn’t go back to the original dose. Just reduce your current dose by 10% for the next month, and then another 10% and so on. If there are no withdrawal side effects even beginning to show up, then you could speed up the taper–don’t change the rate (stay at 10%) but reduce the interval between drops such as 3 weeks or 2 weeks and see how it goes.
If withdrawal side effects begin to show up, hold the taper at whatever level you are until they go away, then continue the taper, perhaps at a slower pace.
Cordially,
Neil
Hi Dr. Bauman
I have been taking celexa for 16 years. I started taking them for panic attacks only I am not depressed. In January this year I had a little break down which landed me in total panic attacks so bad I was down for almost two months, but I feel like the celexa didn’t really help me but I continued to take it and in June decided I would wean off with the help of my physiatrist. He said I could take 5 mgs off every 6 wks I’m now down to 25mgs and started getting the side effects and panic attacks so I went back to 30mgs and finally after 5 days just barley feeling better, however after reading your information on weaning off I will be paying closer attention. Now my question is after I am off completely what happens if I still have a panic attacks? They are so debilitating
Thank you
Kristine
Hi Kristine:
One of the little mentioned facts about Citalopram (Celexa) and kindred drugs is that they can CAUSE panic attacks as one of their side effects. And the longer you take such drugs, the less effective they become and the more likely they are to cause side effects such as panic attacks.
So, after 16 years, this drug could be causing your panic attacks, not preventing them. Its a possibility.
As you know, you need to taper off very slowly, taking around a year to taper off.
Now to answer you last question regarding what you do if you have panic attacks. First, if you taper of very slowly, that should reduce the risk of having one. And if you do feel like you are close to having one, there is a lot of good information on the Internet of natural things to do (apart from using drugs). For example, this website (https://healthprep.com/conditions/10-techniques-to-help-you-survive-a-panic-attack/) gives you 10 techniques to help you. It would be good to start using them while you are tapering off and you might find that doing them is enough to ward them off so you never get them anymore.
Cordially,
Neil
I’d like to come off citalopram 20mg as I find it interferes its Elvanse 50mg but I feel like I can’t function with or without it. Seizures and tingling hands and feet with shaking and severe nausea when not taking For 18/20 hours I realise I should have tapered and will follow your 10% rule. But when I take it with the elvanse I feel jittery and very very anxious the opposite of the way it should work. Taken for six months now and no change. I’m concerned about feeling highly depressed if I come off it.
Hi Charlie:
I don’t know how to advise you in tapering off the Citalopram since you are also taking Elvanse. You need to work under a knowledgeable doctor, preferably one that knows how to help you deal with your depression without having to take drugs.
Cordially,
Neil
Hello doctor
I’ve been on 30mg for a year and I thought I was ready to come off
Unfortunately my doctor could not be reached for the last 4 months so I spoke to my pharmacist that told me to take 22.5mg for a week 15mg for week, then 7.5 mg for a week and then I’m done
I realize this was too quick so decided to stay on 22.5mg.
It has been 6 weeks and I’m only feeling worse and worse. I think I should go back up to 30mg what do you think
Hi Anthony:
What did you decide to do? I’m way behind in answering.
There are two philosophies on this. One is that you have supposedly weathered the worst of the withdrawal in the past couple of months so going back to the original dose would just be prolonging the agony, thus you could tough it out until the symptoms go away and then start tapering more slowly this time.
The other philosophy is to go back to the original dose and then taper slowly from there.
The choice is yours. You’d hate to go back and then find out that if you’d hung on another week you would begin feeling fine where you are now. But there’s no way to know that. So that makes deciding a bit difficult.
Cordially,
Neil
Hi, I’ve been on citalopram 10mg for 6 months for postpartum depression. Occasionally I increased to 20mg with hormonal imbalances. I’ve been off it for 7 days due to missing doses during a bereavement. I’m having some mild dizziness and irritability but that’s it (so far) It wasn’t my plan to go cold turkey but do I just keep going?? I am desperate to get off it as I feel ready and would like to fully be in control of my mental and physical health again.
Hi Jenny:
If you can stand the withdrawal side effects, and you haven’t built up much of a dependence on the Citalopram, then quitting cold turkey should be ok.
Cordially,
Neil
I have been on Citalopran for 14 years. I take 60mg every day. I want to try and get off of it and see if my memory improves. Will it really take me over 3 years to do that?
Hi Alashandra:
There is no set time to taper off a given drug. It all depends on how much dependence you have built up for a particular drug. You can taper off as quickly as your body allows. That means you might be able to taper off in 3 or 4 months, or it may take a year or more.
Tapering off slower is always a good way to start off. Then if no side effects show up, you can try speeding it up a bit more. You want to taper off a drug at a rate that don’t allow side effects to bother you. If side effects begin to show up, then slow down the taper rate to a point where you don’t feel bad and go at that rate.
