Celexa (Citalopram) and Breastfeeding Safety
Citalopram can be used during breastfeeding, but it requires careful monitoring due to documented cases of infant adverse effects including excessive somnolence, decreased feeding, and weight loss. 1
Key Safety Considerations from FDA Labeling
The FDA label explicitly documents two case reports of breastfed infants experiencing:
- Excessive somnolence
- Decreased feeding
- Weight loss
In one case, the infant recovered completely after the mother discontinued citalopram; the second case lacked follow-up data. 1
The FDA states that the decision to continue or discontinue either nursing or citalopram therapy should weigh the risks of infant exposure against the benefits of maternal treatment. 1
Clinical Context and Risk-Benefit Analysis
While citalopram is excreted in human breast milk 1, the documented adverse events appear to be reversible and relatively uncommon based on available reports. However, the limited safety data and documented cases of infant complications place citalopram in a higher-risk category compared to some alternative SSRIs.
Research suggests that among contemporary antidepressants, sertraline and paroxetine should be considered first-line medications for women requiring antidepressant treatment during the postpartum period who wish to breastfeed, while citalopram is associated with a relatively higher risk of adverse events (though with low severity). 2
Monitoring Recommendations
If citalopram is used during breastfeeding, closely monitor the infant for:
- Excessive sleepiness or sedation 1
- Poor feeding or decreased appetite 1
- Inadequate weight gain or weight loss 1
- Irritability or behavioral changes 1
Alternative Considerations
Most commonly used drugs are relatively safe for breastfed babies, with the dose received via milk generally much less than known safe doses given directly to infants. 3 The general principle is that most medicines can be used safely during breastfeeding at recommended doses. 4
If initiating new antidepressant therapy postpartum, consider sertraline or paroxetine as safer alternatives with better documented safety profiles in breastfeeding. 2
Common Pitfall to Avoid
Do not automatically discontinue effective maternal treatment without weighing the serious risks of untreated maternal depression against the documented but relatively uncommon and reversible infant effects. Untreated maternal depression has severe repercussions on infant well-being. 2