Long-term antidepressant therapy may present challenges when discontinuation is attempted, particularly after prolonged exposure and previous withdrawal symptoms. We report a woman in her 60s with a history of depression, post-traumatic stress disorder, and generalized anxiety disorder who had taken citalopram 40 mg daily for approximately 23 years and wished to discontinue treatment because of concerns about long-term medication exposure and possible worsening of gastrointestinal symptoms. A gradual, symptom-guided taper was undertaken over approximately nine months from 40 mg to 35 mg, 30 mg, 20 mg, 15 mg, 10 mg, 5 mg, 2.5 mg, and ultimately 0 mg. Early reductions were associated with irritability, insomnia, anxiety, and transient somatic symptoms, with the most prominent symptom cluster occurring after reduction from 30 mg to 20 mg. Extended periods of dose stabilization were used before further reductions. In contrast, later reductions from 10 mg to 5 mg and from 5 mg to 2.5 mg were comparatively well tolerated. A brief episode of passive suicidal ideation while maintained on 2.5 mg prompted additional observation before complete discontinuation. Following cessation, the patient remained off citalopram across two follow-up visits, reported stable mood, and did not experience the anxiety, irritability, or jaw tightness that had previously occurred with delayed or missed doses. This case illustrates that discontinuation after decades of citalopram therapy can be achieved through gradual dose reduction, individualized stabilization periods, and longitudinal clinical monitoring.

citalopram, antidepressant discontinuation, antidepressant withdrawal, selective serotonin reuptake inhibitor, deprescribing, tapering, long-term therapy