Cordially,
Neil
Hi Neil,
Firstly, thank you very much for all of the advice given, it’s greatly appreciated.
I was on Citalopram 20mg for about 3 years. I wanted to come off it as I had been feeling much better for about a year. However, I believe I tapered much too fast based on reading all of these responses (I only tapered over a month – 20mg, 15mg, 10mg, 5mg to zero).
My last dose was one week ago. Since then I’ve been very tired with strange vibration feelings in my body.
My question is – do you think I should go back on them, and then taper much more slowly? If so, should I go back on the full 20mg dose? I did not feel any withdrawal effects while tapering, I only started to feel the withdrawal effects the day after my last dose.
Thanks so much.
Hi Adam:
I think what I’d do in your situation would be to go back to the last taper dose level (5 mg) and stay on that until the withdrawal effects go away. Then start tapering down again–but going much slower than you were. For some people the final taper doses need to be very slow. I think this is your situation. I’d spin out that 5 mg dose over a number of weeks or months–reducing it by 10% each time for a week or more at each level.
I don’t think you need to go back to the full dose–since you’ve tapered down to 5 mg without any problems.
Cordially,
Neil
Thanks so much Neil, that sounds like a sensible plan, I will go ahead with your suggestion.
And just to add – not many people would be happy to spend their time giving strangers such thoughtful advice, so I just wanted to thank you again.
A
I have been on 10mg of Citalopram for 4 days but can’t deal with side effects, could I just stop taking them?
Hi Eunice:
I’m not an expert on this. I THINK you could get away with stopping cold turkey, but I’d feel happier if you did even a brief taper such as cutting your pills in half and taking a half dose for 3 days or so, then cut a half in half and take a quarter dose for 3 days or so, before stopping. If side effects from tapering off occur, then you can go slower.
Cordially,
Neil
Hey Neil. About 3 months ago my citalopram dose was put up half a tab (10mg) after 6 years of taking it. I got vivid images of suicide etc. So I dropped back down 2 months ago. This was done overnight. Recently I have started to experience palpatations, quite interesting after I missed a dose it was very bad and randomly it happens now too. I didn’t realize this was a symptom either but the ‘brain shocks’ have been a bit uncomfortable all other symptoms have been mild. What I’m wondering is do I stick with dose until my symptoms go away or keep lowering my dose and put up with the symptoms? My doctor said I can go to half a tab for 3 days and stop entirely but considering how I’ve been on it for 6 years I think it might be better to do it gradually.
I’m currently on 20mg
What are your thoughts?
Hi Kayla:
When you’ve been on a drug for several years, it’s wise to slowly taper off it to avoid all the nasty side effects you can experience.
You have the two possibilities as you know–stay with the current dose until your side effects go away, or continue tapering (very slowly). Personally, I think the better part of valor is to stay where you are (you’ve already put up with 2 months of withdrawal side effects–probably the worst is past now) and when they become minimal, then begin tapering off using a risk reduction taper of 10% a month on the descending balance.
Brain zaps are an indication that you are tapering too fast.
Cordially,
Neil
Thankyou so much for your prompt reply, I will definitely do that ☺️
Hi. I have been on 2 medications for just over 2 years for extreme anxiety and panic attacks. Citalopram and Mirtazapine. I am ready to come off of them and try a more natural approach. I havr read your article and would like to do the 10% taper but I am wondering if I can taper off both at the same time?
Hi Hailee:
You could taper off both at the same time, although I wouldn’t recommend it. It’s hard enough dealing with one drug at a time.
I think what I’d do if I were you is taper off the easier drug first which is likely the Mirtazapine. You may be able to taper of it a bit faster than the Citalopram. Then once you are completely off it and everything is ok, then do the 10% taper off the Citalopram. You can taper off as fast as you can as long as side effects don’t appear, or if they appear are so minor they don’t really bother you.
Cordially,
Neil
Thank you for your quick reply. I will try what you recommended.
Dr Bauman,
Hallelujah, I have a success story for you.
Thanks for your direction on how to taper off Citalopram, I am now free and clear of this horrible drug.
I wrote to you a little over a month ago. I had been on 10 mg for over 10 years and finally decided it wasn’t working for me and when I tried to “get off” I suffered the many side effects, which led me to find you.
After your recommendations, (I was able to speed up the process a tad bit), I’m now off the drug with no intentions of EVER going back to this type of drug again.
This drug was devastating to my body and my physician did me a huge disservice by prescribing it to me for “hot flashes”.
The only symptom I have left after this many years of being on this drug is a little bit of a ringing in my ears, but I’ll take that over the other many symptoms while trying to taper off this drug, and with time I hope the ringing in the ears will dissipate as well.
I just wanted to let your readers know to stay the course and don’t give up. Even if you feel like it is hopeless you will get better.
