The figures
This last figure is about antidepressants in general, not specifically about citalopram, and the cohort dates from 2011. It is the best available national figure on long-term use, but not a recent or substance-specific measurement.
No addiction, but a difficult withdrawal
Important to clarify: citalopram and other SSRIs are not classified as addictive in the same sense as an opioid or benzodiazepine. There is no compulsive seeking behavior or euphoria like with those drugs. The risk lies elsewhere: withdrawal symptoms may occur when stopping, and in practice the duration of treatment is often longer than strictly necessary, simply because a clear evaluation moment is never built in.
A doctor starts citalopram for a depression or anxiety complaint. A reasonable and often effective choice.
If the effect is good, it is recommended to continue the treatment for at least 6 to 12 months after recovery.
After that period, tapering is recommended, but that conversation does not always take place structurally.
Repeat prescriptions via the GP tacitly maintain the use.
If you stop (too quickly), withdrawal symptoms can occur that feel like a relapse, while it is often withdrawal.
The safety signal: dose limit due to heart rhythm
Citalopram has a dose-dependent risk of prolongation of the QT interval, which in rare cases can lead to a serious cardiac arrhythmia (torsade de pointes). This has led to an official maximum dosage: 40 mg per day for adults and maximum 20 mg per day for the elderly. In people at increased risk, for example due to heart failure, a recent myocardial infarction or an electrolyte imbalance, extra caution is advised and sometimes an ECG is considered before starting treatment.
This is not an acute, new incident as with oxycodone and nitazenes. It is a longer known but still relevant and officially recognised risk, from which the dose limit arises directly.
In-depth video
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Do you recognise this pattern?
Have you been taking the same antidepressant for years without there having been a discussion about tapering? Share your experience. Not to appoint a doctor, but to make the pattern visible.
Justification and sources
- Zorginstituut Nederland (GIPdatabank/Zorgcijfersdatabank), 2024: 213,330 users of citalopram (ATC N06AB04), +15.3% since 2020.
- Nivel: "Antidepressants in one in three patients long-term prescribed" (2011 cohort, SSRIs as a group): 65% after 1 year, 38% still in use after 5 years.
- Pharmacotherapeutic Compass / NHG Standard Depression: treatment duration at least 6-12 months after remission, longer in case of recurrence, then gradually tapering.
- Pharmacotherapeutic Compass / CBG-SmPC: maximum dose 40 mg/day (adults), 20 mg/day (elderly); dose-dependent QT prolongation and risk of torsade de pointes.