What are the guidelines for using Celexa (citalopram) during pregnancy?

From the Guidelines

Celexa (citalopram) should be used during pregnancy only when the potential benefits outweigh the risks, and this decision should be made in consultation with a healthcare provider. The use of Celexa during pregnancy has been associated with a risk of neonatal withdrawal symptoms, including continuous crying, irritability, jitteriness, and/or restlessness; shivering; fever; tremors; hypertonia or rigidity; tachypnea or respiratory distress; feeding difficulty; sleep disturbance; hypoglycemia; and seizures 1. However, several recent reviews have not identified adverse neurodevelopmental outcomes among infants born to women treated with SSRIs, including Celexa, during pregnancy 1.

When considering the use of Celexa during pregnancy, it is essential to weigh the potential risks against the benefits of treating depression. Untreated depression during pregnancy can have severe consequences, including poor prenatal care, inadequate nutrition, increased substance use, and potential for self-harm. The medication should be continued during pregnancy at the lowest effective dose, as withdrawal of medication may have harmful effects on the mother-infant dyad 1.

Some key points to consider when using Celexa during pregnancy include:

• The typical dosage ranges from 20-40 mg once daily, with 20 mg being the starting dose for most patients.
• Pregnant women should generally not exceed 20 mg daily due to concerns about QT prolongation at higher doses.
• If you're currently taking Celexa and discover you're pregnant, don't stop the medication abruptly; instead, contact your healthcare provider immediately to discuss your options.
• There's also a potential risk of neonatal withdrawal symptoms if used late in pregnancy, which may include irritability, feeding difficulties, and respiratory problems in the newborn.
• Alternative treatments like psychotherapy may be considered for mild to moderate depression, while medication may be necessary for severe depression.

It is crucial to consult with a healthcare provider to determine the best course of treatment for depression during pregnancy, as they can help weigh the potential risks and benefits of Celexa and other treatment options 1.

From the FDA Drug Label

Pregnancy Category C In animal reproduction studies, citalopram has been shown to have adverse effects on embryo/fetal and postnatal development, including teratogenic effects, when administered at doses greater than human therapeutic doses There are no adequate and well-controlled studies in pregnant women; therefore, citalopram should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus Neonates exposed to citalopram tablets and other SSRIs or SNRIs, late in the third trimester, have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Infants exposed to SSRIs in pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN).

The guidelines for using Celexa (citalopram) during pregnancy are as follows:

• Pregnancy Category C: Celexa has been shown to have adverse effects on embryo/fetal and postnatal development in animal studies.
• Risk vs Benefit: Celexa should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.
• Potential Complications: Neonates exposed to Celexa in the third trimester may develop complications, and infants exposed to SSRIs in pregnancy may have an increased risk of persistent pulmonary hypertension of the newborn (PPHN).
• No Adequate Studies: There are no adequate and well-controlled studies in pregnant women, so the decision to use Celexa during pregnancy should be made on a case-by-case basis 2.

From the Research

Guidelines for Using Celexa (Citalopram) During Pregnancy

• The use of Celexa (citalopram) during pregnancy is a topic of interest due to its potential effects on the fetus and the mother's mental health 3.
• A literature review conducted in 2017 found that paroxetine and fluoxetine have the strongest association with negative outcomes, such as significant malformations, persistent pulmonary hypertension (PPHN), and poor neonatal adaptation syndrome (PNAS), while the associations between sertraline and citalopram with negative outcomes remain mixed and generally unsubstantiated when controlled for maternal depression and associated factors 3.
• The review suggests that sertraline and citalopram should be considered first-line drug treatments for anxiety and depression in pregnant women in the SSRI class, as they have a more favorable safety profile compared to other SSRIs 3.
• Another study published in 2012 found that escitalopram, a related SSRI, may be considered safe during pregnancy, particularly with regards to major malformations, but may be associated with an increased risk of perinatal complications 4.
• However, it is essential to note that the available data on the safety of citalopram during pregnancy are limited, and more research is needed to fully understand its effects 3, 4.
• In terms of breastfeeding, the available data suggest that sertraline can be continued during breastfeeding, as the concentration found in breast milk is very low and has not been linked to infant complications 3.
• The safety of citalopram during breastfeeding has not been extensively studied, and more research is needed to determine its safety profile in this context.

Key Considerations

• Pregnant women with depression or anxiety should discuss the potential risks and benefits of citalopram treatment with their healthcare provider 3, 4.
• The decision to use citalopram during pregnancy should be made on a case-by-case basis, taking into account the individual woman's medical history, the severity of her symptoms, and the potential risks and benefits of treatment 3, 4.
• More research is needed to fully understand the safety and efficacy of citalopram during pregnancy and breastfeeding, and to inform evidence-based guidelines for its use in these populations 3, 4.