You can possibly speed the process up as I did, but listen to your body, it will tell you and all you do is just go back to your schedule and keep going.
Thank you Dr Bauman
Rhonda
Hi Rhonda:
I’m always delighted to hear success stories. So many people tell me their woes with drugs–but not their success stories as they successfully withdraw from a drug and their ears return to normal or near normal.
Thanks for your success story.
Cordially,
Neil
I do not k ow if you are still using this blog now that we have Covid, but this has been so helpful. My son has been on Depokote, Cogentin, olonzapine and was put on this awful drug 3weeks ago. I was looking for ways to get him off of it as it is not good for him. He has had a TBI, takes aspirin and plavid and trazadone at night which he has just started taking about 3weeks.
I am so thankful that I found this blog.
He will be off verry quickly since he just started taking10mg.
Hi Laverne:
He is taking all those drugs for TBI? Seems excessive. I’d think a better idea would be to go to one of the Amen Clinics (https://www.amenclinics.com/) and have a SPECT scan to see exactly what parts of his brain aren’t getting enough blood flow, etc. and then be treated for exactly what is wrong, rather than just throwing drugs at it and hoping they might help.
Cordially,
Neil
Hi. I have been on 40 mg celexa and 150 mg Wellbutrin for over 20 years. I started taking them to deal with stress in the classroom. I retired this year and decided to quit using them. I did a very bad taper over 3 weeks. 2 weeks later had major side effects that started celexa again. I did 10 mg for a few days then up to 20 with little improvement for a few days. I am now back up to the original doses for celexa and Wellbutrin. I’ve been on them for 2 weeks now. I am still having some issues: severe insomnia (haven’t slept in a week) severe constipation ( no bm for almost 2 weeks, and weight loss(almost 20 pounds). My appetite is gone and I am forcing myself to eat and drink. I don’t urinate like I did before. I set up an appointment but it is almost 4 weeks away. I am 63 years old. I had gastric bypass almost 10 years ago. I’ve tried natural remedies like melatonin, otc sleep side, prunes, oth counter fiber, etc. if I ever get straight I do want to try your method of tapering. Do you have any advice for me?
Hi Kathy:
I don’t know what you should do to get your body working properly now. That is not my area of expertise. You need to work with your doctor (MD) or naturopath (ND).
When you are ready to taper off these drugs, one rule is to only taper off one drug at a time, so if you want to get off the Celexa first, then leave the Wellbutrin alone until you are completely off the Celexa. And I’d recommend one of the slow taper protocols mentioned in this article.
Cordially,
Neil
I am SO SO SO thankful I came across your page Dr. I have been on 20mg of Citalopram for 9 years now. I am desperate to come off this drug. I am 100% doing your 10% taper recommendation and following all of the steps and advice you have shared. Thank you so much. I have always been so reluctant to ask my GP for help as they reduce the dosage way to fast. I have a picture of a beaker I am looking at purchasing and would like to be able to send you a picture of it so you can tell me whether or not it is the correct on to buy. It is a 100ml beaker with all of the small lines in between the main ML’s.
Hi Sophia:
As long as it has every marking from 0 to 100 it will work fine. It will be a tall thin beaker. The short fat ones typically are only marked off every 10 ml and that is not accurate enough for your purposes.
I’ve sent you an email showing the kind I mean since I can’t post images here.
Cordially,
Neil
Hi Dr I take lorazepam for 6 days 1 mg I want to swich to st johns wort do I need to taper do 1/2pill for one week than half
of half for onother week what do you think whT is best way to temper and its ok to swich to st johns wort from lorazepam
Hi Niko:
I doubt you have built up any dependence on the Lorazepam after just 6 days so if it were for myself, I’d just stop the Lorazepam and begin taking the St. John’s Wort. Always best to run it by your doctor of course.
I don’t know why you are taking the Lorazepam, but if it is for depression, then St. John’s Wort should work. If it is for anxiety, then St. John’s Wort is not the right herbal.
Cordially,
Neil
Hi Dr,
I really hope you can help me, I want to completely come off of my 10mg of citalopram that I have been taking for the past 3/4 years.
I’ve read 90% of your replies to others but;
I only have 2 weeks of medication left (1 per day) and I cannot really afford to buy more.
Would I be able to taper off within those two weeks safely?
I really hope to hear back from you soon.
Kind regards
Amy.
Hi Amy:
How fast you can get off Citalopram depends on whether your body has built up a dependence to the Citalopram. Not everyone does, or not at the same rate. I have no way of knowing whether you have built up any dependence or not, so I cannot advise you whether you need to taper and if so, what a safe taper-rate would be for you.
Since you have been on Citalopram for between 3 and 4 years, I’d assume you have built up some degree of dependence on this drug and therefore a slower taper rate would be better than a faster taper.
