Tapering off Celexa (or any antidepressant) when you get pregnant

Please can you tell me how to alleviate Citalopram withdrawel? I need to reduce asap as I’m pregnant but doctor says just redude by 10mg every other day whereas Pharmacist says it’s not good to take during preganancy, So I want to stop taking it….any help appreciated.

So much controversy exists over the use of antidepressants during pregnancy.  In the olden days (about five years ago) the conventional wisdom was that you avoid use of antidepressants during the first trimester (the time when organogenesis–the development of organ systems of the body–is completed), but then you were OK.   Then there were scattered reports that there can be third trimester effects, with use of the antidepressants associated with a risk of the newborn having difficulties with agitation and breathing.  Now, to complicate the issue further, there are studies that show minimal effect on the developing fetus during the first trimester.  

Now, you have two opinions about what to do with your antidepressant.  From a purely theoretical perspective, your pharmacist is absolutely right.  From a clinical standpoint, your doctor is absolutely right.  So what do you do?

Well, this humble psychiatrist tends to be very practical.  Yes, in theory it is best to get off the medicine as quickly as possible.  As you mentioned, this can be associated with some difficult withdrawal effects, although this is less common with Celexa than with some of the others.  Your individual reaction is really our guide here.  Getting off by 10 mg every few days is pretty quick, but you might be fine.  You give no numbers, so I will pretend that you are taking 40 mg daily as treatment for your first bout of depression.  I would have you drop to 20 mg daily for 5 days, then 10 mg daily for 5 days then stop.  If you felt crappy, I would slow it down some.  

Bottom line with depression and pregnancy is that some women who are pregnant need antidepressants and some don’t.  Unbridled depression and anxiety has also been show to increase the risk to the pregnancy, so just getting off the medicine is not always the answer.  You must take clinical issues into account and modify the clinical recommendations as needed.  I would urge you to be in close contact with your psychiatrist.  I would double urge you to be in therapy as that, by itself, will decrease the need for medicine.

Good luck and congratulations!!!

–Dan Hartman, MD

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