Can your Citalopram dose be increased from 20mg to 40mg? (3 factors to consider)

In this article, we will discuss the topic “Can your Citalopram dose be increased from 20mg to 40mg?” We will also cover the factors to consider when adjusting your Citalopram dosage, the maximum recommended dose, associated side effects, and what to do if you can not tolerate the higher dose.

Can your Citalopram dose be increased from 20mg to 40mg?

Yes, your Citalopram dose can be increased from 20mg to 40mg if you are not experiencing improvement in your condition, your depression is worsening, and you have no other risk factors associated with your health.

However, dose escalation should only be done under a doctor’s supervision. Your doctor may not directly switch you from 20mg to 40mg of Citalopram. 20 mg, in general, is considered the standard dose of citalopram and most people do well on it. However, some people do require dose escalation.

It is important to note that dose escalation should be done gradually and with close monitoring. The sudden shift in dose can cause disturbing side effects and not everyone can tolerate this.

To avoid this, your doctor may gradually increase your dose, 5-10mg at a time to help your body adjust to this change(1). In some cases, people may experience side effects even on 20 mg of citalopram.

In such cases, most doctors prescribe an even lower dose, such as 15 mg or lower, to help the patient adjust to the antidepressant. However, citalopram does not come in a 15 mg formulation, so 10 mg tablets are mostly preferred.

What factors to consider when increasing Citalopram dosage?

Some factors to consider before increasing your Citalopram dosage from 20mg to 40mg include:

  • Patient’s age
  • Underlying medical conditions like liver or kidney disease
  • Evaluation of sodium and potassium levels
  • Tolerability at higher doses

Your doctor will assess your condition, and current symptoms, and decide whether dose escalation is necessary. Citalopram may begin to show positive results within 1-4 weeks and may show complete therapeutic benefits in 8-12 weeks.

What is the recommended dose of Citalopram?

For adults aged 18-65, the starting dose of Citalopram is 20mg with a maximum recommended dose of 40mg. Your doctor may prescribe this dosage if you do not have any other underlying medical conditions like liver or kidney disease.

However, for adults over 65 and those with liver disease, the starting dose is 10mg, with a maximum dosage of 20mg.

Since Citalopram is metabolised by the liver, patients with liver disease may experience delayed drug metabolism, leading to increased drug levels in the blood.

Patients below 18 years of age should not use Citalopram for the treatment of anxiety and depression due to safety concerns(2).

Common side effects of increasing Citalopram dose

Some patients may experience common side effects when increasing their Citalopram dose from 20mg to 40mg, or if they accidentally take 40mg of Citalopram. These side effects may resolve on their own as your body adjusts to the higher dose.

It is important to keep in mind that these side effects vary from person to person, and not everyone using Citalopram is prone to these adverse effects. Some of the common side effects may include:

Some rare side effects may also occur in sensitive patients. If you experience any of the following rare side effects, please immediately reach out to your healthcare provider.

  • Suicidal thoughts
  • ECG changes
  • Chest pain
  • Allergic reactions
  • Bleeding abnormally/unusual bruising
  • Muscular contractions
  • Hyperactivity
  • Flu-like symptoms/runny nose, watery eyes, or fever
  • Changes in weight (gain or loss of appetite)
  • Low sodium levels in the blood (especially for elderly patients)
  • Serotonin syndrome (can be life-threatening) (2,3)

High doses of citalopram can also affect the liver and kidneys. Typically, citalopram is not considered a bad antidepressant for the liver and kidneys, and patients with renal diseases may not require dose adjustment. However, every case is different.

If you have any underlying disease and you accidentally take a higher dose of citalopram, it is crucial to seek immediate medical attention.

What if you can’t tolerate a higher dose of Citalopram?

If you can’t cope with the recently increased dose and are experiencing bothersome side effects, please reach out to your healthcare provider.

Citalopram is a well-tolerated medicine but some patients may feel that it is not suitable for them, as they experience more side effects associated with Citalopram and they find it difficult to cope with them.

In such cases, talk to your doctor. They may reduce the dose by tapering it off over one to two weeks.

If your depression symptoms are not going away, which may take some time as SSRIs show their effects over weeks, then your doctor may again try to increase the dose once your body adjusts to it.

If the depression symptoms are not improving and your body is not adjusted to the increased dose, then your doctor may taper it off gradually and switch you to a good alternative (4). Just make sure you do not make any changes to your prescription on your own.

It is also important to make sure that you do not take citalopram with any controlled substance or alcohol, as it can increase the risk of disturbing side effects and can be life-threatening for patients with cardiac and liver diseases.


In this article, we have discussed the feasibility of increasing Citalopram dosage from 20mg to 40mg. However, it should only be done under the supervision of a qualified healthcare professional.

The dose of Citalopram should only be increased, when no improvement is observed, your depression symptoms are worsening, and when there are no other risk factors involved.

You may experience common side effects when the dose is increased; however, rare and serious side effects must be given immediate medical help.

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Sharbaf Shoar N, Fariba KA, Padhy RK. Citalopram. 2021 Dec 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29489221. Available from: 


The Food and Drug Administration (FDA). Celexa (Citalopram Hydrobromide). [Internet]. [Revised Jan 2017]. Available from: 


PubChem [Internet]. Bethesda (MD): National Library of Medicine (US), National Center for Biotechnology Information; 2004-. PubChem Compound Summary for CID 2771, Citalopram; [cited 2023 Sept. 20]. Available from:


Chu A, Wadhwa R. Selective Serotonin Reuptake Inhibitors. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32119293. Available from: 

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