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Citalopram Tapering

This entry was posted in Antidepressant on by .
Medically Reviewed Fact Checked

Last Updated on August 3, 2022 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Professional citalopram tapering requires expertise that, unfortunately, is uncommon for medical professionals and most treatment facilities, since it is not taught in medical schools.

Are you destined to remain dependent on SSRIs like citalopram (brand name Celexa)? We at Alternative to Meds Center believe the answer is an emphatic “NO!” We have the expertise and the experience to help you. We have been in your shoes.

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citalopram tapering success
Alternative to Meds has been a leading authority on holistic citalopram tapering for more than 17 years. Using holistic and environmental medicine, we have published evidence demonstrating that over 77% of people we helped get off SSRIs, replacing medication with a holistic lifestyle, suffer fewer side effects and enjoy better mental health than while medicated. It is not only about reducing symptoms, but it is about feeling better and enjoying natural mental health. Many of our staff at the center have, themselves, endured and overcome these struggles in order to become the dedicated caregivers that we are.
Watch this video of a woman who came to us hopeless. Like many of you, she felt she had tried everything and failed. Her naturopathic doctor referred her to us to get off of the meds that were not working. Not only did she get off of the antidepressants and benzos, but she regained her ability to walk, resolved her anxiety and depression, and even regained her lost professional career.

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Citalopram Tapering in a Context of Overall Health

neurochemistry and SSRIsCitalopram tapering can be made much more tolerable by using methods derived from understanding the ways the drug interacts with the central nervous system. We should not overlook the benefits of micro-nutrients that can support comfortable citalopram cessation. At the Alternative to Meds Center, we also view education as an important component of antidepressant tapering programs offered at our facility. Tapering citalopram is best done within an overall context of improving physical and mental health.

SSRIs and Brain Chemicals

Citalopram is an SSRI antidepressant that alters the way serotonin is distributed throughout the body. Although they are often called “brain chemicals,” neurotransmitters and hormones such as serotonin are distributed throughout the body, along the central nervous system pathways, including the brain. Most of our serotonin (95%) is found in the gut and only 5% in the brain.9 Despite the inference made in much SSRI drug advertising, SSRIs are not like a vitamin. No drug, including citalopram, can create more serotonin or other naturally occurring neurochemicals. Be aware that the advertising materials that saturate the market tend to suggest they can, but research tells us that antidepressants are NOT like vitamins and are nothing like “a health tonic.” The drug is thought to hold serotonin molecules suspended instead of being reabsorbed along the nerve pathways. As a result, serotonin accumulates rather than recycled as would normally happen if no drug was present. It may take some weeks for this artificial restructuring to occur, and often, unpredictable mood swings and even suicidality can accompany the process. It is important to understand how drug efficacy wanes over time, as the pooled serotonin molecules begin to degrade. Prescribers will try to counter the loss of efficacy by raising dosages over time. The effects of this can lead to further dysregulation of the fine wiring in the brain and CNS. The mechanics are explained, at least in part, by something called “downregulation” which is discussed further below.4

The overall problem with drug-based therapy is that it completely overlooks and short-circuits looking for the actual causes of symptoms. Root causes may include inadequate nutrition, lifestyle, or even genetic factors in human health. These should be checked before beginning drug-based therapy, but are often not explored.

How to Make Weaning Off Citalopram More Comfortable

As with any antidepressant medication, simply stopping citalopram abruptly can overwhelm the delicate interactions between the CNS, brain, digestion, and potentially all systems in the body. That is why the FDA advises that weaning citalopram slowly over a period of time is the safest approach.6

A person who has suffered from health/mental health concerns over time may have become subject to poor nutrition, lack of exercise, poor sleep, and withdrawal from social contacts. These factors may have cumulatively lowered a person’s overall vitality. This is not an uncommon situation and can be greatly helped within a nurturing inpatient setting where our client is surrounded by supportive, helpful, and socially mindful staff and residents, who are sensitive to the goals a person may have regarding improving overall health. There is great joy in recovery and which can be enhanced in a warm and welcoming social setting that an inpatient facility can provide.

