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Can The Reduction In Celexa Dosage Cause Depression?

Posted on Wed, 1 Oct 2014

Question: I have been taking Gylenia and Celexa for almost 5 years now. My GP called and said due to my new prescription provider and the FDA he has to cut my dosage of Celexa from 40 mg to 20 mg. I am so afraid it's gonna send me into depression that I'm about to tell them to forget the Gilenya. I don't understand this?

Answered by Dr. Jonas Sundarakumar (1 hour later)

Brief Answer:
Clarifications provided.

Detailed Answer:
Hello and thanks for your query.

The FDA has revised its recommendations regarding the prescription of the antidepressant Celexa (Citalopram). According to the revised guidelines, doses above 40mg are not recommended because it can cause abnormalities in the electrical activity of the heart.

Since your dose in only 40mg (and not above 40mg), I'm not sure why your GP has decided to cut it down to half. Even it has to be reduced, it has to be done more gradually, in order to avoid rebount depression and anxiety symptoms. So, I would suggest that you discuss with your GP about cutting it down more gradually - for example 30mg for a month and then 20mg further on.

Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Jonas Sundarakumar (20 minutes later)

Thank you for that information. They said it had something to do with taking it with Gilenya (my MS medication). I don't understand what the problem is with combining the 2 medications? Also, they already called in my next refill for 20mg. How can I step down by myself. Before Celexa I had horrible depression, crying a lot, withdrawn from others. I'm afraid I'm going to "crash" back into it.

Answered by Dr. Jonas Sundarakumar (16 hours later)

Brief Answer:
Clarified...

Detailed Answer:
Hello again,

Though very rare, there is a potential interaction between Celexa and Gilenya and thus there is a very small risk of electrical / conduction abnormality of the heart. This could be another reason why your GP wanted to cut down the dose of Celexa.

If you would like to step down the dose gradually, then I would suggest that you decrease the dose to 30mg till your next refill and then continue with 20mg. Don't worry, it's unlikely that you will "crash" back into a depression because you're not completely off the medication and 20mg is still an effective therapeutic dose.

Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar