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FDA recommends lowering Celexa's maximum daily dose
August 25th, 2011
12:51 PM ET

FDA recommends lowering Celexa's maximum daily dose

The Food and Drug Administration is recommending that patients taking the anti-depressant Celexa (citalopram hydrobromide) take no more than 40mg a day. The FDA says anything more can cause abnormal heart rhythms, and studies show there is no therapeutic benefit with doses higher than 40mg. The recommendation includes generic versions of the drug.

Celexa, is made by Forest Laboratories Inc., and is in a class of drugs called selective serotonin reuptake inhibitors (SSRIs). Serotonin is a neurotransmitter–it helps relay messages from one part of the brain to another. Researchers believe serotonin imbalances can influence your mood and lead to depression. SSRIs like Celexa increase the amount of serotonin in the brain, which can help improve mood.

Although the drug is available in 10mg, 20mg and 40mg pills, 60mg doses can be used to treat certain patients with depression.

"Most patients are treated with lower doses of Celexa," Sandy Walsh, FDA spokesperson said. "But we issued the safety communication today [Wednesday] to make sure doctors and patients have the most up to date information possible to make treatment decisions."

The FDA says at-risk patients include "those with underlying heart conditions and those who tend to have low levels of potassium and magnesium in their blood."

The  safety announcement warns doctors not to prescribe the drug for patients with congenital long QT syndrome (LQTS)–a condition of the heart's electrical system that can lead to cardiac arrest or sudden death. LQTS is rare–only about 1 in 5,000 Americans have the condition.

Patients, the agency says, should not stop taking Celexa or change their dose without first talking to their doctor.  Stopping suddenly can cause side effects. Any patient who has shortness of breath, irregular heartbeat or dizziness while taking the medication should see their doctor.


soundoff (57 Responses)
  1. hooxopeNago

    discount karen millen dresses

    August 25, 2011 at 16:10 | Report abuse | Reply
    • Dave

      I find it interesting that the side effect "abnormal heart rhythms" has surfaced. I was told by the pharmacist when I first started taking this that Celexa can cause nausea and that I should take a half pill (10mg) the first few days. I took a half pill the first two days, no problems. The third day I took it, I took the full 20mg dose. It does cause nausea. Not only that, I developed a rapid, pounding, irregular heartbeat. I actually thought I was having a heart attack. That is until I read through the dozens of side effects. Rapid, pounding, irregular heartbeat is one of the many possible side effects. Needless to say, I never took it again.

      August 27, 2011 at 16:49 | Report abuse |
  2. drjani

    Studies have shown more tha half of the times placebo or CBT works better than antidepressants. Also if they are supposed to balance the "chemical imbalance"–are they overbalancing some other chemicals and causing harm??
    Something to think about before asking a doctor for the "pill" to fix all our problems
    DR. J

    August 25, 2011 at 18:44 | Report abuse | Reply
    • stepasidesue

      You're ignorant!

      August 25, 2011 at 18:51 | Report abuse |
    • noyouare

      no, you are. Therapy has no known side effects, whereas most drugs do. They are marketed to us via mas media and then pulled when they find out they cause death. look at Vioxx,... hell you know what, here, just educate yourself
      http://en.wikipedia.org/wiki/List_of_withdrawn_drugs

      August 25, 2011 at 21:34 | Report abuse |
    • Monica

      You are so right. I did great on Prozac for 6 weeks at 10 mg, the lowest dose. Depressed again a couple of years later, I was assured by my GP that 20mg was the minimum dose and I should try it. Felt like I didn't know who I was, couldn't find my way out of a paper bag in 3 days on the stuff. Quit that, asap. Also took Lexapro 40mg.. first tab, had a total panic attack meltdown. SSRI are not for me! I hope everyone is prepared for the possible side effects and has a Dr. willing to treat them.

      August 25, 2011 at 22:39 | Report abuse |
  3. Scott

    I say this every time i see one of these stories, SSRI's are poison and psychiatrists are legal drug dealers. A very,very small fraction of people taking SSRI's actually need them.

