There is no fixed time limit for taking citalopram. Many people stay on it for years, and some take it indefinitely. The right duration depends on your history of depression, how many episodes you’ve had, and how well the medication is working for you. U.S. guidelines don’t specify a maximum treatment duration, and long-term use is considered safe for most people with appropriate monitoring.
Recommended Minimum Before Stopping
Most guidelines recommend staying on citalopram for at least six months after you start feeling better, not six months from when you first took the pill. This continuation phase is meant to solidify your recovery and reduce the chance of symptoms returning. Canadian guidelines, which are more specific than U.S. ones on this point, recommend at least six months for a first episode and two years or more for people at higher risk of relapse.
The distinction matters because depression often comes back. In a study of elderly patients published in The British Journal of Psychiatry, those who stayed on citalopram had a 32% recurrence rate over 48 weeks, compared to 67% for those switched to a placebo. Put differently, the risk of depression returning was about three times higher in people who stopped the medication. These numbers help explain why many prescribers are comfortable with patients staying on citalopram well beyond the initial recovery period.
Who Benefits From Staying On Longer
If you’ve had two or more episodes of depression, most clinicians will recommend staying on citalopram for at least two years, and possibly much longer. The more episodes you’ve experienced, the stronger the case for ongoing treatment. Other factors that favor longer use include episodes that were severe, took a long time to respond to treatment, or involved suicidal thoughts.
People who had their first episode after age 60, or who have a family history of recurrent depression, also tend to benefit from extended maintenance. For some of these patients, staying on citalopram indefinitely is a reasonable choice, not an emergency or a failure, just a practical way to keep a recurring condition managed.
Side Effects With Long-Term Use
The side effects you experience in the first few weeks, like nausea, headaches, or sleep disruption, usually fade within a month or two. But some effects can persist for as long as you take the medication.
Sexual side effects are the most common complaint with long-term use. These can include reduced sex drive, difficulty reaching orgasm, or genital numbness. Australia’s Therapeutic Goods Administration has updated warnings for citalopram and other SSRIs to note that in some cases, sexual dysfunction can persist even after stopping the drug. This doesn’t happen to everyone, but it’s worth being aware of if sexual side effects are bothering you, because waiting them out may not resolve the issue.
Earlier research suggested that SSRIs might weaken bones over time, raising concerns about fracture risk. However, a more recent real-world study comparing citalopram, escitalopram, and sertraline found no clear dose-dependent increase in osteoporosis risk. The absence of a dose-response pattern suggests these medications may not directly cause bone loss, though researchers haven’t fully closed the book on this question.
Cardiac Monitoring for Long-Term Users
Citalopram can affect heart rhythm by prolonging something called the QT interval, which is the time it takes your heart’s electrical system to reset between beats. A prolonged QT interval raises the risk of dangerous heart rhythm problems, though this is rare at standard doses.
Because of this, the maximum recommended daily dose is 40 mg for adults and 20 mg for people over 65 or those with liver problems. If you have heart disease, a very slow heart rate, or low potassium or magnesium levels, your prescriber should consider an ECG before starting treatment. If you develop palpitations, dizziness, or fainting while taking citalopram, a cardiac evaluation is warranted regardless of how long you’ve been on it.
For most healthy adults on standard doses, routine cardiac monitoring isn’t required. But if you’re on other medications that also affect heart rhythm, or if you take diuretics that can deplete electrolytes, periodic checks of your potassium and magnesium levels are a good idea.
What Happens When You Stop
If you and your prescriber decide it’s time to come off citalopram, the process matters as much as the decision. Stopping abruptly after more than four to six weeks of use can trigger discontinuation symptoms within a day or two: dizziness, electric shock sensations, anxiety, vivid dreams, nausea, irritability, and flu-like aches. These typically last a few weeks but can be uncomfortable enough to mimic a relapse, which sometimes leads people to restart the medication unnecessarily.
A typical tapering schedule for citalopram steps down gradually: from 40 mg to 30 mg, then 20 mg, then 10 mg, then off. Each step usually lasts two to four weeks, though some people need slower reductions. At 20 mg, citalopram’s long half-life means some people can stop directly from that dose without significant withdrawal. Others prefer or need to taper down to 10 mg first. The pace should match how you’re responding at each step, not a rigid calendar.
The return of depression symptoms during or after a taper is different from withdrawal, though they can look similar. Withdrawal symptoms tend to start within days and feel physically distinct (the electric zaps are a giveaway). Depression symptoms usually emerge more gradually, weeks after the dose change, and feel familiar. Knowing the difference helps you and your prescriber decide whether to slow the taper, pause, or resume treatment.