Citalopram - pregnancy and breastfeeding

Citalopram - Pregnancy and Breastfeeding
This fact sheet is for women who take citalopram and are concerned about its effects on pregnancy and
breastfeeding. It does not include information about all the side effects and should be read in addition to
information provided with the product. It is very important that you speak to a doctor before you decide to stop
using citalopram.
What is citalopram?
Citalopram belongs to a class of medicines called selective serotonin reuptake inhibitors (SSRI). It is used to treat
major depression and anxiety disorders (e.g. obsessive-compulsive disorder, panic disorder, generalised anxiety
disorder, post-traumatic stress disorder and social phobia).
Should I stop taking citalopram before becoming pregnant?
There are high rates of relapse in people who stop taking citalopram. Studies have suggested that untreated
depression during pregnancy is associated with pregnancy complications and adverse pregnancy outcomes 1. The
decision to stop, start or to continue taking citalopram, or to change how you take citalopram, must be made with
your doctor. You and your doctor should talk about the possible risks and benefits of treatment choices in your
individual situation. Ongoing consultation with your health care providers is very important throughout your
pregnancy.

Can taking citalopram during pregnancy cause birth defects?
A birth defect is an abnormality that develops in the baby during pregnancy. All women carry a 3 to 5 percent risk of
having a baby with a birth defect (that is, 3 to 5 births in 100). Of all the antidepressants that are used during
pregnancy, citalopram is one of the most studied. While some studies have linked citalopram to some form of birth
defects, most studies have shown that there is no association between citalopram and birth defects2-4. However,
because the findings are inconsistent, it is important that you and your doctor discuss your individual situation either
before you become pregnant or during your pregnancy. Stopping citalopram can also put your pregnancy at risk.
Are there any other concerns if I continue taking citalopram during late pregnancy?
Inconclusive information suggests babies may be at a slightly increased risk of developing pulmonary hypertension -
a potentially serious lung problem, when mothers take citalopram during late pregnancy. Pulmonary hypertension is
a very rare condition, affecting 1 to 2 babies out of 1000 births. Majority of women (99%) taking SSRIs give birth to
healthy babies5,6. Tell your obstetrician if you are taking citalopram, as you and your baby wil need to be monitored
during late pregnancy.
Will my baby have withdrawal symptoms after the birth?
Unfortunately, it is impossible to predict if your baby will have withdrawal symptoms from citalopram after the birth.
Withdrawal symptoms reported include problems with breathing, irritability, tremor difficulty feeding and
problems with sleep. The symptoms will usually be mild and your baby is likely to recover without treatment.
However, some babies may need to stay in a special care nursery for a few days until the symptoms resolve 7.
Will taking citalopram have any long term effects on my baby’s behaviour and development?
There have been limited studies about the long term effects on baby behaviour and development following exposure
to citalopram during pregnancy. Based on the available information, children exposed to citalopram during
pregnancy do not have any significant differences in their behavioural and development compared to children not
exposed to the medicine8-10.
Can I breastfeed my baby if I continue taking citalopram?
There are several published reports on citalopram and breastfeeding. Very small amounts of citalopram are found in
breast milk but no serious or harmful effects have been found in breastfed babies11. Watch your baby for any
potential effects such as drowsiness, irritability, poor feeding and restlessness. Discuss with your doctor or other
healthcare providers the risks and benefits associated with taking citalopram while breastfeeding your baby.
If you have questions about the information on this fact sheet or other medicine exposures during pregnancy, cal the
Royal Women’s Hospital Medicine Information Service on 03-8345 3190.
PPMIS revision date: 16 May 2011

Source: http://ppmis.org.au/uploads/wyg/Citalopram_FV491111.pdf