    August 25, 2011 at 19:37 | Report abuse | Reply
    • Tom, Tom, the Piper's Son

      And of course, you're qualified to say this because you are a doctor? A psychiatrist? What, exactly, is your are of expertise?

      Or are you just another pompous twit who thinks you know something when you don't have a clue?

      August 25, 2011 at 21:33 | Report abuse |
    • Scott

      My area of expertise is i have taken them and have done a lot of research about them and the field of psychiatry. Everything about SSRI's are a fraud from the manipulated clinical trials, to the ghost writing in medical Journals, to the FDA approval process which is in the pocket of big pharma just as much as the SEC is to the banks. On top of the fact that their efficacy does not reach clinical significance and are responsible for a myriad of suicides and homicides. SSRI's have their place but in a very selective manner. Futhermore the whole chemical imbalance theory of depression has never been proven and is a line toted by big pharma and its lap dog psychiatry. Some psychiatrist will begrudgingly admit this. For those that are happy taking an SSRI great, just good luck getting off of it if you can. SSRI's are just another mind and body damaging "treatment" form psychiatry just like lobotomy and anti-psychotics. The facts are pretty self-evident when it comes to SSRI's and when one investigates further, it gets worse.

      August 26, 2011 at 09:57 | Report abuse |
    • Tom, Tom, the Piper's Son

      You're not a doctor and you're not qualified simply by the fact that you've done research and you've taken SSRIs. You're just another fear-monger who thinks he's hot stuff on an anonymous board.

      All medications have side effects. The benefits for many millions of people who have taken SSRIs are clear.

      August 26, 2011 at 17:20 | Report abuse |
    • i call BS

      Scott, you sound exactly like the anti-vaccine nuts. What a bunch of nonsense!

      August 26, 2011 at 17:37 | Report abuse |
    • Scott

      Whether i sound like a vaccine nut is beside the point, everything i stated is a fact. As much as 50% of SSRI journal articles have been ghostwritten with that number being almost 100% with regard to SSRI children studies. Look up Paxil study 329 for an example. Secondly, if you want to see how much the FDA is in the pocket of big pharma look up the 1991 hearings for Prozac. 14 years later they reversed the decision because 6/8 member sitting on the FDA at the time had serious ties to pharma. Thirdly, psychiatry is an outright joke that receives the most money from pharma out of any of the medical "specialties". Look up Joseph Biederman and Senator Grassely investigation. I could keep going but it seems peoples biases and myopia are getting in the way of the truth. I have also seen Tom Tom's medication cheerleading before which leads me to question his motives. Anyone who seriously looks into SSRI's will determine that they have been a disaster for kids/adolescents, are based off a faulty and gross simplification of mental/emotional illness, and that there is so much money to be made from them that the deck is stacked against anyone who opposes them. SSRI's are just another pharma scheme which will stop at nothing to make another buck. I am sure they do help some people, but given an objective cost benefit analysis, SSRI's fail miserably.

      August 26, 2011 at 19:01 | Report abuse |
    • Tom, Tom, the Piper's Son

      Question my motives all you like, dunderhead. The fact is that you are a kook who isn't a doctor, a psychiatrist, or a scientist, and you can't back up your claims with data. You are just another dufus.

      August 26, 2011 at 19:12 | Report abuse |
    • Tom, Tom, the Piper's Son

      I wonder, Scooty, just what DO you think people suffering from depression should do? Just live with it? Continue to suffer? Lose jobs? Commit suicide? The fact is that SSRIs have helped millions of people to feel better, to regain some semblance of normal interest in life, and to be able to engage in psychotherapy. If you've got something that works better, by all means, cough it up, Einstein.

      I await your pronouncement.

      While you're at it, give some citations for your sources of information. I'd like to see what unimpeachable sources you scour for your conclusions that SSRIs are nothing but a hoax.

      August 26, 2011 at 19:40 | Report abuse |
    • Tom, Tom, the Piper's Son

      Yeah, that's what I expected. Scooty isn't able to come up with any alternatives for those who are paralyzed by depression, unable to function, and on the verge of suicide.

      Thanks for confirming my impression that you're a jackazz.