Also, since you have read my many replies, you know that the “safe” taper rate is 10% per month on the descending balance which would typically take around a year to complete.
Anything faster than that is “less safe”. So my advice is to find a way to do the slow taper if you want to avoid any withdrawal side effects.
If you choose to go faster, you increase the risk of nasty withdrawal side effects. Thus, you want to spread out the taper as long as you can.
Since Citalopram has a half-life of about 35 hours, you can spread out the taper more than for a drug with a shorter half-life.
If you only have 14 pills life, here is one possible taper rate you might want to try.
Split the pills into quarters. (actually some halves and some quarters)
4 days take 3/4 pill per day
10 days take 1/2 pill per day
12 days take 1/4 pill per day
24 days take 1/4 pill every second day
You can adjust it as you like depending if you are feeling side effects or not. It would be a good idea to run it by your doctor to see what he says.
Cordially,
Neil
Thankyou so much, I’ll try your method.
And my first thought was to see my doctor but I’m unable to get an appointment, earliest appointment I can get is in the next 16 weeks.
Amy
Hi Neil,
First of all, thank you in advance for taking the time to respond. Regarding the 10% taper table you provided. I’m slightly confused, because you said that each 10% reduction is per month and I counted 50 rows in that table. So that would be over 4 years! But you mentioned something like “it could take you over a year to complete”.
I know you said that it could be sped up to every 3 weeks, or even less, but even so based on that reduction schedule it seems to me that it would never be around a year – am I missing something here?
Many thanks,
David
Hi David:
You’re right. The way I wrote it WAS confusing. Thanks for bringing it up.
I’ve rewritten those places to make it clearer. If you do the slow 10% taper per month, and want to get to a very low “jumping off” point, it would take you 4 years, not just one year.
In contrast, if you used a fast taper of 10% per week, and the same very low jumping off point, then it would take you just 1 year.
However, the total length of time depends on what you consider a “safe” jumping off point. People may choose considerably different jumping off points. The safe jumping off point is that point where, when you stop taking the drug, you don’t experience any (or minimal) withdrawal side effects.
Feel free to modify the taper to fit your body. You don’t have to slavishly follow the taper schedule, but if you don’t know where to start, this is a “safe” taper protocol that should work for most people.
Cordially,
Neil
Hi Neil,
Thanks so much for your reply and I’m glad my “catch” was helpful. By the way, it’s good that I came back to check to see if there was a reply, as I didn’t receive an email alert from the site when you responded.
A couple of other questions if you don’t mind:
2. I’m not in the US at the moment and unfortunately the liquid form of Citalopram is not available here. I spoke with a psychiatrist here and they said they don’t trust the compounding pharmacies for this, so she recommended switching to Lexapro for the tapering process. She said they’re similar enough to not be an issue, but I just don’t like the sound of adding in another variable to the equation. If I’m not feeling well I won’t know if it’s the tapering speed/amount or the medication switch. Do you have any experience with this? Do you think it’s a good/bad idea?
Note: besides switching to Lexapro she also laid out a more aggressive tapering approach which concerns me. Going with a fixed amount instead of the 10% approach of the latest “balance” of the dose.
3. From the Surviving Antidepressants website I read that it’s easy enough to make your own liquid by dissolving the pills in water. However, it’s not clear to me if this is an ok approach from a “chemistry standpoint”. If it’s not an issue to do this, what about storage? Does it need to be done daily, or can one make a batch and use it over a longer period without it losing its potency? It takes about 20 minutes to dissolve a 20mg pill, so not ideal to have to do it daily.
Thanks in advance for you response. It’s really very generous what you’re doing here for everyone.
Best,
David
Hi David:
Escitalopram (Lexapro) was basically derived from Citalopram so is somewhat similar in its actions.
Why did your psychiatrist recommend switching to Escitalopram–because you can get it in liquid form? If so, that might be a good solution. Otherwise, I don’t see the point of switching.
I don’t know whether you can just stop the Citalopram one day and start the Escitalopram the next day or not. Ask your doctor or pharmacist. If so, I’d do the switch well BEFORE you start the tapering process by at least a month or more so you know any side effects, changes in how you feel, etc. Once you are stable on the new drug, ONLY then should you begin the tapering process. That way you’ll know any emerging side effects are due to withdrawal, not the change in drugs.
If you can’t just switch from one to the other instantly, then you might want to taper off the Citalopram while at the same time tapering up on the Escitalopram. For example, you could take 3/4 the dose of Citalopram and 1/4 the dose of Escitalopram for a week, then half and half for a week and then 1/4 and 3/4 for a week. This is just a hypothetical example. Run it by your doctor what a safe change-over rate would be.
It is quite possible you can taper faster than the 10% descending balance rate. The 10% descending balance protocol is considered a generic “safe” rate for any drug. You may be able to safely taper Escitalopram faster–I don’t know.
