In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether exposure to citalopram/escitalopram may increase the risk for birth defects above that background risk. This information should not take the place of medical care and advice from your health care provider.

What are citalopram and escitalopram?

Citalopram is a medication used to treat depression. Citalopram belongs to the class of antidepressants known as selective serotonin reuptake inhibitors or SSRIs. A common brand name for citalopram is Celexa®.

The drug escitalopram contains the same active medication as citalopram. These two drugs act in the body in a very similar way. Escitalopram is used to treat depression and generalized anxiety disorder. It is also an SSRI and is sold under the brand name Lexapro®.

I am taking citalopram/escitalopram, but I would like to stop taking it before becoming pregnant. How long does the medication stay in my body?

Each person breaks down a medication differently. For most people, citalopram or escitalopram will be out of the body one week after the last dose. If you are going to stop taking citalopram/escitalopram, you should talk to your health care provider about cutting back on the dose slowly. This will help to avoid any withdrawal symptoms. You should not make any changes in your medication without first talking to your health care provider. They can help you decide if stopping citalopram/escitalopram is right for you.

Can taking citalopram/escitalopram make it more difficult for me to become pregnant?

It is not known if taking citalopram or escitalopram will make it harder to get pregnant. Rats had some reduced fertility after being exposed to citalopram. So far, there have been no reports of humans having a harder time getting pregnant while taking these medicines.

Should I stop taking citalopram/escitalopram when I find out I’m pregnant? What about weaning off my medication before the third trimester?

Studies have shown that when depression is left untreated during pregnancy, there may be increased risk for miscarriage, preeclampsia, preterm delivery, or low birth weight. Some women remain well after stopping their antidepressant medication during pregnancy. For other women, the effects of stopping their medication may be more harmful than the risks of staying on it. After delivery, untreated depression can lead to difficulty bonding with your newborn and an increased risk for postpartum depression.

You and your health care provider should discuss the benefits of taking citalopram or escitalopram for your specific situation and the potential risks to the baby before making a decision. If it is decided that you should stop taking citalopram or escitalopram during pregnancy it needs to be done gradually to avoid any withdrawal symptoms.

Can taking citalopram/escitalopram during my pregnancy cause birth defects?

Citalopram has not been associated with an increase in birth defects in human studies. One study showed that less citalopram might cross the placenta than some of the other SSRI medications. There have been some individual reports of babies born with eye defects whose mothers took citalopram during pregnancy. These are case reports and do not mean that there was a connection with the eye defects and the medication. Most of the available information shows exposure to citalopram during pregnancy does not increase the risk for birth defects over the background risk of 3-5% stated above.

There are no large studies looking at the risk of birth defects when escitalopram is used during pregnancy. Since it is very similar to citalopram, escitalopram is also unlikely to increase the risk of birth defects over a background risk.

I need to take citalopram/escitalopram throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby?

If you are taking citalopram or escitalopram at the end of your pregnancy, your baby may need some extra care for the first few days of life. Babies exposed to any SSRI may have breathing problems, jitteriness, increased muscle tone, irritability, problems sleeping, tremors and difficulty feeding. These symptoms are typically mild and disappear by two weeks of age.

Are there any other problems citalopram or escitalopram can cause when used in the third trimester?

Two studies showed that babies whose mothers take SSRIs like citalopram or escitalopram during the third trimester may be at a small increased risk for pulmonary hypertension, a serious lung problem at birth. Further study is needed to know if this risk actually exists. It is a good idea to tell your obstetrician and your baby’s pediatrician that you are taking citalopram or escitalopram, so that extra care will be available if needed.

Will taking citalopram/escitalopram have any long-term effect on my baby’s behavior and development?

One small study followed eleven babies of mothers who took citalopram during pregnancy. At one year of age there was no difference in their development compared to children who were not exposed. More studies are needed before we will know if there are any long-term effects on the baby’s brain development.

Can I take citalopram/escitalopram while breastfeeding?

Several studies have shown that small amounts of citalopram and escitalopram are found in breast milk. There have been a few cases of sleepiness and weight loss, but in most studies no harmful effects were seen in the breastfed babies. Some studies also showed no difference in the intellectual development of babies whose mothers took citalopram or escitalopram while breastfeeding. The risk to the breastfed infant appears to be small, and the benefits of breastfeeding are well known. Be sure to talk to your health care provider about all your choices for breastfeeding.

What if the father of the baby takes citalopram/escitalopram?

There are no studies looking at risks to a pregnancy when the father takes citalopram or escitalopram. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures and Pregnancy at http://www.mothertobaby.org/files/paternal.pdf.

References Available By Request