Celexa

What is Celexa?

Celexa is an antidepressant known as a selective serotonin reuptake inhibitor (SSRI). It is currently available as a brand name and generic medication. The active ingredient in Celexa is citalopram. It is available in tablets and oral solution and is taken once daily. It is only available by prescription from your doctor. 

What is Celexa used to treat?

Celexa is used to treat major depressive disorder in children, adolescents, and adults as well as several off-label indications including panic disorder, social anxiety, eating disorders, generalized anxiety disorder, premenstrual dysphoric disorder, and posttraumatic stress disorder. Depression is a type of mood disorder that causes feelings of continuous sadness, despair, hopelessness, and/or loss of interest in daily activities for at least a 2-week period of time. These feelings can lead to symptoms of anxiety, irritability, fatigue, difficulty concentrating, changes in sleep patterns, feelings of worthlessness, or thoughts of suicide. If left untreated, these symptoms can interfere with your ability to function socially, at work or school, and in daily activities.

You can learn more about depression during pregnancy here. You can also learn about treatments for depression here. Moms can also experience postpartum depression after the baby is born. You can read about postpartum depression here and ways to prevent postpartum depression here.

How does Celexa work?

Celexa works by increasing the presence of the neurotransmitter serotonin in the brain, which can improve symptoms of depression and anxiety. It is thought that depression is caused by lower amounts of some chemicals, including serotonin. 

If I am taking Celexa, can it harm my baby?

It is recommended that doctors use caution when prescribing this medication for pregnant women during the third trimester. Celexa is transferred from the mother to the baby in utero. 

The American College of Obstetricians and Gynecologists recommends individualizing SSRI and SNRI treatment. It is important to weigh the risks versus benefits before taking this medication or another medication or before stopping antidepressant therapy. Women who stop antidepressant medication during pregnancy, but who are at a high risk of postpartum depression can restart their antidepressant medications after delivering. 

Evidence from animal studies with Celexa:

When given to pregnant animals at much larger doses than the maximum recommended human doses, Celexa was found to cause reduced growth of the babies, decreased survival, and an increased risk of birth defects. When high doses of Celexa were given to pregnant rats, maternal toxicity occurred and heart and skeletal defects, decreased survival, growth, and neurodevelopment in the babies were reported.

Evidence for the risks of SSRIs or SNRIs in human babies:

SSRIs such as Celexa have been associated with an increased risk of birth defects, particularly heart defects, with use during pregnancy. However, some studies suggest there is no increased risk of birth defects particularly with first trimester use. The Danish National Birth Registry found no increase in risk of birth defects with first trimester use of  SSRIs such as Celexa. One Danish, one Canadian, and one Australian study all found an increased risk of heart and skeletal defects when Celexa was used during the first trimester of pregnancy. Early exposure to Celexa in a study from Finland found an increased risk of neural tube (brain and spinal cord) defects. Other studies including the U.S. National Birth Defects Prevention Study and the Swedish Medical Birth Registry found no increased risk of birth defects previously associated with Celexa use during pregnancy. One study found an increased risk of autism spectrum disorder with second and third trimester antidepressant use during pregnancy. The Swedish Medical Birth Register found no increased risk of autism spectrum disorder in children 7 to 8 years old who were exposed in utero to Celexa. Studies show Celexa has not been associated with an increased risk of miscarriage, but SSRIs do have an increased risk of causing abnormal heart rhythm in babies. An increased risk of clubfoot has been reported in babies whose mothers took SSRIs for at least 30 days during the second or third trimesters. The Danish National Birth Registry found no association between Celexa exposure during pregnancy and miscarriage. Incidence of low birth weight and respiratory distress have been reported in babies exposed to SSRIs.

A study in 1700 pregnant women found no increase in the risk of birth defects with SSRI use during pregnancy, but there was an increased risk of neonatal intensive care or specialized care in babies exposed to SSRIs in utero. Third trimester exposure to Celexa has been associated with more complications and neonatal intensive care in newborns. Antidepressants that affect serotonin, including Celexa, used late in pregnancy may cause your baby to be born with persistent pulmonary hypertension of the newborn (PPHN) and other health problems. These problems may require hospitalization, respiratory support (to help maintain normal breathing), and nutrition by injection of fluids (due to inability to feed). Other antidepressants that affect serotonin, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), are known to cause health problems in babies when taken by expecting moms. The health problems that have been reported in babies exposed to SSRIs or SNRIs are caused by their effects on serotonin.

