Coming off citalopram in early pregnancy

[lolabell]

Hi,
I am currently on 20mg of citalopram and have been for 18 months. It's mainly for anxiety. I discovered I was pregnant on Monday and today I am 4weeks 4days. I went to see one of the dr's at my surgery this morning to talk about coming off citalopram. He advised me to go cold turkey and just stop as there is evidence that taking citalopram in early pregnancy can cause heart defects. He also said that risk was very small and that I should try not to worry. I said that I didn't feel I could just stop taking the tablets as I know that this isn't safe for me and that the side effects are dreadful. I agreed with him to cut down to 10mg for 1 week and then to do alternate days for 1 week and then stop taking them. I will be 6 weeks 4 days when I am off them (all being well).

I now feel extremely guilty about the fact that I can't just stop them. I am just too scared to come off them so abrubtly. Does anyone else have this concern right now or have some advice?

I read the older thread about citalopram which ran from 2008 which was reassuring, but I would value any input from people who are going through this dilemma now, or have been through it. With my previous pregnancy I was on 10mg citalopram when I discovered I was pregnant and stopped taking it at 5 ish weeks. I didn't have too many ill effects during pregnancy but had bad PND after she was born. My daughter suffered no ill effects from the 10mg in early preg. My dr from the first preg didn't even tell me about the possible problems with citalopram but now I know I am worrying. I am concerned that I will panic until my 20 week scan and they tell me that everything is ok.

Thanks so much.
Lolabell

Citalopram can be taken throughout pregnancy. My understanding is that fluroxetine (prozac) is prescribed normally simply because it is the most common so and more is known about any potential side effects.

You need to get you anxiety managed, not just to stop the anti d's. See if you can get a referral to the mental health midwife, you should also be under a consultant if you have mental health problems. (I know this because I have, also anxiety, with sometime depression)

Please don't feel guilty. You are doing your best to provide a healthy mother for your children. Speak to your community midwife as soon as possible.

I wrote a long reply earlier and then the internet crashed!

Basically, I am now 28 weeks with DC2, and have been on Citalopram for 18 months too. Both for anxiety and PND.
My (lovely) GP wanted me to stay on it for the pregnancy as I am high risk for antenatal and post natal depression.

I take 10mg every other day, and this seems to be keeping me level and reasonably balanced. (Pregnancy mood swings not withstanding!!)

on a day to day basis, I feel ok. My anatomy scan at 20 weeks, and my growth scan (today) show no abnormalities with the heart which is reassuring.

I weighed up the risks versus how my mental health would be affected by trying to cope without Citalopram, and made the decision after a good discussion with my Gp and the midwife.

I dont know if you have the service in your area, but I am also in contact with PEWS (Perinatal Emotional Wellbeing Service) who are helping me with my anxieties about this pregnancy and birth. The website is babyblues.co.uk I think.

Sorry for waffling on, hope something helped!

Thanks for your messages. Unfortunately I have a husband who wants me to stop taking the tablets straight away and a mum who is a community nurse - I confided in her and now she is insisting I stop immediately too. It is so difficult. I am worried about the consequences of stopping so suddenly although my hubby says I will be fine and that I should stop reading scare stories on the internet. My last tablet was yesterday 10mg.

I will look at the website you suggested Inneedofsanity. Billybolly, I didn't realise there was a mental health midwife. The dr didn't mention it. I will ring the surgery today and find out.

In the mean time I will let you know how I get on with coming off the tablets.

Gosh! My GP seemed to think citalopram in pregnancy was fine. Please see a 2nd GP for a second opinion before going cold turkey - it can give you palpitations and panic attacks and all sorts

I had been on Prozac for 18 months too when I found out I was pregnant. My gp said the same as yours, that there was some research to say they could cause heart defects. As we had already discussed coming off the tablets in the coming months anyway, we decided that at my stage, the risks of taking them outweighed the risk of me relapsing so I came off them cold turkey.

I am now 12 weeks so been off them for 8 and doing ok I think. A few minor wobbles but I think that's hormones and tiredness.

Good luck.

Take advice from your gp and / or midwife and take your partner with you.

I have been taking 20mg citalopram since the birth of my son 16 months ago and am due to have my second son next month. The first trimester is a very emotional time.

Like you, when I found out I was pregnant I stopped taking the tablets abruptly and I ended up all over the place and very anxious. I didn't enjoy that trimester at all and started taking the antidepressants again on the advice of my gp.

Your job is to grow and carry the baby in the healthiest and calmest way you can. Only you can weigh up the potential risk to the baby versus the potential risk to you and your ability to have a healthy pregnancy. You need to talk to your mother and partner though, as they also need to support whatever decision you make for your own peace.

Stay happy!

With all due respect, it is yourmental health that needs TLC right now, not your husband or mothers. for you that they are adding to the pressure and anxiety.
My husband supports me fully in taking the 10mg alternate days as he knows how quickly I can deteriorate.
Please look after yourself. Xx

Hi, Yes, my mum is pretty militant about it to be honest and saying all the what ifs and how would you ever forgive yourself if something was wrong with baby etc etc (thanks mum). Hubby is supportive either way - if I had to pace myself to come off them he would understand, I just think he wants me to give cold turkey a try. He knows that I was able to come off the 10mg without any bad effects last time - 20mg could be very different though.

So anyway, today I haven't had a tablet. Have been feeling sick and have no idea if it is morning sickness or comiing off the tablets. It's the potential dizzyness and palps that worry me. Anyhow I have an appointment with doc on 24th April.

I am appreciative of the messages. They are a huge help.
I will keep you updated.
Obviously I still have the 10mg tablets in the cupboard - 2 weeks worth.

Hi Celestia, are there side effects to coming off prozac quickly? Did you experience any of them or was it ok?

I've been on Citalopram for nearly 5yrs and I'm 28 weeks pregnant. My GP is very keen for me to not have my dosage altered whilst I'm pregnant, as it increases the risk of antenatal and postnatal depression. There is NO evidence that says it is a high risk drug, otherwise he would have taken me off it straight away. He did take me off of my Amitriptyline though, as this is NOT thought to be safe in pregnancy.

I think your family need to get off your back and you need to seek a second opinion though. At the end of the day it's you that matters, NOT what they think!

I would back up what all the others seem to be saying. I was in a very similar position to you, although I had already started tapering from 20mg a day, very slowly, when I found out I was pregnant. My GP told me to come off them immediately, for the same reasons as yours, but I really didn't want to do that. So, I just sped up the tapering process a bit, but not much. I basically dropped my dosage by 10mg total a week (so, I went from 140mg a week to 130mg), and so on for about 10 weeks, and then stopped completely. To be honest, I found it really hard even at that speed, and the second trimester was tough in terms of anxiety, and crying a lot. But it's hard to work out what was being pregnant (and pretty sick until about 20 weeks), and what was coming off the tablets, which I had been on for about 6 years. So, I would say to look into the study that has showed the heart defect risk a bit more (from the internet research I did, it is one Danish study, but I might be wrong), and then weigh the risks up vs your own health. It's worth bearing in mind that stress and anxiety are not great for the fetus either! Not to add to the guilt in any way, but I think some doctors are very quick to just follow any guidelines they are given if there is any tiny increased risk. The same doctor was very anti me taking paracetamol when I had a fever of 103 the other week. So, please don't feel guilty whatever you choose to do, and I hope it all works out well.

No, I didn't have any side effects but Prozac does have a long half life so takes a while to leave your system.

Hi, Yes it was the Danish study. I am going to see how I get on and I'll post my progress on here. Strangely I am only worrying about side effects at the moment and not a relapse. I think I have probably almost forgotten what that's like. I have CBT starting next week. I have been on the waiting list for ages, and I am going on a meditation retreat at the end of the month. I am hoping that these things might make coming off the tablets a little easier.

On a trickier note I work Mon-Weds as a school teacher. Could there possibly be a worse job to come off anti-ds with? Roll on bloody half term (and it's technically still Easter).

Hi Lolabell,
I am really angry and suprised that your Mum is behaving like this especially as she is a nurse. It is really unfair for you and I just want to give you a big hug as say BELIEVE IN YOURSELF and DO WHAT YOU FEEL IS RIGHT. I have been where you are now and got myself in such a state until I started believe in myself and followed my feelings. I have 2DC and am currently pregnant with my third and have been on antidepressents on all of them. My first I was on Seroxate and my second and third Prozac. Both of my first two children are very healthy happy children and had text book pregnancy's and labors with both. I think you would be very suprised if you knew the amount of mothers that have taken antidepressents throughout their pregnancies. It is true that not all antidepressents are safe but there are a few out there that are. Please look after yourself and listen to your emotions and if you feel they spiralling out of control then seek help and if medication is the way to go then don't beat yourself up about it xx At the end of the day if you and your Husband are happy then no-one else matters on how you go about your pregnanciesxxGood Luck

Hi Lolabell, I understand that this is a difficult decision for you and I wanted to give you my experience - and that is all it is - on the off chance you find it helpful. I am not suggesting for a minute you should follow what I did, I just know I always like to hear the experiences of others!

I had my daughter in 2010, when I found out i was pregnant i was taking citolapram and had been doing so for about a year. I was very concerned but my wonderful GP did lots of research and he suggested that there are no known side effects but that the side effects for mother and child after birth of a drepessed mother are well documented. With that in mind he suggested that i stayed on it but did way there was a tiny risk of withdrawal for the baby after birth. I did my own research into anti-depressants and felt that for me the right choice was to attempt to come off them before the birth so that the baby would have no risk whatsoever of having any antidepressant in their system. I was strongly discouraged from going 'cold turkey' and during my second trimester i cut down very slowly to nothing by 24 weeks. I made this decision knowing that i had great medical support shoudl i show any signs of depression after the birth.

The result? My daughter is absolutely fine, i would be staggered if we ever found out she has any side effects from me having taken it. We were both, thank god, fine after the birth and i have no returned to using Citolapram.

Good luck Lolabell and please know it is absolutely your decision - both your family and partner had the opportunity to discuss the use of medication and pregnancy with you BEFORE you got pregnant so now i really dont believe they have any right to an opnion. You need to do what is best for you. There is always guilt being a mum and it starts before they are born! If you do your best - that is enough xxxx

Hi Everyone, Well I am a week into cold turkey and so far everything has been ok. I feel extremely sick at times (which may be part baby and part cold turkey) and a little light headed but none of the dreadful head zaps and dizzyness that I have read about. My mood is fine so far. I am feeling emotions again and that's nice in a way because when I was on the citalopram I couldn't cry. The reason I haven't been on the computer is because of the nausea, but it's not too bad today!! I will post again to keep you updated. xx

My GP told me the same thing then my midwife hit the roof and said he was absolutely wrong and that I can take through pregnancy if I need too. I have not started taking it again but have been refered to the Perinatal mental health team (appt on wednesday) so I can decide what to do for the best and be supported throughout my pregnancy. If I knew it was safe, I would have continued taking it and am having a rough time now.

If your doing ok without then thats fantastic but do know that you have options.

I think the cold turkey advice thing is naughty and emotive as newly preggy women clearly want the best for their baby I've had to come off my tabs (same family as citalopram) from 100mg a day to nowt. Clearly as this thread,shows everyone gets different advice, however my kind gp said that whilst it would be preferable to stop immediately it would be bad for my mental health - I ran out of tablets once for 3 days and was in a dreadful state so cold turkey would have been awful.
So anyway basically did the same as your gps suggestion - half dose for week, 1/4 dose for following 3 days then finally 1/8 dose alternate 3 days so basically in just over 2 weeks was off my meds, and touch wood, I feel fine, had no wobbles at all.
Now 9 weeks no meds feeling great- as you can do

I was taking citalopram when I got pg with DD. Panicked (was unplanned) and stopped cold turkey. Struggled on but by 12 weeks I was in a bad state. Went to GP, got fast tracked to pyschaitrist, and was prescribed Sertraline. Was a big relief. Stayed on it until DD about 18 months. I do regret going cold turkey as for me it wasn't the right thing to do.

I did this and it was a massive mistake - I was heading for a breakdown shortly afterwards. Going cold turkey isn't sensible at any time and why some GPs (including mine) think it's ok in pregnancy is beyond me.

I can't understand the different messages people have had from their GP's. I am seeing him next thursday so I will ask him about it. I am mindful that when the baby is born I could have a relapse - I think that sometimes pregnancy hormones can carry you through, then once the baby is born and reality sets in - well, you know what I mean. xx

Yep lolabell that is the only consistent message - confusion!

I was on them for anxiety to and went cold turkey best thing I ever did anxiety is gone pretty much and even took one of my tablets as I felt a bit anxious about a christening an felt sick as a dog I personally went cold turkey when trying for my last lo and because the hormones change in your system I felt great for a change

I have severe depression and bipolar II disorder. My last GP (who was crap beyond crap) had put me on highest dose of citaloplam (instead of my usual meds for my bipolar), and when I went to see them when I found out I was pregnant told me to stop taking them. Did this gradually over a period of weeks..... I didn't notice side effects, mainly because I had 'flu, chest infections, throat infections and ear infections throughout my first trimester.... combine that lot with morning sickness. However midwife had told me that it was ok to take them. There is a lot of conflicting advice about them. I checked with a gynae consultant at work and after our conversation felt that I'd made the right choice for me.
I personally feel really, REALLY proud of myself for coming off them for the pregnancy. It has to be said that feeling the baby kick and reminding myself of the little person that's growing inside of me has given me the most brilliant feeling ever.
However I do have days when I just sit and cry and cry; thankfully not into the depths of OD which has happened in the past. But this is due to pregnancy hormones, NOT my depression. It's completely normal to feel down when pregnant. Due to my bipolar I was referred to the community mental health team in pregnancy, which is routine if you've been on medication/diagnosed. The nurse wanted me to start taking a new medication and was really pushing me into it, telling me that I would 100% have postnatal depression and should start taking this medication. Medication which has had no clinical trials in pregnancy, and can pass through breastmilk and affect baby's brain and heart. Strangely enough I'm not taking it. Luckily I've changed GP, have my mum (health visitor), and consultants and doctors at work (I work in operating theatres) so have more than enough experts to ask, who all said not to take it! I think that in some ways, we are being set up to take a fall. I'm going to ride my hormones out (I'm 39 weeks tomorrow) after the birth, let myself experience everything. Luckily husband knows the signs of my episodes and he says that I haven't had any during pregnancy. Other than the normal anxious, omg I'm going to be a mum and give birth feelings! Like I said I take a real sense of pride in myself, as the last 9 months I've been better than I have for the last 10 years, and it's all down to the little thing wriggling away inside of me!

I was on 20mg citalopram as soon as I told the doctor I was pregnant he wanted to take me off it and when I saw the midwife she felt the same way, I went down to 10mg for a while and I'm now off of it, it's really difficult and I'm still getting side effects but I know it's for the best.