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Citalopram when pregnant


Pregnancy, breastfeeding and fertility while taking citalopram

Citalopram and pregnancy

Citalopram can be used in pregnancy. Some studies have suggested that citalopram might occasionally affect the development of a baby’s heart. However, if there is any risk, it is small, and most babies born to women taking citalopram have a normal heart.

When citalopram is taken in the weeks before delivery it can sometimes cause short-term withdrawal symptoms and, very rarely, breathing problems in the baby. Your baby will be checked after birth and given extra care if needed.

Taking citalopram in the last month of pregnancy may slightly increase your risk of bleeding after delivery. However, because this side-effect is rare and treatable, it is not a reason to stop taking citalopram for most pregnant women.

It is important that mental health problems are well treated since these can affect both you and your baby’s wellbeing. Depression and anxiety can sometimes get worse during pregnancy, and after the baby’s born.

Speak to your doctor if you get pregnant. They will help you weigh up the risks and benefits so you can decide on the best treatment for you and your baby.

Citalopram and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take citalopram while breastfeeding.

Citalopram passes into breast milk in fairly small amounts. It has often been used during breastfeeding without any problems but has been linked with side effects, including poor feeding, colic, and being unusually sleepy, irritable or restless, in a very small number of breastfed babies.

If you notice that your baby has any of these side effects, or you have any other concerns about them, talk to your health visitor, midwife, pharmacist or doctor as soon as possible.

Although other medicines that pass into breast milk in smaller amounts might be preferred while you are breastfeeding, it is important you take the medicine that works for you. If you are breastfeeding, or planning to breastfeed, talk to your doctor or pharmacist to help you decide what is best for you.

It's important to continue taking citalopram to keep you well. Breastfeeding will also benefit both you and your baby.

Citalopram and fertility

Citalopram may possibly reduce sperm quality, but it's not known whether this reduces male fertility or not. Speak to your doctor if you're having difficulty conceiving a baby.

For women, there's no evidence to suggest that taking citalopram will reduce your fertility. Speak to a pharmacist or your doctor if you're trying to get pregnant as they may want to review your treatment.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

Find out more about how citalopram can affect you and your baby on the Best Use of Medicines in Pregnancy (BUMPS) website.

Page last reviewed: 9 February 2022
Next review due: 9 February 2025

Citalopram use in pregnancy: prospective comparative evaluation of pregnancy and fetal outcome

Comparative Study

. 2005 Dec;193(6):2004-9.

doi: 10.1016/j.ajog.2005.05.012.

Anna Sivojelezova  1 , Samar Shuhaiber, Lorig Sarkissian, Adrienne Einarson, Gideon Koren

Affiliations

Affiliation

  • 1 The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Ontario, Canada. [email protected]
  • PMID: 16325604
  • DOI: 10. 1016/j.ajog.2005.05.012

Comparative Study

Anna Sivojelezova et al. Am J Obstet Gynecol. 2005 Dec.

. 2005 Dec;193(6):2004-9.

doi: 10.1016/j.ajog.2005.05.012.

Authors

Anna Sivojelezova  1 , Samar Shuhaiber, Lorig Sarkissian, Adrienne Einarson, Gideon Koren

Affiliation

  • 1 The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Ontario, Canada. [email protected]
  • PMID: 16325604
  • DOI: 10. 1016/j.ajog.2005.05.012

Abstract

Objective: Citalopram is a selective serotonin reuptake inhibitor indicated for depression. The safety of this medication in pregnancy has not been fully established. The purpose of this study was to investigate whether citalopram is associated with an increased incidence of adverse pregnancy outcomes.

Study design: Pregnant women who contacted the Motherisk Program, a Teratogen Information Center in Toronto, Ontario, with regard to the safety of citalopram in pregnancy were enrolled in the study. The exposed women were matched to a disease-matched group of women and a nonteratogenic group. All women were matched for age (+/- 2 years) and gestational age at time of first call to the Motherisk (+/- 2 weeks). A structured telephone follow-up interview was conducted following the expected date of confinement.

Results: The total number of pregnant women enrolled in this study was 396 (132 women in each group). A total of 125 women took citalopram at least in the first trimester. Seventy-one (54%) women continued to take the drug throughout pregnancy. One hundred fourteen women (86%) had live births, 14 (11%) had spontaneous abortions, 2 (1.5%) had elective terminations, and 2 (1.5%) experienced stillbirths. Fetal survival rates, mean birth weights, and duration of pregnancy were not statistically different among the 3 groups. Of 108 live-born infants whose mothers were exposed to citalopram in the first trimester, there was 1 (0.9%) male infant born with a major malformation. There was a relative risk of 4.2 (95% confidence interval 1.71-10.26) in neonates exposed to citalopram close to term to be admitted to special-care nurseries as compared with the unexposed infants.

Conclusion: Citalopram use during the period of embryogenesis in pregnancy is not associated with an apparent major teratogenic risk. Late pregnancy use of citalopram is associated with increased risk of poor neonatal adaptation syndrome, recently described with other selective serotonin reuptake inhibitors.

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Publication types

MeSH terms

Substances

FGBNU NTsPZ. ‹‹Depression in General Medicine: A Guide for Physicians››

The choice between the need for pharmacotherapy, on the one hand, and the prevention of risks to the health of the fetus or newborn (the risk of congenital malformations, pre- and neonatal complications, etc. ) on the other, is required from the doctor in case of depression that manifests or worsens during the period pregnancy.

When deciding on such an alternative (the proportion of benefit to the mother and the potential risk to the child), a number of circumstances are taken into account, including the possibility of a negative impact on the development of the fetus by the mother's severe mental state during pregnancy. nine0003

Psychotropic drugs for pregnant women are prescribed if absolutely necessary according to strict clinical indications:

- with pronounced affective manifestations with anxiety, agitation, sleep and appetite disorders, aggravating the somatic condition of pregnant women and women in childbirth;

- with suicidal thoughts and tendencies.

However, in some cases, such as unplanned pregnancy, antidepressants are taken out of ignorance - a depressed woman, not yet aware of the pregnancy, may continue to take psychotropic drugs and be exposed to them. nine0003

Penetrating through the placenta or with mother's milk, psychotropic drugs can have an adverse effect on the fetus or newborn. Microsomal enzymes of the fetal liver are less active and are in a lower concentration compared to the liver of adults, which prolongs and enhances the effect of drugs. In the prenatal period, the blood-brain barrier is not yet fully formed and the immature CNS is generally more sensitive to the action of drugs. At the stage of embryogenesis, as well as in the early postnatal (neonatal) period of ontogenesis, the development of these vital structures is not completed, which can enhance the toxic effect of psychotropic drugs on both the fetus and the newborn. Such effects include potentially reversible, dose-dependent effects that may be exacerbated by the fact that metabolic systems have not yet fully formed. The constant use of drugs by a pregnant woman can lead to drug dependence of the fetus and, ultimately, to a withdrawal syndrome in the newborn [Vybornykh D. E., 1996].

During lactation, taking antidepressants due to the possibility of the neonatal complications listed above is also highly undesirable. The mother should be convinced that in this situation it is more appropriate to feed with donor milk or artificial mixtures.

Differentiation of antidepressants in accordance with the degree of risk of developing toxic effects for infants fed by a mother taking psychotropic drugs of this class is shown in Table. 16. nine0003

Table 16 Risk of developing toxic effects in infants breastfed by mothers taking antidepressants

Level of risk

short

average

tall

Mianserin
Moclobemide
Trazodone
Amoxapine

SSRI
MAOI
Mirtazapine

Doxepin
Maprotiline
Nefazodone
Venlafaxine

TCAs (majority)

When deciding on the use of antidepressants during pregnancy, it is necessary to take into account data on the risk of teratogenic effects of antidepressants. The teratogenic effects of antidepressants cannot be completely ruled out from laboratory animal data and some very limited clinical observations. nine0003

There are 3 classes of teratogenicity of psychotropic drugs: class A - no teratogenicity in animals, no studies of the risk of teratogenicity in humans, or teratogenicity in animals has been established, but not in humans;

class B - known to be teratogenic in animals, no risk of teratogenicity in humans, or no risk of teratogenicity in animals or humans;

class B - teratogenicity has been proven, but the benefits associated with prescribing drugs sometimes outweigh the risks (eg, in a life-threatening situation). nine0003

The distribution of drugs by teratogenicity classes is presented in Table. 17. Data are given for the first trimester of pregnancy.

Table 17. Distribution of psychotropic drugs by teratogenicity class Psychotropic Drug Directory, 1997]

SBOSN: maprotiline (ludiomil) OIMAO: Moclobemide (Aurorix) Normotimics: carbamazepine (finlepsin) nine0082

* Due to lack of human teratogenicity data, not recommended for use during pregnancy .

In this aspect, in the treatment of pregnant and lactating mothers, drugs of the group of irreversible MAOIs should be abandoned first of all.

These data show that the risk of a teratogenic effect is minimal with the use of class A drugs. Not found. The results of a meta-analysis, combining a large amount of information, indicate the safety of fluoxetine for intrauterine development of the fetus. Accordingly, the fact of exposure to fluoxetine does not require the termination of psychopharmacological therapy or termination of pregnancy [Addis A., Koren G., 2000]. Some reports, however, indicate that women treated with fluoxetine and TCAs were more likely than in the control group (6.8%) to have spontaneous abortions (13.5 and 12.2%, respectively) [Stokes P. S. , Holtz A., 1997].

According to preliminary data from a 12-month follow-up of children whose mothers took SSRIs (fluoxetine, fluvoxamine, sertraline) during pregnancy or lactation, no adverse effects on the development of the child were registered [Stowe Z. N., 1995; Winn, 1995; Stowe Z. N., Nemeroff S. V., 1996; Yoshida K. et al., 1997; Piontek C. M., 2001].

The introduction of class B drugs: melipramine-imipramine, anafranil-clomipramine, doxepin-sinequan in animal experiments at doses many times higher than those used in clinical practice may be accompanied by a teratogenic effect. At the same time, at the clinical level, there are currently no convincing data on an increased risk of defects in the embryonic development of the fetus due to the use of these drugs during pregnancy [Puzynski S., 1988]. At the same time, the use of TCAs classified as class B, , i.e., drugs with proven teratogenicity (amitriptyline, nortriptyline), requires special care (justified only in extreme, life-threatening situations for the patient) due to the threat of fetal developmental disorders .

Of great importance for successful therapy is the early detection of depression that manifests during pregnancy. Thanks to this, it is possible to carry out sparing psychopharmacotherapy - the relief of affective disorders at a still undeveloped stage with the help of low doses of medications in short courses. The use of psychotropic drugs in such cases is also the prevention of postpartum depression. nine0003

How safe is it to take antidepressants during pregnancy?

Summary. New study investigates the teratogenic effects of selective serotonin reuptake inhibitors and venlafaxine

Depression is very common in women during pregnancy. It is estimated that in developed countries every 10th pregnant woman faces this problem. As is known, cognitive-behavioral or pharmacotherapy is used as the first-line treatment for a depressive episode, in which selective serotonin reuptake inhibitors (SSRIs) are most often prescribed to this category of patients. However, the risks of taking them during pregnancy remain not fully understood. It should be noted that in Europe antidepressants are prescribed by about 3% of pregnant women, in North America - 4-10%, however, many women refuse such therapy due to possible risks. nine0003

According to some studies, SSRIs may have negative effects on the fetus, in particular, increase the risk of birth defects of the cardiovascular system. The literature also describes the possibility of an increase in the risk of other defects (anal atresia, hypospadias, craniosynostosis, etc.), but with a much smaller evidence base.

To better understand the effect of SSRIs and venlafaxine (SSRIs and norepinephrine) on the fetus, an international team of scientists conducted a large observational study, which included 2 cohorts. The researchers analyzed Danish medical databases (1997-2010), Finland (1996-2006), Iceland (2003-2007), Norway (2005-2010) and Sweden (2006-2010) and identified all children born as a result of singleton pregnancy, as well as all siblings (from the same mother). From the SSRI group, the following drugs were included in the analysis: fluoxetine, citalopram, paroxetine, sertraline, fluvoxamine, and escitalopram. A child was considered to have been exposed to them in utero if the mother took SSRIs from 30 days to day 1 of the last menstrual cycle until the end of the first trimester (97 days after the last menstrual period).

Records of 2,303,647 singletons and 2288 siblings were analyzed. About 1.6%, or 36,772 of the children in the entire sample, were exposed in utero to the studied antidepressants. Of these, 3.7% had a severe congenital defect, while in the control group — 3.2%. Thus, the use of antidepressants by the mother increased the risk of having a child with congenital malformations by 13% (relative risk (RR) 1.13; 95% confidence interval 1.06–1.20).

The analysis based on sibling data showed different results. Note that this analysis included 895 families with at least one child exposed to antidepressants in utero and with at least one child who was born with birth defects. The relative risk increase in this case was only 6%.

If in the primary analysis the increase in the risk of having a child with heart malformations when the mother was taking SSRIs or venlafaxine was increased by 15%, then in the analysis of data on siblings it was reduced by 8%. The same applies to congenital stenoses of the pulmonary arteries, the RR of which in the primary analysis was 1. 48, and in the analysis of siblings - 0.56. nine0003

In general, the study yielded conflicting data. One possible explanation is that a simple analysis cannot take into account all the potential factors that are involved in the formation of the relationship under study. Sibling analysis helps to take into account some of these factors, such as heredity and some of the lifestyle features that cannot be calculated when analyzing the entire cohort. According to his results, the increased risk of birth defects was small. nine0003

According to one hypothesis, the neurotransmitter serotonin is an important signaling molecule involved in the development of various cells and tissues during embryogenesis, including the development of the heart. Theoretically, SSRIs, by acting on the metabolism of serotonin, can affect this process. These data are partially confirmed in experiments on animal models. On the other hand, it is not known for certain what effect the changes underlying the depressive disorder have on the fetus.

Teratogenic class

AND nine0003

B

AT

SSRIs: fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)

TCAs: imipramine (melipramine), clomipramine (anafranil), desipramine (petylyl), doxepin (sinequan)

TCAs: amitriptyline, nortriptyline

Tranquilizers: chlordiazepoxide (Elenium), alprazolam (Xanax), diazepam (Relanium), lorazepam (Ativan), oxazepam (Nozepam) nine0003

Antipsychotics: butyrophenone and phenothiazine derivatives, risperidone

SSOZS: tianeptine (coaxil)*

Normotimics: lithium preparations

Tranquilizers: clonazepam (antelepsin)

Antipsychotics: clozapine (azaleptin)

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