      August 26, 2011 at 20:56 | Report abuse |
  4. Bribarian

    SSRIs have helped a lot of people, and when it comes to depression, there aren't that many options to deal with it. Don't listen to the "you iz being poisoned" crowd.

    August 25, 2011 at 20:11 | Report abuse | Reply
  5. evensteven

    I take Zoloft and it has improved my life tremendously . . .

    August 25, 2011 at 20:21 | Report abuse | Reply
    • Tom, Tom, the Piper's Son

      I'm glad it's been of help to you; I know a number of people whose lives have been improved tremendously with therapy and with medication. It isn't "poison", no matter what the dimwits say.

      August 25, 2011 at 21:34 | Report abuse |
    • Andrea M

      I enjoyed trading around for Zoloft in high school, it made the monotony much more pleasant.

      August 25, 2011 at 21:49 | Report abuse |
  6. noyouare

    why do most ssri's have black box warnings?

    August 25, 2011 at 21:36 | Report abuse | Reply
    • Jillian

      Because what may be good for one may not be good for some, and that needs to be evident.
      Where a selective serotonin reuptake inhibitor may work very well for some adults, other adults and adolescents may not benefit so much from this type of treatment.
      The truth is that the use of these kinds of anti-depressants/anxiety meds in teenagers can actually cause worsening of symptoms that they can't bounce back from. Their chemistry is still changing and all is not yet lost for them, and it has become apparent that in a lot of cases prescribing SSRI's to the youth is more comparable to amputating a broken arm instead of putting a cast on it. A malleable mind that still has the ability to learn new coping mechanisms shouldn't be stunted by the last resort use of medication if there truly is another treatment.

      Also, in cases of severe depression and the introduction of a chemical meant to help can cause the symptoms to become exacerbated before they actually get better. Unfortunately, depending on how bad-off a person is, this sudden increase in suffering can be a real tipping point between living and ending it all. Times of panic and major depression operate on extremes; which is why the correct medication AND therapy is the best way to go. Without a support network of some kind, most people will not succeed. These are all stressed in the new 'black box' warnings.

      August 26, 2011 at 10:58 | Report abuse |
  7. Mitch Rapp

    I had a bad accident that destroyed my left shoulder and required replacement surgery, followed by a stroke, Prostate Cancer, a heart attack that required 2 stents. All of this caused a major episode of depression. Thanks to Wellbutrin and Zoloft I have made a strong com back.

    August 26, 2011 at 04:00 | Report abuse | Reply
    • Matt

      Hang in there Mitch!!

      August 26, 2011 at 07:22 | Report abuse |
  8. Matt

    This is depressing......

    August 26, 2011 at 07:21 | Report abuse | Reply
  9. Fired Up

    People who take SSRI are the same people that think taking a pill will make them drop fat and gain muscle with NO actual effort. Laziness is the cause for depression, as well as ego. Get off of your backsides ans DO something to change your life. Do the work and stop reaching for pills that do more harm than good.

    August 26, 2011 at 07:32 | Report abuse | Reply
    • Tom, Tom, the Piper's Son

      You are an idiot.

      August 26, 2011 at 08:04 | Report abuse |
    • Jillian

      People who make baseless assumptions about large groups of people are the same people who think the world is flat.

      ...

      See how that worked? No actual facts in that statement whatsoever, but I said it anyway.
      The problem with people like you is that you think you know about things you obviously know NOTHING about. Try telling someone with a major depressive disorder or anxiety disorder to just get off their backside and see how little that helps. It's not just about feeling sad, here; there is a slew of different problems that accompany these conditions. Lack of energy, lack of 'long view', listlessness, panic, self-destructive behavior– these things make it nearly impossible to lead a normal life. If just getting up and going out somewhere could cure depression/anxiety, trust me, that would be the preferred treatment. BUT IT'S NOT. Because before you can get back to that healthy social point in your life you must first address the chemical problem that is keeping you from it.
      It must be hard for you to believe that there are individuals in your perfect world who have very real chemical imbalances in their brain, that life isn't all sunshine and lollipops to everyone despite how much they'd like for it to be.