Babies whose moms have taken SNRIs or SSRIs late in the third trimester have developed health problems including neonatal abstinence syndrome (withdrawal from drug exposure in utero) upon delivery. The following is a list of some health problems that have been reported in babies exposed to either SNRIs or SSRIs.

• Difficulty breathing
• Vomiting
• Difficulty feeding
• Constant crying
• Irritability
• Changes in body temperature
• Slowed and ineffective breathing
• Shakiness/jitteriness
• Low blood sugar levels
• Seizures
• Hyperactive reflexes
• A condition where breathing temporarily stops
• Poor blood flow or insufficient amounts of oxygen in the blood, leading to bluish colored skin
• “Floppy baby syndrome” (a condition characterized by too little muscle tone; babies often cannot control their neck muscles)
• A condition where muscles have too much muscle tone, causing spasms and stiff, rigid limbs

Using SSRIs in late pregnancy may also be associated with PPHN, a serious breathing problem in newborn babies that can lead to death. A study that looked at 836 healthy babies and
377 babies born with PPHN, found that taking SSRIs after the 20th week of pregnancy was associated with a 6 times higher risk of PPHN. Another study that looked at 831,324 babies born in Sweden found a 2.4 times higher risk of PPHN when moms reported taking SSRIs in early pregnancy and a 3.6 times higher risk when moms reported taking SSRIs in both early and late pregnancy. 

Bottom line: Celexa should not be used during pregnancy unless the benefits of treatment outweigh potential risks to the baby. Human studies have shown that Celexa may cause negative side effects in the developing baby. Taking antidepressants that affect serotonin, like Celexa, during the third trimester of pregnancy may increase the risk that your baby is born with various health problems.

If I am taking Celexa and become pregnant, what should I do?

If you are taking Celexa and become pregnant, you should contact your doctor immediately. Your doctor will determine if your medication is medically necessary, or if it should be discontinued until after the birth of your baby.

If I am taking Celexa, can I safely breastfeed my baby?

Celexa passes into human breast milk. The manufacturer of Celexa recommends considering the risks versus benefits for the mother and baby before deciding to continue or discontinue this medication while breastfeeding a newborn. No adverse events from Celexa exposure through breast milk have been reported, but it is unknown how exposure could affect long-term neurobehavioral development. If a woman requires Celexa while breastfeeding, it can be continued. The use of SSRIs and SNRIs (other antidepressants that affect serotonin) while breastfeeding has been associated with harmful side effects such as sleepiness, poor feeding, and jitteriness in breastfed babies. Women who take Celexa successfully during pregnancy may continue the medication while breastfeeding a newborn. If a woman who is breastfeeding is starting a new antidepressant medication, other antidepressants may be preferred. The American Academy of Pediatrics states that the effects of Celexa on a nursing infant are unknown, but may be of concern.

Bottom line: In breastfeeding moms who are taking Celexa, nursing infants should be monitored for drowsiness and irritability. The long-term effects of Celexa on a nursing infant are unknown.

If I am taking Celexa, will it be more difficult to get pregnant?

Animal studies suggest Celexa is associated with impaired sperm production in males and decreased mating in males and females. SSRIs such as Celexa have been associated with decreased libido (interest in sex) and failure to orgasm. 

If I am taking Celexa, what should I know?

Celexa should not be used during pregnancy unless the benefits of treatment outweigh the potential risks to the baby. Human studies show there is a low risk of birth defects with use of Celexa during the first trimester of pregnancy. Taking antidepressants that affect serotonin, like Celexa, during the third trimester of pregnancy may increase the risk of health problems in newborn babies.

In breastfeeding moms who are taking Celexa, nursing infants should be monitored for negative side effects. Long-term effects of Celexa exposure on nursing infants are unknown.

If I am taking any medication, what should I know?

This report provides a summary of available information about the use of Celexa during pregnancy and breastfeeding. Content is from the product label unless otherwise indicated.

You may find Pregistry's expert reports about mental health disorders and the individual medications used to treat mental health disorders here.   Additional information can also be found in the resources below. 

For more information about Celexa during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:
 

Mayo Clinic: Depression (major depressive disorder)

National Institute of Mental Health: Depression

WebMD: Major Depression (Clinical Depression)

Allergan:  Celexa Prescribing Information