Methods used in citalopram tapering include:
  • Gradual titration or tapering over weeks or months in small increments to avoid harsh withdrawals 10
  • Allow enough time for withdrawals to settle between dosage adjustments 11
  • Cross-tapering using a drug with a longer half-life 13
  • Address insomnia or sleep disturbance with improved sleep hygiene 12
  • Overhaul the diet, omit sugars, caffeine, and refined carbs, and opt for unprocessed clean foods, organic is recommended where possible
  • Supplementation to support neurotransmitter repair, such as L-lysine, L-arginine, passionflower, kava, magnesium, and others.14
  • Test for and remove neurotoxic accumulations such as heavy metals, pesticides, and other neurotoxic elements from the body 15
  • CBT or other forms of psychological support 16
  • Physical comfort therapies such as therapeutic massage, Reiki, acupuncture 17-19

This is not a complete list but provides examples of options that have proven efficacy for improvements in mental and physical health.

What is Citalopram Prescribed For?

An astounding 12-15% of the population is taking antidepressants today. Citalopram was first marketed as Celexa© for the treatment of depression, but over the years, a much longer list of off-label uses has developed.1,8

Off-label uses of citalopram include:
  • Alcohol use disorder
  • Coronary arteriosclerosis
  • Premenstrual dysphoria
  • Post-menopausal flushing
  • OCD (obsessive-compulsive disorder}
  • Bipolar*
  • PTSD
  • Panic disorder
  • SAD {social anxiety disorder}

*It should be noted that diagnostic criteria for bipolar and many such conditions have become quite general. Often a prescription is written after a brief conversation in a doctor’s office. Overprescribing, especially in the elderly, has been studied extensively as a growing problem.5

SSRIs and Serotonin Syndrome

There can be a reaction to too much serotonin building up which is called “serotonin syndrome.” Anyone taking SSRI medication should be aware to watch for the signs and if suspected, immediate medical intervention is needed as the condition can become life-threatening. Typically the treatment would include immediate cessation of whatever drug is causing the SS to occur, but done in a hospital setting where life-saving protocols are close at hand.

Signs of serotonin syndrome* include:
  • weaning off CitalopramMuscle rigidity
  • Mental confusion
  • Dilated pupils
  • Agitation, restlessness
  • Elevated heart rate
  • Heavy sweating
  • Diarrhea
  • Headache
  • Twitching
  • Fever and/or chills

*SS needs immediate medical attention as the condition is potentially life-threatening.7

Understanding Downregulation and Tapering SSRIs

Another factor to consider in tapering citalopram is that the body tends to react defensively against the presence of a serotoninergic agent, such as citalopram. The body begins reducing the number of active serotonin receptors. This is called “downregulation.” This defense mechanism is an innate attempt to bring the body’s neurochemistry into balance. It has been discovered that the presence of SSRI or serotonergic medications results in the receptors that transport serotonin becoming inactive or impaired in their function.4

The serotonin molecules that remain unused will eventually degrade and become lost. This can lead to a deficiency of available serotonin, and possibly other types of hormones and natural neurochemicals. Despite the enthusiasm of drugmakers, some researchers believe that antidepressants are possibly little or no more effective than placebo, while some believe they are destructive to neurochemistry over time. There has been some controversy over these points, but it still serves to do one’s own research for a better understanding of the mechanics involved.3

Long-Term Effects of SSRI Medications

Some side effects are felt soon after starting the medication, such as an elevated mood. However, others are not instantaneous but occur over time. The body will eventually adapt to the presence of citalopram, and during the course of taking an antidepressant, various reactions to the drug may result. It adds further complexity to the situation when a person suffers a set of new or worsening side effects after long-term use of SSRIs.

Reactions or side effects could include worsened depression, various aches and pains, suicidal thoughts, and many others. These can be uncomfortable enough that a person may decide that getting off citalopram is necessary. Because of downregulation and other factors, a person may experience a decrease in available serotonin.1 There are effective strategies using orthomolecular nutrition and other protocols to mitigate the situation, to soften and even out the long-term effects of SSRIs such as mood swings, disrupted sleep, or other reactions. These strategies assist the citalopram tapering process greatly.

Handling Root Causes for Symptoms

identify root cause for symptomsCitalopram tends to have a numbing or dampening effect on neurochemistry. This is the theory behind drug-based therapy. This dampening effect might be compared to giving an aspirin to a person who has a broken leg. It can reduce discomfort to some degree for a short while. A physician may genuinely think this would help a patient in crisis. However, doing so will not get to the root cause of the problem.