In any case, if you begin developing withdrawal side effects, then you know you are tapering too fast. If that happens, then pause the taper until the side effects go away, then resume the taper, but at a slower rate. It’s up to you how fast you choose to taper.
I don’t know if dissolving pills in water changes their chemistry or not. I’d ask your pharmacist. Using warm water will allow the pill to dissolve faster than in cold water. But the way to do it is to first crush the pill into a fine powder (use a mortar and pestle). That will really increase the dissolving speed. And even if you don’t wait for it to fully dissolve, stirring the solution vigorously before pouring out the “wasted” amount, will still give you the correct dose as the undissolved particles will be dispersed equally throughout the water.
I wouldn’t store anything. Each day, I’d use a 100 ml beaker of water, dissolve the pill. Then, the first day you’d pour out 10 ml (10%) and drink the rest. You’d do this for 1 month (or whatever taper period your choose). The next taper would be 10% of 90% or 9 ml. So you’d pour out 10 + 9 = 19 ml and drink the rest. The next step would be 10% of 81% or 8.1 ml, so you’d pour out 27.1 ml (10 + 9 + 8.1 =27.1) and drink the rest and so on.
Cordially,
Neil
Hi Neil,
Thanks for your reply. Is there a way to be notified automatically after you respond? I keep forgetting to check back ;).
In terms of the recommended switch from Citalopram to Lexapro by the doctor … yes, it was solely because it’s available here in liquid form here in Brazil and Citalopram isn’t. But I fully agree with you in that I don’t like the idea of an abrupt switch. That said, I also don’t feel like delaying the start of my taper to adjust to a new medication first. I think I’d prefer to go through the hassle of making my own Citalopram liquid.
Regarding my question as to whether or not dissolving the Citalopram tabs in water changes their chemistry at all… I’ve been trying to find the answer online without any luck. Local pharmacists in Brazil usually aren’t very helpful. Any ideas where to find a reliable answer? Given that it’s water soluble I would think it would be ok, especially if it’s consumed immediately after dissolving, but what do I know?
Thanks again, and all the best,
Scott
Hi Scott:
I’m sure there is a way to be notified automatically, but I’m sure I don’t know how to implement that on my website. Some people seem to know almost instantly when I reply to their comments, even if it is a month later, while other only find my replies by accident when they check back for some reason–like you did.
I don’t know where to find the information on dissolving pills in water changes their effectiveness either. I tend to think that for tablets, it doesn’t make any difference, especially if you first grind them to a fine powder, then dissolve them and drink the correct amount immediately. I think that is what I’d do if I was in your shoes.
And even if all the tablet didn’t dissolve, by grinding the pill to a powder and stirring the water vigorously, the fine particles would be evenly distributed throughout the water for a minute or so, so you’d have time to pour out the amount to be discarded, before anything settled to the bottom and thus mess up your carefully calculated dosage.
Cordially,
Neil
I can’t tell you how much I appreciate your helpful tapering schedule. I’ve been on Celexa since 1999. I’m on 10 mg. Is it possible to taper 1% every two days, rather than three days? Or is that too fast? Thank you.
Hi Kim:
There is no “correct” speed to taper off a drug. It all really depends on your body and whether you have developed a dependence on the drug. The very slow tapers are the “safe reduction” tapers that almost guarantee you won’t have any withdrawal side effects, but you can taper faster if your body is ok with it. It’s just that the risk of withdrawal side effects increases the faster the taper.
If you want to, try a faster 2 day/percent taper and see how it goes. If you do not experience any withdrawal side effects, then great, go for it. If you begin to see withdrawal side effects beginning, pause for a few days at wherever you are in the taper until they go away, then continue from then on at a slower rate. Do what works best for you.
Cordially,
Neil
Hi Dr. Bauman,
I was prescribed 20mg. Celexa 20 years ag for fibromyalgia. Many times I tried to stop taking it, every time with horrible side effects.
Finally, a pharmacist suggested I stop taking one pill on Tuesdays for a month. If that seemed ok, stop taking it Tuesdays and Thursdays for a month, and so on.
I spent over a year doing that until I was on 1 half pill, 10mg, twice a week.
I stayed that way for over a year, because I made a major life change and moved to a new city and state by myself as an empty nester and knew that the timing was not good for me to go off completely.
Although I had not heard of your weaning timetable, I had read that the last bit of celexa to leave your brain is the hardest.
Three months ago while I was traveling I realized that not only had I not brought my celexa with me, I had already missed 2 weeks dose. I felt ok, so I didn’t think to go back in n once I got home.
Then I started feeling negative, had more fearful thoughts, struggling to find any joy in anything. Unfortunately I do not like where I have moved and have not found a “community” here, so this is really awful timing.
My question is, after being off 3 months, should I just gut it out?
I am taking 400mg. Of SamE.
