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Citalopram patient leaflet mentions withdrawal symptoms (not discontinuation!)

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Hi all, I was just readin the citalopram liquid leaflet and wanted to see if they mention withdrawal. They DO! They also list a lot of the symptoms but they miss many as well. https://www.medicines.org.uk/emc/files/pil.3349.pdf dated 3/2017  They also recognize that some people may take longer to withdraw (us) though I think the 2 wk is ridiculous. Even when I first stopped them many years ago after being on them for 3 years my severe physical symptoms went for probably 6 weeks or longer. And did not start until a week off, not a couple of days. 


I wish they had this 20 years ago when I was getting onto them. Maybe I would have stopped to think about it. But then again, my doctor was so adamant that I would have probably gone with her assurances of safety.


Withdrawal symptoms seen on discontinuation of SSRI treatment

Withdrawal symptoms when treatment is discontinued are common, particularly if discontinuation is abrupt (see section 4.8 Undesirable effects). In a recurrence prevention clinical trial with citalopram, adverse events after discontinuation of active treatment were seen in 40% patients versus 20% in patients continuing citalopram.

The risk of withdrawal symptoms may be dependent on several factors including the duration and dose of therapy and the rate of dose reduction. Dizziness, sensory disturbances (including paraesthesia), sleep disturbances (including insomnia and intense dreams), agitation or anxiety, nausea and/or vomiting, tremor, confusion, sweating, headache, diarrhoea, palpitations, emotional instability, irritability, and visual disturbances are the most commonly reported reactions. Generally these symptoms are mild to moderate, however, in some patients they may be severe in intensity. They usually occur within the first few days of discontinuing treatment, but there have been very rare reports of such symptoms in patients who have inadvertently missed a dose. Generally these symptoms are self-limiting and usually resolve within 2 weeks, though in some individuals they may be prolonged (2-3 months or more). It is therefore advised that citalopram should be gradually tapered when discontinuing treatment over a period of several weeks or months, according to the patient's needs (see “Withdrawal symptoms seen on discontinuation of citalopram”, Section 4.2)" https://www.medicines.org.uk/emc/product/1392/smpc



Withdrawal symptoms seen on discontinuation of citalopram

Abrupt discontinuation should be avoided. When stopping treatment with citalopram the dose should be gradually reduced over a period of at least one to two weeks in order to reduce the risk of withdrawal reactions (see section 4.4 Special Warnings and Special Precautions for Use and section 4.8 Undesirable Effects). If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose, but at a more gradual rate." https://www.medicines.org.uk/emc/product/1392/smpc


Now only if the GPs would get on board and read and tell this to their patients, that would be good. 


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