Thinking about switching from citalopram? Good—there are several safe and effective options, but the right choice depends on symptoms, side effects you’re trying to avoid, medical history, and drug interactions. Below I’ll walk you through common medication swaps, what each tends to do, and practical steps to discuss with your prescriber.
Escitalopram — This is very similar to citalopram but is the active S-form. Many people find it works the same or better with fewer side effects at a lower dose. Doctors often try it first if citalopram wasn’t ideal.
Sertraline — A widely used SSRI. It can help both depression and anxiety and is sometimes less sedating. It’s a solid option if you struggled with tiredness on citalopram, though it can cause digestive upset at first.
Fluoxetine — Known for its long half-life, which lowers withdrawal risk when stopping. It can be more activating, so it suits people who need energy, but it may increase anxiety or insomnia in some.
Paroxetine — Effective but more likely to cause weight gain, sexual side effects, and withdrawal symptoms. Usually considered when other SSRIs haven’t worked.
SNRIs (venlafaxine, duloxetine) — These work on serotonin and norepinephrine. Venlafaxine can be strong for severe depression; duloxetine also helps nerve and muscle pain. SNRIs may raise blood pressure in some people, so monitoring is needed.
Bupropion — A non-SSRI that boosts dopamine and norepinephrine. It’s activating, rarely causes sexual side effects, and can help with low energy and smoking cessation. It’s not ideal for people with a seizure history.
Mirtazapine — Often used when sleep and appetite are issues because it makes you sleepy and can increase weight. It’s useful if insomnia is a big problem alongside depression.
Older drugs (TCAs, MAOIs) — Tricyclics and MAO inhibitors work but have more side effects and interaction risks. They’re usually reserved for treatment-resistant cases and require close supervision.
Talk to your doctor about why citalopram isn’t working or which side effects you want to avoid. Mention past meds, other health issues, and current supplements or drugs—interactions matter. Don’t stop citalopram abruptly; many doctors recommend a gradual taper to reduce withdrawal. If your plan is to switch to a different antidepressant, your prescriber will choose a cross-taper or a washout period depending on the new drug.
Keep track of what improves and what doesn’t after the change, and expect 4–8 weeks to judge effectiveness. If side effects appear, report them—sometimes a simple dose change helps. And remember, medication is one tool: therapy, sleep, exercise, and reducing alcohol can all boost results.
If you want help preparing questions for your doctor or comparing two specific drugs, tell me which ones and I’ll give a short comparison to bring to your appointment.
