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Lisa, MSN, FNP-BC, CCRN, Nurse Practitioner
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What is the lowest efective dosage of celexa I started taking a 20mg

Resolved Question:

What is the lowest efective dosage of celexa? I started taking a 20mg. dose over 10 years ago for PMMD. Over the past two years I found that the 10mg dosage was sufficient. I am in my early 50s and have not gone through menopause. At a recent appt. with my GP, she suggested that Zoloft may be a better choice. Would it be better to lower my celexa dosage or change to zoloft. Pros and Cons?
Submitted: 5 years ago.
Category: Health
Expert:  Lisa, MSN, FNP-BC, CCRN replied 5 years ago.

Thank you for writing in today.

My question is this---why change? If the Celexa 10 mg is working for you. You don't necessarily need to change. All age groups, from young adults to geriatric patients take Celexa, and the drug is well tolerated. Your GP may have a specific reason for recommending the change, such as cost, side effect, or health condition not listed in your inquiry, but, in general, I find that if someone's antidepressant is working and he/she is tolerating the medication without any significant side effect, I am reluctant to make changes. Now, with that being said, if I had a patient that had been taking Celexa for 10 years and only taking 10 mg of Celexa, I may consider a taper and possible discontinuation of the medication.

It is very reasonable to attempt to taper and discontinue antidepressants at times, especially if the patient has been on the antidepressant for prolonged period of time. However, there are several things to consider before recommending a taper and discontinuation. First of all, the person's past medical history would also have to be considered. For example, if a person has a history of previous medication dose reduction and/or discontinuation and that person failed, meaning the person developed signs or symptoms of depression, PMMD, etc, then I would be reluctant to make such a recommended.

There are many factors to consider when adjusting antidepressants. I'm sure your GP has her reasoning. At this point, I would have to recommend speaking with your provider. I would ask her to provide more clarification regarding her recommendation. Also, if you feel it may be worth discussing, you may want to ask her if you would be a candidate for a wean and discontinuation.

Celexa and Zoloft are in the same drug class. They are both select serotonin reuptake inhibitors (SSRIs). They do act similarly. Some people are able to switch between SSRI drugs and achieve the same therapeutic effect; however, some patients may not tolerate or respond to one SSRI but do very well with another. Everyone if unique. The key is finding the one that works for you, and it does sound like this one must work for you.

I generally start my patients at 10 mg of Celexa and titrate the dose up. I don't prescribe doses any lower than 10 mg. If a patient is wanting to try for a reduced dose, lower than 10 mg, I generally will recommend a taper/discontinuation trial---again, if appropriate, based on history.

For what it's worth, you are likely nearing menopause, hopefully your symptoms of PMMD will improve in time. Although, perimenopause and menopause can bring on a few challenges too.

At any rate, please don't make any changes to your meds without consulting your GP.

I hope this helps you. Obviously, you won't be able to make your decision without consulting your GP, but I hope this helps you be better informed.

If you have any questions or need clarification, please let me know.

Take care.

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