      You are an example of why there is still a stigma against people who rely on outside help to live balanced lives. I wouldn't typically wish any mental problem on anyone, but I think in your case I'll make an exception. You have no clue how it is to be deeply effected by a disability that no one can see or cure, and I think you deserve to suffer a bit if you're living your life so high and mighty with all the answers.

      August 26, 2011 at 10:42 | Report abuse |
    • itakethis

      I think you should be on medicine.

      August 26, 2011 at 10:46 | Report abuse |
    • GO2BAT

      Obviously you know nothing about those who have suffered from depression, I hope for those around you whom you love never do as your empathy level is that of ignorance and lack of understanding for the human experience of life when all doesn't go like a bed of roses!

      August 30, 2011 at 16:33 | Report abuse |
    • Tetra

      I have been taking Celexa for about 5 years now, it has helped me a great deal. Some of us have no other option even if we do have a therapist, eat right, exercise. It is a chemical imbalance. Any one else who says they are bad for you and that depressed people are lazy etc. don't know what they are talking about. It is ok to take the meds you need to have a life again. With out them I don't think I would be here today. Depression kills millions of people each year and if there is medication for some one to take to help them, then let them.

      February 26, 2013 at 13:44 | Report abuse |
    • Trish

      I started taking this pill when I had stress issues and chronic anxiety. No matter what I did (work to stay positive, yoga/breathing, exercised regularly) i still had a physical pit in my stomach all the time. I was literally in a good mood with a pit in my stomach. So it doesn't have to do with laziness.

      There may be some people out there who would benefit from a placebo, but some of the symptoms this drug treats goes beyond "mental" symptoms. I am also generally in a better mood as well, but the anxiety/pit in my stomach are gone. This is the only medication I am on, and generally do not condone drugs when other alternatives are available, but as you can see, I have tried many alternatives.

      July 19, 2013 at 13:54 | Report abuse |
  10. itakethis

    I take this medicine and I know that without it I would be dead. It helped me tremendously!

    August 26, 2011 at 10:27 | Report abuse | Reply
    • Heather Lynn

      I have been taking this medication for about 6 months now, at the 40mg dose.... it has changed and saved my life. Never listen to people who give their opinion without ever actually "being there". Depression was eating me alive from the inside out and I thank God that my doctor had also had an issue with depression over the years. Celexa is what brought her back, so she recommended it for me..... Every single day looks brighter, I smile more, sleep better, eat better, have a better outlook, don't fly off the handle as easily and actually think about what I say, before I say it. It has made me believe in myself again...... I thank God for Celexa!

      June 12, 2013 at 23:54 | Report abuse |
  11. findmydream

    I was on Celexa for several years. They need a lower minimum dose for those who need to wean off of it. Even at 5mg (half a 10 mg pill) I had problems going to zero.

    August 26, 2011 at 11:21 | Report abuse | Reply
    • guest

      I agree. I was unable to get off of the Celexa because of withdrawal side effects. Couldn't even get close to weaning off Effexor – crushing headaches for days on end. These meds are helpful and necessary (and probably saved my life), but getting off them can be next to impossible. Physicians need to disclose that fact to patients.

      August 29, 2011 at 14:44 | Report abuse |
  12. Sy2502

    To get a good cold shower about how rampant ignorance and stupidity still are in this country, read the comments to articles like this one, or about vaccines. Staggering.

    August 26, 2011 at 13:07 | Report abuse | Reply
    • Tom, Tom, the Piper's Son

      It really is. I never cease to be amazed at the absolute dimwittedness of people who refuse to accept medical or scientific research and are convinced, like Scott, that doctors are in the pockets of the ultimate evil (in their crazy minds), "Big Pharma."

      August 26, 2011 at 17:24 | Report abuse |
    • Junior Ranger

      Are you kidding me? It doesn't take a rocket scientist to follow the money trail. Open your eyes! Here's an easy one to get your simple mind around: FDA raids Raw Milk seller, but millions die from Big Pharma and FDA slaps them on the wrist. Why? Does Raw Milk kill as many people? NO.