Like peeling off a band-aid, when tapering off citalopram these original symptoms may again present and sometimes with a vengeance, as the anesthetic effect is no longer there. This may result in returning and sometimes intensified original symptoms. Additionally, the drug itself causes side effects. Then, combining both sets of symptoms can result in a level of discomfort that just cannot be endured. Sometimes a person will give up the idea of getting off citalopram altogether because the level of discomfort has just spiraled beyond all expectations, and has become too great to withstand. However, this situation can be helped greatly by using proper citalopram tapering, weaning, and titration methods as we use at Alternative to Meds Center.

If poor diet, exhaustion from insomnia, or exposure to toxins have resulted in mental health symptoms, then a full assessment of possible factors and their treatment, can be powerful tools for improving natural mental health without drugs.

Diagnostic Tools Used in Tapering Citalopram

citalopram holistic taperingA highly useful set of diagnostic tools applicable to tapering SSRIs includes testing for neurotoxic accumulations. Heavy metals and other toxins could be contributing to, if not directly causing, a person’s insomnia, faulty digestion, or resultant fatigue. Testing for vitamin and mineral deficiencies could reveal that too much zinc was causing chronic headaches. Or perhaps a simple blood test might reveal too little calcium in the blood, which is called hypocalcemia, which has resulted in chronic depression and stomach cramps.2

Most patients who come to our center have never been recommended to get such testing, or if they have, incomplete follow-up may have left symptoms unresolved. Alternative to Meds Center uses these and many other diagnostic tools to isolate root causes for conditions that were troubling a person before they ever began on medication. Clients respond positively to correcting these deficiencies or removing these toxic accumulations, typically reporting great relief because of better sleep and improved appetite, more mental clarity, a calmer disposition, feeling brighter, and many other welcome changes.

Comprehensive Plan for Stopping Citalopram at Alternative to Meds Center

citalopram holistic treatment alternativesAlternative to Meds Center uses a multi-faceted program to help our clients toward their health goals. Using testing and other diagnostic tools, root causes for certain conditions can be isolated and then corrected while safely and comfortably reducing or eliminating prescription drugs over time. Also of high importance is providing a nutrient-rich diet that is clean of toxins and additives to support rebuilding healthy neurochemistry, and also support all the systems of the body as they begin to transform back to natural function. And the removal of the neurotoxic burden through cleansing techniques is another vital segment that will open the door to natural mental health, increased vitality and energy, and a reduction or elimination of the symptoms that led to one or more prescriptions in the first place.

Education is offered as an integral part of the program. Various subject modules are designed to give our clients a highly practical understanding of how the CNS functions, including healthy neurotransmitter function, how to create and maintain a healthy microbiome, and many other subjects that even physicians are coming to the center to learn more about. Learning about properly weaning off citalopram can literally change your life.

For More Information on Citalopram Tapering

Have you or a loved one been considering weaning off citalopram or other prescription drugs, without success? We can help. Please contact us at Alternative to Meds Center to find out more about our comprehensive citalopram tapering methods so that you or your loved one can consider the potential benefits available to you in much greater detail.

1. Sharbaf Shoar N, Fariba KA, Padhy RK. Citalopram. [Updated 2021 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: [cited 2022 July 11]

2. Merck Manual, Consumers Version, “Hypocalcemia (Low Level of Calcium in the Blood)” [cited 2022 July 11]

3. Kirsch I. Antidepressants and the Placebo Effect. Z Psychol. 2014;222(3):128-134. doi: 10.1027/2151-2604/a000176. PMID: 25279271; PMCID: PMC4172306. [cited 2022 July 11]

4. Guzman, F “Mechanism of Action of SSRIs” Psychopharmacology Institute [Dec 2016, updated May 17, 2022] [cited 2022 July 11]

5. Bobo WV, Grossardt BR, Lapid MI, Leung JG, Stoppel C, Takahashi PY, Hoel RW, Chang Z, Lachner C, Chauhan M, Flowers L, Brue SM, Frye MA, St Sauver J, Rocca WA, Sutor B. Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population. Pharmacol Res Perspect. 2019 Jan 23;7(1):e00461. doi: 10.1002/prp2.461. PMID: 30693088; PMCID: PMC6344796. [cited 2022 July 11]

