Is Citalopram Safe During Pregnancy?

Citalopram During Pregnancy

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Pregnancy can lead to many complications, and depression or anxiety are bound to creep in while you are expecting your child. Doctors typically prescribe many different types of drugs to ward off your anxiety during pregnancy. Citalopram is one such antidepressant that helps boost serotonin levels in your body and eases your depression. But, if you were wondering whether it is safe to take Citalopram during pregnancy, read our post below. Here, we look at Citalopram (Celexa) and how it affects pregnant women.

What is Citalopram (Celexa)?

Citalopram or Celexa is the brand name of a prescription anti-depressant. It is an SSRI drug that doctors typically prescribe as 20-60mg doses to treat anxiety and depression. In some cases, doctors may inject the drug to quicken the relief. Citalopram, which is marketed as Celexa, was the third-highest prescribed drug in the United States in 2013, with around 39 million prescriptions.

Having received the stamp of approval from the U.S. Food and Drug Association in 1998, Citalopram is also given off-label for treatment of a range of other health conditions like anxiety disorders, eating disorders, obsessive-compulsive disorder, diabetic neuropathy and more. It is most effective, however, in the treatment of depression and ranked fifth in the list of top 10 effective anti-depressants and fourth for being a cost-effective solution.

Known as “happy pills”, the popularity and potency of this drug makes it a commonly used drug. The FDA has advised patients to avoid taking more than 40 mg per day, as it increases the possibility of the person suffering from fatal heart problems. The announcement came after studies concluded that patients, who took 60 gm of Celexa daily, faced a greater risk of having heart problems than otheres. These problems occurred due to the heart’s electrical activity as compared to patients who took a lower dose of the medication.

Children born to women taking antidepressants are at an increased risk of developing heart defects. There appears to be an increase of 0.4% in heart defects in children, whose mothers took the Citalopram during pregnancy (1). In fact, studies showed that women who took Citalopram during pregnancy first trimester, increased the chances of malformations. SSRIs have been found to be dangerous is because they move past the placental barrier. So, when a pregnant woman uses Citalopram, the fetus is exposed to the drug, which enters into its tissues and bloodstream. Hence, the child comes into the world on an anti-depressant.

It helps boost the levels of serotonin in the body thereby reducing depressive symptoms and maintaining a person’s mental balance. Known to belong to a category of anti-depressants, which are commonly referred to as Selective Serotonin Reuptake Inhibitors (SSRIs), taking Celexa, which is a common brand name for Citalopram, during your pregnancy, may increase the possibility of birth defects in your child.

[ Read: Is Cymbalta Safe During Pregnancy ]

Citalopram And Pregnancy:

The FDA divides prescription drugs into five categories based on the risk involved in taking them. On a scale of 5, Celexa, or Citalopram scored a C because it has harmful effects on the fetus and is linked to an increased risk of birth defects in some animal studies. However, human studies have not generated enough results.

It is not altogether clear whether taking Citalopram makes it harder for one to get pregnant though animal studies have shown a reduced fertility rate after exposure to Citalopram. Even if you are taking this anti-depressant when pregnant, do not make any changes in your medication without consulting your doctor as it could have negative consequences. Visit your healthcare provider and let them help you decide if you can stop the medication because if depression is left untreated during pregnancy, there is a greater risk of preeclampsia, preterm delivery or even having a miscarriage.

Hence, the effects of stopping the medication can sometimes be far more harmful than the risks of taking it. This is why you need to approach your doctor for the right guidance in your situation. If you have been told to stop, this should be done gradually so that you do not suffer the backlash of withdrawal symptoms.

[ Read: Eclampsia During Pregnancy ]

Is Citalopram Safe During Pregnancy?

When you consider the various pros and cons of this SSRI, there is no definitive answer to this question. You need to weigh which is the better alternative – do the risks to yourself and your child outweigh the benefits and relief that you will get from your current state? The answer to this question will help you determine whether this anti-depressant is ‘safe’ or not.

Various other factors, like how far your pregnancy has progressed, will also play a role in determining whether to stay off it or not. For some, the use of Citalopram when pregnant may be a necessity so, in such a case, there is no getting around it.

Side Effects Of Citalopram During Pregnancy:

The consumption of Citalopram, or Celexa gives rise to certain side-effects at times. If you encounter these side effects, you should contact your doctor for prompt medical help. Some of the side effects that you may experience when you take Citalopram while pregnant include:

  • Allergic reactions
  • Rashes on your skin
  • Hives
  • Swelling of the face, lips, tongue or throat
  • Difficulty breathing
  • Panic attacks
  • Anxiety attacks
  • Mood or behavioral changes (2)

Most anti-depressants have negative effects on a pregnant mother and hence, many healthcare professionals advise women to stay away from them unless prescribed by a qualified doctor. Similarly, exposure to Citalopram can reduce the gestation period by three days and cause a 55% increase in the possibility of a preterm delivery. There is also the increased risk of the child’s weight at birth being lowered by 75g and reduce the APGAR scores below normal levels, which help evaluate the health of a newborn baby.

Research that focused on head and facial defects associated the use of Citalopram in pregnant mothers, with birth defects like a reduction in the size of the child’s skull as well as other facial deformities. The use of SSRIs by pregnant mothers can increase the odds of having a child with craniofacial and cardiac malformations, among other defects. Therefore, the use of Citalopram is now regarded as a matter of concern.

Some studies also showed that urinary defects and defects of the digestive system were linked to the use of Citalopram during pregnancy. However, more studies have to be conducted for conclusive results. There is not yet enough evidence showing the use of Citalopram linked to increased risk of stillbirth.

Studies on animals concluded that high doses of Citalopram in pregnancy are linked to embryofetal toxicity and have negative effects on postnatal development of the child. However, in opposition to this, studies on pregnant women brought evidence that there was no emergence of malformative neonatal toxicity. Even if the pregnant mother takes Citalopram when the embryo is forming and developing, it did not lead to teratogenic risk in humans. However, some results show humans spontaneously abort the fetus.

Citalopram is also considered responsible for increasing the chances of the child having premature fusion of the skull structure which is also referred to as craniosynostosis (3). When the study was conducted in a controlled laboratory setting, some of the craniofacial changes that were witnessed included flattening of the midface, reduction in the prominence of the upper jaw, a depressed nasal bridge and others. These morphological alterations did match with human case studies, leading to the conclusion that use of Citalopram during pregnancy is related to birth defects and hence, is not safe for pregnant mothers.

Also, if you feel impulsive, irritable, hostile, aggressive, more depressed or restless, you should report these symptoms to the doctor immediately. Despite being good in the treatment of depression, Celexa is a potent drug and can take a drastic turn if not administered properly.

There are still controversies regarding whether septal heart defects have risen to children whose mothers were prescribed this SSRI during early pregnancy. However, it is certain that Citalopram has the ability of inducing a mixed-affective state, which includes episodes of mania and depression, along with a host of other related symptoms.

As for the role of a father, there does not seem to be any increased risk for the development of the baby if the father has been using Citalopram, either before or around the time you became pregnant. So, there is nothing to worry about there.

[ Read: Hypertension In Babies ]

Stages Of Damage From Citalopram During Pregnancy:

A baby’s internal organs are formed during the first 12 weeks of pregnancy. It is a crucial time and you need to avoid using Citalopram as it can lead to many birth defects for your unborn child:

  • If the pregnant mother used Citalopram during her first trimester, the risk of having a miscarriage increases. She may also experience a premature delivery.
  • Mothers, who take Citalopram 12 months before the delivery of the child, are at an increased risk of having a child with Autism Spectrum Disorder. When pregnant women took this SSRI during the first trimester, the risk of developing autism increases four times more than women, who did not use any SSRI.
  • Use of Citalopram during the first trimester of pregnancy was associated with an increased risk of the baby developing neural tube defect, including spina bifida.
  • Citalopram during early pregnancy was also said to lead to an increased risk of heart defects. However, 1 in every 100 babies is detected with heart defects and this is considered the normal “background population risk.”
  • Single studies drew links between taking Citalopram usage during early pregnancy and the development of neural tube defects as well as defects of eyes and limbs.

If the mother takes Citalopram during late pregnancy, the baby may suffer from withdrawal symptoms, also known as ‘neonatal withdrawal.’ Close monitoring of the baby after birth is advisable. Some of the symptoms that the baby is likely to suffer from include:

1. Persistent Pulmonary Hypertension:

This means the baby will be unable to adapt to breathing outside the womb. Though this affects just one baby out of every 700 newborns, it can be serious. It is common in babies whose mothers took this SSRI before 20 weeks of pregnancy and then stopped. Babies born with PPHN suffer from an abnormal flow of blood through their lungs and heart, and their bodies are deprived of oxygen. This can cause organ failure and hence, poses a serious problem. Nearly 20% of babies born with PPHN do not survive and those who do, suffer from breathing problems for a major part of their lives.

2. Learning and Behavioral Problems:

Taking medicines at any stage of pregnancy can affect a child’s learning and behavior. Since SSRIs are known to affect chemicals in the brain, if used during pregnancy, they can affect the brain development of the baby. However, due to the limited number of studies conducted, there is no conclusive evidence to say that use of Citalopram during pregnancy was linked to learning and behavioral problems in babies.

3. Hypoplastic Left Heart Syndrome:

This is when the left side of the infant’s heart does not get fully developed. The child may need a heart transplant to survive, as it can result in sudden death.

4. Craniosynostosis:

This is when the sutures in the infant’s skull harden prematurely. This causes the child to have a misshapen skull. It also leads to intracranial pressure and improper growth in the child’s head.

5. Other Defects:

Some studies show that there is also the possibility of developing problems, like oral cleft, pulmonary stenosis, septal defect, tetralogy of fallot and even coarction of the aorta.

[ Read: Heart Diseases In Babies ]

Risks Of Taking Citalopram During Pregnancy:

During the neonatal stage of the child’s development, clinical findings have found certain symptoms to surface when the mothers were prescribed Citalopram during their pregnancy. If the pregnant mothers were exposed to SSRIs in the third trimester of pregnancy, neonates were found to experience the following problems:

  • Problems breathing
  • Cyanosis
  • Apnea
  • Seizures
  • Temperature instability
  • Vomiting
  • Difficulty feeding
  • Hypotonia
  • Hypertonia
  • Tremors
  • Irritability
  • Jittery feelings
  • Hyperreflexia
  • Constant crying

These effects were seen to arise either at birth itself or a few days after the birth of the child although whether the features are a result of direct toxicity of Citalopram is not completely certain. These symptoms are usually mild and should disappear within two weeks.

If SSRIs are used by the mother during late pregnancy, it can increase the risk of the newborn suffering from persistent pulmonary hypertension.

Administering Citalopram During Pregnancy:

  • Usually, women prescribed Citalopram to ward off depression have to take the medication once a day, either in the morning or evening. The drug can be taken with or without food. It has to be taken the same time every day and it is important to follow your physicians instructions. This way, you will neither take more or less than what is prescribed, as it can have adverse implications.
  • It may take three to four weeks for the effects for the medication to show results. You should continue to take it even when you begin to improve as abruptly stopping the use of Citalopram is can cause you to experience withdrawal symptoms. Always talk to your doctor before deciding to stop your medication.

[ Read: Antidepressants During Pregnancy ]

Things To Keep In Mind:

Before you start taking Citalopram, there are a few things that you should know.

