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Dose increase of Citalopram and FDA warning of risk of QT prolongation

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I am 43 year old male who has a history of anxiety and depression. I'm currently taking 30mg of citalopram and 1.0 mg of clonazepam.

I started the 30mg dose of citalopram two weeks ago. Before that, I was on 20mg for quite a few years. I feel like the citalopram dosage increase is helping and my family doctor said that it might even make sense to go to 40mg.
I asked her if that might be getting a bit high since the FDA has issued a warning about high dosages of citalopram being related to QT prolongation. She said that 40mg is fine, and even 60mg would be OK.
I thought that was a strange thing to say since the FDA warning is clear that 60mg doses should be avoided.

But, I recently discovered this link which seems to indicate the FDA warning may have been premature:
http://www.ncbi.nlm.nih.gov/pubmed/23640689

I have no history of heart issues, nor do I fall into any of the risk categories the FDA describes. So, should I be at all concerned about an increase to 40mg. I want to be very cautious since I've not had a major depressive episode in at least 5 years, but I find I still need to stay on medication or my anxiety and mood do start to get worse.

I would appreciate some feedback on this.

Category: Psychiatrist

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Dr. Srikanth Reddy
Category: Sexologist
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Expert:  Dr. Srikanth Reddy
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Hello,

Thanks for your query at DoctorSpring. I have gone through what you have stated and I can understand what you are going through.

Citalopram is a good drug since ages and the routine dosages are around 20 mg. It does cause some cardiac worry above 20 mg but then they are quite rare. In fact many of my patients are also doing good on 30mg of citalopram. But one caution I take is that I do a repetitive ECG of my patients and try to monitor the QTc interval. If it is to cause the problem the same is reflected on the ECG and hence caution can be taken. Probably it will make you feel better that I did not notice any changes in QTc interval with citalopram 30 mg inspite of me being cautious.
So I think that is fine.

You should also insist your psychiatrist to consider your for cognitive behavioural therapy along with the medications. That will help in not further increasing your medication dosage.

Hope that helps
Regards
Dr. Srikanth Reddy
NeuroPsychatrist

Dr. Srikanth Reddy
Category: Sexologist
Experience: 
Doctor of Medicine (MD), Psychiatry Residency Program,2001 – 2012
M.B.B.S,Mahatma Gandhi Institute Of Medical Sciences, Sevagram

Certificate Course in sex Therapy and Counselling, Sexology and Counselling, A
Sexology,Medikon Sexual Sciences, Mumbai

Training in Advanced Neurology at a leading corporate hospital (CARE hospital) in Hyderabad

Child Psychiatry Training in National Institute of Mental Health and Neuro-Sciences, Bangalore

Sex Therapy and Counsellingat MEDIKON Sexual Sciences, Mumbai.
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