Transitioning from Citalopram to Duloxetine: Tapering Recommendations

Introduction to Tapering

Citalopram is associated with a discontinuation syndrome characterized by dizziness, fatigue, nausea, sensory disturbances, anxiety, irritability, and other symptoms when stopped abruptly, according to the American Academy of Child and Adolescent Psychiatry 1
Both citalopram and duloxetine affect serotonin levels, and starting duloxetine without properly tapering citalopram could potentially increase the risk of serotonin syndrome, as noted by the American Academy of Child and Adolescent Psychiatry 1, 2

Gradually reduce citalopram over 2-4 weeks rather than stopping abruptly, as recommended by the American Academy of Child and Adolescent Psychiatry 3, 4
Begin duloxetine after completing the citalopram taper or during the final stages of tapering when on a very low dose of citalopram, according to the American Academy of Child and Adolescent Psychiatry 2
Start with the standard initial dose of duloxetine (usually 30mg or 60mg daily), as suggested by the American Geriatrics Society 5, 6

Both medications can cause discontinuation syndromes, so patients should be educated about the importance of not missing doses of the new medication (duloxetine), as recommended by the American Geriatrics Society and the American Academy of Child and Adolescent Psychiatry 5, 2
Be aware that both medications have potential for drug interactions with MAOIs and other serotonergic medications, according to the American Academy of Child and Adolescent Psychiatry 1, 2

Starting duloxetine at too high a dose while still on significant amounts of citalopram could increase the risk of serotonin syndrome, as noted by the American Academy of Child and Adolescent Psychiatry 1

The American Academy of Child and Adolescent Psychiatry emphasizes that gradual tapering is prudent to avoid withdrawal symptoms from SSRIs and to prevent unexpected return of symptoms weeks to months after the last dose 7

Weekly assessments should include: mood symptoms, anxiety levels, suicidal ideation or behavior, sleep patterns, appetite and weight, and any discontinuation symptoms, as recommended by the American Academy of Child and Adolescent Psychiatry 7

Do not misinterpret discontinuation symptoms as relapse - withdrawal symptoms from fluvoxamine typically emerge within days and are self-limiting, whereas true relapse develops more gradually over weeks, according to the American Academy of Child and Adolescent Psychiatry 7

If severe symptoms develop during tapering that pose safety concerns, return to the previous dose and extend each reduction phase by 1-2 weeks, as suggested by the American Academy of Child and Adolescent Psychiatry 7

Some patients may require slower tapering if withdrawal symptoms emerge, potentially extending the timeline to 6-8 weeks, as noted by the American Academy of Child and Adolescent Psychiatry 7