  • Inform your doctor if you are allergic to Citalopram or any of its ingredients
  • Let your doctor know what other medication you are taking or planning to take
  • Citalopram is very similar to another SSRI known as Escitalopram so make sure you do not take both these drugs at the same time
  • Citalopram may cause drowsiness so do not perform any potentially hazardous tasks until you know how the medication affects you
  • Make sure the doctor knows what herbal supplements or diet you are following while on this medication.
  • Alcohol can cause the side effects of Citalopram to worsen so make sure you ask your doctor whether alcohol use is permitted.
  • Make sure you keep all appointments with your doctor. You may need to take certain tests, including an electrocardiogram before you begin and during your treatment.
  • Ensure the drug is stored at room temperature and kept tightly closed and out of reach of children.
  • Lastly, if you become pregnant while taking Citalopram, call your doctor immediately as it may cause problems in the newborn baby if taken during the last months of pregnancy.

[ Read: Citalopram While Breastfeeding ]

Effects Of Citalopram On Breastfeeding:

Celexa is excreted in breast milk and hence, causes sleepiness or weight loss in infants, who are being breastfed. Nursing mothers are advised not to use it when breastfeeding the child. The FDA has categorized it as a Pregnancy Category C drug, as there still aren’t enough well-controlled studies involving humans.

  • In fact, the effects of Citalopram if taken during breastfeeding are quite evident. A case study found that the relative infant Citalopram dose obtained from breast milk is around 9% of the maternal dose.
  • Similarly, another study conducted on seven women who took Citalopram and their infants showed that the plasma concentrations of Citalopram in the infants were very low or almost absent and there were no adverse effects. Some studies have said that Citalopram therapy may be continued during breastfeeding if it was used during pregnancy or if other antidepressants have proven to be ineffective.
  • It may not be possible for mothers who have taken Citalopram during pregnancy or postpartum to breastfeed their newborn without additional breastfeeding support. There have been certain behavioral side effects that have been found in the newborn, like drowsiness or fussiness. However, till date there have been no findings that indicate developmental problems. There have also been cases that have reported infants showing decreased feeding and excessive somnolence as well as weight loss when being breastfed by a mother who was on Citalopram.
  • Through breastfeeding, the child receives some amount of Citalopram into their bodies. The amount received depends on the metabolic capacity of mother and child. Most infants had around 7% of their mother’s Citalopram plasma levels, which is considered bad.
  • Some of the noticeable effects of Citalopram seen in breastfed infants include:
  • Uneasy sleep that reversed when the dose of Citalopram was reduced and the formula was partially supplemented.
  • Infant irritability and restlessness are present when Citalopram was taken by the mother two months postpartum.
  • A breastfed infant, whose mother takes 40mg of Citalopram every day, is prone to numerous adverse health effects like irregular breathing.

[ Read: Safe Medications During Pregnancy ]

In Conclusion:

While there are clear indications that Citalopram causes a number of negative effects on the fetus, it does not mean a pregnant patient suffering from depression should stop taking their medication. Instead, the medication should be prescribed in doses that are safe for the fetus and do not result in these side effects. Most of the adverse effects were found to occur when patients took more than the prescribed dosage of the medication.

In general, doctors try to avoid prescribing antidepressants to pregnant women. However, in some cases, it becomes a necessity. Though septal heart defects are common in infants when pregnant women take SSRIs, researchers have observed the risk to infants increases when their mothers take more than one SSRI during pregnancy.

Hence, the surmounting evidence shows that some SSRIs are responsible for disrupting the normal development and functioning of the fetus, thereby causing increased risk of birth defects, and Citalopram is certainly such an SSRI. Hence, you should make use of this drug only if the benefits outweigh potential harmful effects to the fetus. If the mothers continue to use this drug in the late stages of pregnancy, the development of the fetus should be monitored, particularly in the third trimester. Though the drug has negative side effects for a pregnant mother, abruptly stopping the use of it should be avoided at all costs. So try and steer clear of it altogether to avoid complications.

If you have witnessed the effects of Citalopram usage when pregnant, feel free to share your views with us. We would love to hear from you.

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