Should I switch to St. John’s Wort, and if you think that is a good idea do I just stop the SamE one day and take the St. John’s Wort the next?
Hi Georgia:
You are right that the last bit of Celexa to leave your brain is the hardest to get through. That is why near the end you are taking almost minute quantities of Celexa but just stopping there causes problems so you taper down to what seems to be ridiculously-small amounts before you finally “jump off”.
Whether you just “gut it out” or go back on a very low dose is up to you. My thinking is that if you can “gut it out”, go for it as the worst should be over after 3 months without the Celexa.
Is the SamE helping you? If so, you might want to continue on it. If not, you might want to switch to something else, or combine it with something else. I don’t know whether taking St. John’s Wort at the same time as SamE is a good idea or not. You need to run it by some qualified health care professional. My gut feeling is that you could take both at the same time. If I were going to do this, I’d stay on the same dose of SamE and start with a low dose of St. John’s Wort and work up to the recommended dose–all the time watching out for any negative side effects.
Be aware that St. John’s Wort can take from a few days to a few weeks before you notice any difference–that is why I suggest building up slowly on it.
Cordially,
Neil
Thank you so much.
Given that I was on Celexa 20 years, I consider myself lucky that my symptoms aren’t worse after reading other’s stories here.
It has been 3 months, but I’ve read that the withdrawals can last many months or years.
I still have intense feelings of hopelessness, and my memories are so vivid and feel so sad, that I know my brain has been affected. I just hope not permanently so.
Hi Neil,
For some reason I can’t seem to reply any longer to the thread I had going with you. Anyway, I’m about 5 weeks into my 10% taper. The first 10% I held for 2 weeks, but then I decided to try a 10% reduction every week. So far so good.
In our prior exchange I had pointed out to you that the monthly schedule would take over 4 years to complete. I noticed that when you updated your original post it now says on a weekly schedule of 10% reductions it would take a year. But based on your grid a weekly 10%, with a jump-off after 0.6, would be 34 weeks – over 2.5 yrs. Please correct me if I’m missing something here.
I’m thinking of trying to speed this up and see how it goes. I have reasons to move this along that I won’t go into here at the moment. Perhaps daily reductions of 10%, or every few days. And then slow it down to weekly once I hit 5mg (I’ve read that the last 5 mg can be the trickiest)? Do you know if there have been any studies as to how long it takes the brain to adjust to each reduction?
I realize that doing a daily, or every few days, taper will make it harder to gauge what dose I would need to return to if I hit a wall, but perhaps it doesn’t have to be such an exact science?
Thanks,
Scott
Hi Scott:
How do you get 35 weeks into 2.5 years? There are 52 weeks in a year so 35 weeks would be roughly 9 months.
I’ve seen some evidence that you can taper faster at the beginning, but need to slow down as you progress. If you don’t, sooner or later it catches up with you and you suffer the withdrawal side effects. I’d think a 10% taper per day is MUCH too fast. If I were doing it, I think a 10% taper per week is about as fast as I’d dare to go. As always, since everyone i different, the appearance of withdrawal symptoms tells you that you are going too fast.
As far as I know, there is no exact science here. The slow taper is the “safe” rate supposedly to almost guarantee you won’t get side effects. So you can go as fast as you want, but the risk of withdrawal side effects increases as you increase the taper rate.
Cordially,
Neil
Hi Neil,
Thanks for the reply. I’m going to have to blame that math error I made on withdrawal brain-fog ;). No idea how I made that obvious error!
I decided to not go any faster than 10% per week and at this point I’m almost at half of my original dose. I’ll definitely be on the look out for increased side effects as I get closer to the tail end. Fingers crossed I won’t have any big issues.
Thanks again,
Scott
Hi Neil,
I just came upon this site-I have been on Celexa , 20 mg for 6 months. I stopped Cold Turkey 9 days ago and started horrible w/d symptoms about 4 days ago, pins and needles in legs, agitation, tinnitus. I was tempted to go back on again to stop these issues but my try to continue if I can – Do you know if the tinnitus will go away? It sucks – I am going to try the St. Johns as you suggested and the l tryptophan – It seems I don’t fair well on meds – I thought the Celexa would help but it has been more harmful – I was hesitant to try it but felt at the time I needed it. Appreciate your commentary
Hi Mary:
As you now know, it is a bad idea to quit any psychotropic drug cold turkey. Bad things happen. Since you want to tough it out, more power to you. I can’t say whether the tinnitus will go away or not, but even if it doesn’t, there are things you can do to help bring it under your control. Try the St. John’s wort and L-triptophan and see whether it helps you.
Let me know how it goes.
Cordially,
Neil
Hello Neil,
I have been on Citalopram 10 mg for 12 years and want to come off of it. I reduced from 10mg to 5mg a few months ago with no issues. I decided to go from 5mg to 2.5mg about three weeks ago and have been dizzy, nauseous, having headaches and just a general unwell feeling. I saw your recommendation to taper by 10% and I’m wondering how to do that with the pills being so small. any advice or help would be so appreciated.
Hi Kate:
Sometimes you can taper quite fast at the start, like you did with a 50% taper, but that soon catches up with you when you tried another 50% taper. Now you have withdrawal side effects.
You might want to go back to the 5 mg dose and wait until all the unwanted side effects go away, then begin a 10% per month taper.
You asked how to do this precise kind of taper. I explained it to Stephen. Scroll down to my reply to Stephen dated December 2, 2018 where I explain how to do this using a mortar and pestle and a 100 ml graduated beaker. The beaker needs to be tall and about 1″ in diameter. You can get the right one on Amazon at https://www.amazon.com/100ml-Plastic-Graduated-Cylinder-Beaker/dp/B0728C224F for about %9.00.
A nice mortar and pestle set is on Amazon at https://www.amazon.com/Best-Mortar-and-Pestle-Set/dp/B01DJBY1LA for around $22.00.
If you have problems, let me know.
Cordially,
Neil
Neil,
I was actually able to get Citalopram 2 mg/mL solution called in by my GP today.
My plan is to go back to cutting a 10 mg pill in half and try taking 5 mg for a bit to reduce my withdrawal symptoms. Once I’m feeling more level, I will start to taper using 10 mg tablets that I cut and the citalopram 2 mg/mL solution. Is there a chart for how I would do this reducing 10% a month.
Thanks a million for your help.
Kate
Hi Kate:
Once you are stable on 5 mg, then it is time to dump the pills and just use the liquid so you can do a relatively precise 10% taper. Since the concentration is 2 mg/ml, you need to take 2.5 ml for 5 mg.
Thus the first month on the taper you’d drink 2.5 ml, the next month 90% of that–namely 2.03 ml. and the next month 90% of that–namely 1.82 ml and so on.
In actual practice, you could probably round it down to 1/10 of a ml. as I don’t think this degree of precision is necessary.
Here’s what I’d do for a somewhat rough but yet slow taper. I’d start with 2.25 ml for 1 month, then 2.0, 1.8, 1.6, 1.5, 1.4, 1.3, 1.2, 1.1, 1.0, 0.9, 0.8, 0.7. 0.6, 0.5, 0.4, 0.3, 0.2, 0.1.
This starts as a 10% taper then eventually just goes down by 0.1 ml per month.
You may be able to taper faster, for example, every 3 weeks or every 2 weeks–but if any withdrawal side effects show up, pause at that level and then continue at a slower rate.
Where you “jump off” is up to you. You may find, for example that when you get down to 0.5 ml or whatever, that no withdrawal side effects show up so you may choose to stop there.
You’ll need a way to precisely measure these amounts. A micro-pipette would do the job that was calibrated in 1/10 of ml.
Cordially,
Neil
Thank you, Neil. I took 5 mg today and will level out before starting to slowly taper by 10% You are an absolute live saver.
Hi Neil.
I have been taking 20mg Citalopram for 12 months now. I would like to slowly tapper off. What is the best way to do this?
Thanks in advance,
Shae
Hi Shae:
Just follow one of the two taper methods I outline in the above article. Use the column headed 20 mg in whichever of the two tables you choose to follow for the correct amount as you taper.
Cordially,
Neil
Hello, I’ve been on 10 mg of Celexa for 22 years. For the last year, I’ve shown signs of prodromal Parkinson’s and REM Behavior Disorder. I have started tapering off of Celexa at a rate of 1% every five days. Is that too fast? I want to get off the drug as soon as safely possible to see if I can minimize my chances of getting full blown PD and RBD.
Hi Kim:
You are wise to to a really slow taper to give your body time to adjust to the reducing amount of Celexa.
A 1% taper every 5 days is certainly a slow (read safe) taper. You may be able to go faster–1% every 3 days. That would shorten your time down to 10 months.
You need to listen to your body. If you don’t have any withdrawal side effects, you can try tapering faster, and if you get withdrawal side effects, then slow down the taper.
Since you have been taking the drug for 22 years, probably slower is better. Find the rate that works for you.
Cordially,
Neil
Thank you so much. I safely and slowly tapered from Valium years ago using the Ashton Method. So, I know that slow and steady wins the race.
Hello, I started tapering off of 20 mg Citalopram in June 2022 and completely ended it in September 2022. My anxiety has been really high since then. There have been some difficult things happen in life since then as well. Additionally, I got tested and my cortisol in the morning was really high which is not usual for me. I am wondering if I tapered off too quickly and my system is out of whack? It has been 5 months now.
Hi Whitney:
A four month taper isn’t excessively fast, but it may have been too fast for your body to adapt to. So much depends on your psychological makeup, how long you were taking the drug and whether your body built up a dependence on the Citalopram.