      August 29, 2011 at 15:26 | Report abuse |
  13. Living with meds

    I'm on SSRIs & other meds as a result of multiple traumas including abuse. I would love to be "normal" & not require meds, but I do. Would you tell someone with diabetes to suck it up? Unless you've been there, you just don't know. Btw – everything affects our brain chemistry – food (or lack thereof), sleep (or lack thereof), drink. Even falling in or out of love affects our brain chemistry. As for "black box warnings", even too much tylenol can cause multi-system organ failure.

    August 26, 2011 at 14:48 | Report abuse | Reply
  14. Amanda

    Interesting that I just found this article! I'm in the processing of lowering my meds. I was on 80mg of Celexa for the longest time (I've been on it about 9 years now). It's the highest dose docs can give. It was lowered to 60mg recently, and just yesterday I decided to taper down to 40mg by myself. I'm terrified of side-effects as I do this and eventually take none!

    August 29, 2011 at 18:07 | Report abuse | Reply
  15. verticalpharmacy

    Are anti depressant addictive? i am in depression big time but i am scare of any medication

    February 10, 2012 at 07:33 | Report abuse | Reply
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    March 16, 2012 at 02:30 | Report abuse | Reply
  17. Calvin

    I have constant panic attacks if I am off of celexa for a week. Thank god for celexa.

    July 6, 2012 at 16:06 | Report abuse | Reply
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  26. Loving it

    I started off with 20 mg, then 40 mg. The pharmacist looked at me and said, this is a very high dosage, you sure you want to take this? Seriously? It's none of his business. I've been taking the 40 mg for about a year but still wasn't feeling the full effect so, without talking to the doctor, I started taking 1 1/2 dosage (60 mg) and feel much better. The ladies at work can tell a difference. I feel more like my old self. I love the fact that I'm "high" off this medicine and if you didn't know that I was taking it, you can't tell. I have tried everything. A couple of them make me seriously ill such as effexor. This is a great product and so far, no side effects.

    October 19, 2012 at 08:29 | Report abuse | Reply
    • Loving it

      OOOPS!!!! I meant to say I love the fact that I'm NOT "high" off this medicine. Geez. I'll proofread next time! :)

      October 19, 2012 at 08:30 | Report abuse |
  27. blah

    You guys can say whatever you want. This drug saved my damn life. I was living with some awful anxiety, weeks without sleep, at the end I was crying all day for no reason. I literally thought I was either going to die, or I would kill myself to end the suffering. My doc prescribed this drug and within a few days I was sleeping and after a few weeks my anxiety had finally subsided.

    I can still feel highs and lows, I laugh and cry when watching movies or whatever, but I don't have that terrible stomach ache and rapid pulse I used to have that occurred by just thinking about a job or school or interacting with others.

    This is NOT a bad drug. If you have similar issues to what I was talking about then try asking your doctor about it. The heart issues have never occurred for me and I am much better off on it. Don't let these horror stories dissuade you from giving this pill a chance.

    May 15, 2013 at 04:38 | Report abuse | Reply
  28. Heather Lynn

    I have been taking this medication for about 6 months now, at the 40mg dose.... it has changed and saved my life. Never listen to people who give their opinion without ever actually "being there". Depression was eating me alive from the inside out and I thank God that my doctor had also had an issue with depression over the years. Celexa is what brought her back, so she recommended it for me..... Every single day looks brighter, I smile more, sleep better, eat better, have a better outlook, don't fly off the handle as easily and actually think about what I say, before I say it. It has made me believe in myself again...... I thank God for Celexa!

    June 13, 2013 at 00:00 | Report abuse | Reply
    • Patria

      Exactly, Heather! All of what you described for the better – me, too.

      September 17, 2013 at 21:54 | Report abuse |
  29. Patria

    I have been on Celexa since 2001. I tapered down and went off it once, thinking I was not in need anymore since my life situations had all changed for the positive. I went a few months without it and began to sink lower and lower, and found myself eating a lot of foods with serotonin in it – then the light went on – I made a visit with my doctor and started on Celexa again and ever since. For me it is calming and I don't even notice physical changes – just my emotional stability is so much better. Not weepy all the time but still have sensitive feelings for others in need – not drugged and unfeeling. Its been a great help to me.

    September 17, 2013 at 21:52 | Report abuse | Reply

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