Celexa Dosage: How Much Citalopram to Take and When

Celexa (citalopram) is a common SSRI used for depression and some anxiety disorders. The dose you start with and where you end up depends on your age, liver health, other medicines, and how you respond. One key fact to remember: higher doses raise your risk of heart rhythm changes, so dosing needs care.

Starting and target doses

For most adults the usual starting dose is 20 mg once daily. After a few weeks, if symptoms haven't improved and side effects are tolerable, doctors may raise the dose to 40 mg daily. The FDA advises not to exceed 40 mg per day in adults because of QT prolongation risk.

For people over 60, and anyone with moderate to severe liver disease, doctors usually start lower and cap the dose at 20 mg daily. That same lower cap applies if you take other drugs that raise citalopram levels, or if you have certain genetic differences in liver enzymes.

Celexa isn’t generally recommended for children and teens for depression unless a doctor decides otherwise. For anxiety, some prescribers start at 10 mg daily and increase slowly. Expect to wait 4–8 weeks to see full benefit.

Special situations and safety tips

If you miss a dose, take it as soon as you remember that day. Don’t double up the next dose. When stopping Celexa, taper slowly—abrupt stopping can cause dizziness, sleep problems, and flu-like symptoms.

Watch for interactions: combining Celexa with MAOIs, other SSRIs, SNRIs, triptans, or certain herbal products (like St. John’s wort) can increase the risk of serotonin syndrome, which is serious. Also avoid mixing high citalopram doses with other drugs that lengthen the QT interval: some antipsychotics, certain antibiotics, and some antifungals.

Common side effects include nausea, dry mouth, sleep changes, sweating, and sexual problems. If you notice fainting, severe dizziness, fast or irregular heartbeat, or new mood changes, contact your clinician. They may order an ECG if they’re concerned about heart rhythm, especially before increasing the dose above 20 mg for older adults.

Kidney disease usually doesn’t require major dose changes, but liver impairment can. If you drink alcohol, talk with your provider—alcohol can worsen depression and increase side effects. Pregnant or breastfeeding? Discuss risks and benefits with your doctor before starting or stopping Celexa.

Bottom line: standard adult dose is 20–40 mg/day, but many people do well on 20 mg. Older adults and those with liver problems should stick to 20 mg or less. Always check with your prescriber before changing dose, and report worrying side effects right away.