If you had been on it for a number of months or years, then I would have recommended a slower 10% taper per month on the descending balance. That would have meant tapering for about a year before stopping it completely.
So it is quite possible you tapered too fast and that your body is out of whack now.
I’d suggest you learn how to deal with your anxiety without taking drugs. A cognitive behavioral therapy program could help you. So could learning relaxation exercises and breathing exercises. You can do these latter two on your own and they can make a big difference especially when you feel yourself becoming more anxious.
Cordially,
Neil
Thank you Neil! I was on the anxiety medication for 10 years so quite a while. I’ve thought about starting CBT just haven’t done it yet. Appreciate your input.
Hi Dr. Bauman,
I have started citalopram 20mg since January. My depression hasn’t clear out completely this is how I feel. But the problem with this depression is the OCD thoughts that doesn’t really goes away . There is time my thoughts come and I fight with them. Now i want to taper the citalopram to 20mg because I am worry after 6 months it will be worse my depression . Would you advice the best way to do it, please. THANKS!
Hi Ornela:
If you’ve only been on Citalopram for two months, your body may not have built up a strong tolerance to the Citalopram. If so, you may be able to taper off quite fast–for example possibly split a pill in quarters and take 3 quarters for 2 or 3 weeks or so, then 2 quarters for another 2 or 3 weeks or so, then 1 quarter for another 2 or 3 weeks and you’re off.
Note: Anywhere in the process, if you begin to experience withdrawal side effects, stop the taper and that point and wait until the withdrawal side effects go away, then continue the taper but at a slower rate.
However, if your body has built up a tolerance to the Citalopram, then you should do the safe slow taper which is reduce it by 10% per month on the reducing balance as explained in my article.
Cordially,
Neil
Dear Dr Bauman,
I started citalopram 20mg in August 2022. I started to feel better and decided to reduce the dose to 10mg from January.
Since April I have been experiencing tinnitus. Which is now causing anxiety.
I now want to taper off 10mg as I’ve been on Citalopram for almost 10 months.
I live in the U.K., I don’t think they sell 5mg or in liquid form.
Can you advise how I can taper off slowly?
Many thanks
Hi Rsha:
Here’s how to do a slow taper if you only have pills available (no liquid).
If you have pills and want to break them into small pieces (which is almost impossible to do), the way to do this is to get a mortar and pestle and grind a whole pill into dust, then dissolve it in exactly 100 ml of water. Get yourself a 100 ml beaker that is marked for each individual ml. (It will be a tall thin beaker.) Just dump the ground pill dust into the beaker, fill it to the 100 ml line with water, put your hand over the top and shake it until it dissolves.
Now all you have to do is pour out the part you don’t need and drink the rest. That way you can essentially split a pill into 100 parts (each 1 ml represents a 1% reduction).
So if you want to taper over 300 days, do the above, then pour out 1 ml and drink the 99 ml. Do this for 3 days. Then pour out 2 ml and drink the 98 ml for 3 days. Continue to reduce it by 1 ml every three days.
If you want to taper faster you could do the 1 ml taper for 2 days or even for just 1 day–but that might be too fast. If you do a faster taper and start getting withdrawal side effects, you know you are tapering too fast so stop until the side effects settle down, then taper slower.
This is an easy way to get a precise taper using only hard pills.
Cordially,
Neil
Hi Neal,
You state, add one crushed tablet to 100 parts of water. Can I do a mix of 20mg of crushed Citaolpram tablet to 20mls of water? Would this solution be the same ratio equivalence as your 1mg/100mls(1:100)? My method a 1:1 ratio.
Hi Stewart:
No, if I put 20 mg tablet in 100 mg water it would be a 1:5 ratio, so yours is 5 TIMES the concentration.
But why would you want to dissolve the tablet in 20 ml water in the first place? The whole idea is not the concentration at the beginning, but ease in calculating the right amount to take–reducing by 1% (1 ml) per day which is easy to do. With your method to do the same taper, you’d have to reduce by 1/5 of a ml per day and that is harder to do. That is why we use a 100 ml beaker. Makes it simple and easy to do.
Cordially,
Neil
hello dr, what do you mean by “Once your nervous system falls off that wall, there’s not much that can be done to put it together again.”
im really scared dr, I was on citalopram 10 mg for two weeks and stopped abruptly, im having horrible withdrawal symptoms and tinnitus .
Hi Leticia:
All I’m saying is that there can be permanent consequences of taking this drug. There are a lot of variables as to whether you will suffer such consequences and how bad they will be.
However, this is not to say that you can’t do anything to mitigate these consequences. You can.
What were you taking the Citalopram for in the first place? That would be a good place to start, by getting that under control without using drugs or else you can just make things worse.
Cordially,
Neil