6. FDA label Celexa [cited 2022 July 11]

7. Volpi-Abadie J MD, Kaye AM PharmD FASCP FCPhA, and Kaye AD, MD PhD “Serotonin Syndrome” The Ochsner Journal, National Institutes of Health, 2013 Winter [cited 2022 July 11]

8. Jannini TB, Lorenzo GD, Bianciardi E, Niolu C, Toscano M, Ciocca G, Jannini EA, Siracusano A. Off-label Uses of Selective Serotonin Reuptake Inhibitors (SSRIs). Curr Neuropharmacol. 2022;20(4):693-712. doi: 10.2174/1570159X19666210517150418. PMID: 33998993. [cited 2022 July 11]

9. Banskota S, Ghia JE, Khan WI. Serotonin in the gut: Blessing or a curse. Biochimie. 2019 Jun;161:56-64. doi: 10.1016/j.biochi.2018.06.008. Epub 2018 Jun 14. PMID: 29909048. [cited 2022 July 11]

10. Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry. 2019 Jun;6(6):538-546. doi: 10.1016/S2215-0366(19)30032-X. Epub 2019 Mar 5. PMID: 30850328. [cited 2022 July 11]

11. Keks N, Hope J, Keogh S. Switching and stopping antidepressants. Aust Prescr. 2016 Jun;39(3):76-83. doi: 10.18773/austprescr.2016.039. Epub 2016 Jun 1. PMID: 27346915; PMCID: PMC4919171. [cited 2022 July 11]

12. Wu JQ, Appleman ER, Salazar RD, Ong JC. Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis. JAMA Intern Med. 2015 Sep;175(9):1461-72. doi: 10.1001/jamainternmed.2015.3006. PMID: 26147487. [cited 2022 July 11]

13. Caffrey AR, Borrelli EP. The art and science of drug titration. Ther Adv Drug Saf. 2021 Jan 19;11:2042098620958910. doi: 10.1177/2042098620958910. PMID: 33796256; PMCID: PMC7967860. [cited 2022 July 11]

14. Lakhan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010 Oct 7;9:42. doi: 10.1186/1475-2891-9-42. PMID: 20929532; PMCID: PMC2959081. [cited 2022 July 11]

15. Berk M, Williams LJ, Andreazza AC, Pasco JA, Dodd S, Jacka FN, Moylan S, Reiner EJ, Magalhaes PV. Pop, heavy metal and the blues: secondary analysis of persistent organic pollutants (POP), heavy metals and depressive symptoms in the NHANES National Epidemiological Survey. BMJ Open. 2014 Jul 18;4(7):e005142. doi: 10.1136/bmjopen-2014-005142. PMID: 25037643; PMCID: PMC4120423. [cited 2022 July 11]

16. Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive Behavioral Therapy for Depression. Indian J Psychiatry. 2020 Jan;62(Suppl 2):S223-S229. doi: 10.4103/psychiatry.IndianJPsychiatry_772_19. Epub 2020 Jan 17. PMID: 32055065; PMCID: PMC7001356. [cited 2022 July 11]

17. Armour M, Smith CA, Wang LQ, Naidoo D, Yang GY, MacPherson H, Lee MS, Hay P. Acupuncture for Depression: A Systematic Review and Meta-Analysis. J Clin Med. 2019 Jul 31;8(8):1140. doi: 10.3390/jcm8081140. PMID: 31370200; PMCID: PMC6722678. [cited 2022 July 11]

18. Richeson NE, Spross JA, Lutz K, Peng C. Effects of Reiki on anxiety, depression, pain, and physiological factors in community-dwelling older adults. Res Gerontol Nurs. 2010 Jul;3(3):187-99. doi: 10.3928/19404921-20100601-01. Epub 2010 Jun 30. PMID: 20635803. [cited 2022 July 11]

19. Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. Treatment effects of massage therapy in depressed people: a meta-analysis. J Clin Psychiatry. 2010 Jul;71(7):894-901. doi: 10.4088/JCP.09r05009blu. Epub 2010 Mar 23. PMID: 20361919. [cited 2022 July 11]

Originally Published Nov 1, 2019 by Diane Ridaeus

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Citalopram Tapering
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