# Citalopram or Sertraline



## greatgazza (May 27, 2010)

Hi there

I am currently 37w and have been taking citalopram 20mg for the last 4 months.  I had weaned myself off them when i got my BFP but went back on them and my obs said they were safe in pregnancy but that if i intended to breastfeed I should switch to sertraline.

I asked the obs for a px for the sertraline last week so that i wasn't trying to get it in a panic when baby came and I took my first dose yesterday (50mg).  However, since reading the patient information leaflet it has worried me somewhat as it says:

"when taken during pregnancy, particularly in the last 3 months of pregnancy, medicines like Sertraline may increase the risk of a serious condition in babies, called Persistent Pulmonary Hypertension of the Newborn (PPHN), making the baby breathe faster and appear bluish.  These symptoms usually begin during the first 24 hours after the baby is born"

I obviously don't want this!

So today I took citalopram again instead.  My obs consultant never mentioned any of this.  I'm wondering whether I would be safer sticking with citalopram until baby is here and then switching to sertraline as it is just a straight swap with no need for weaning/tapering etc.  Although it also says there is evidence that sertraline is excreted in human breast milk and I'm now wondering whether I should try and come off all of them (i have been feeling pretty well for the last couple of months and I don't actually attribute my mood lift to the drugs but to other things)....although given my history of depression i have been quite worried about being very susceptible to PND.

Would be interested in your thoughts.

Thanks very much.

GGx


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## mazv (Jul 31, 2006)

Hi GG,

The PPHN is a class effect with the SSRI drugs and can happen with any of them. The actual incidence is rare but could occur with either sertraline or citalopram so there wouldn't necessarily be any benefit/lower risk from taking one as opposed to the other. Given that you were stable on citalopram for so long then I'd be inclined to remain on that as you have done well on it. Is your prescriber planning for you to continue during remainder of pregnancy and labour or are you weaning off/cutting down now?

As you say with a previous history of depression then you are at increased risk of PND so would need to discuss ongoing treatment post delivery with your Doctor. In terms of breastfeeding then both drugs as excreted into breast milk, you can try and time feeds to minimise exposure to drugs. For the life of me I can't remember the advice for these specific drugs now (I think citalopram may be less favoured because it has a longer half life) Have forgotton relevant password to the information site I need to check so will have to get thsi form work tomorrow and get back to you later.

Maz x


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## greatgazza (May 27, 2010)

Thanks Maz

Ok, didn't know that about citalopram as well, gosh.  My obstetrician was planning for me to be on Citalopram for the pregnancy and then sertraline for breastfeeding as she said sertraline is considered safer during bfing.  I had thought I would have to wean off the citalopram as I did previously, but I was on a higher dose (40mg) and my Obs said that from being on 20mg I won't need to wean and can just stop it one day and start on the Sertraline the next... I was a bit worried about not weaning/cutting down so would be interested in your thoughts on this.  My obs is lovely but sometimes she can be a little bit distracted/forgetful....

It was me that asked my obs if i could switch to sertraline now as i worried about having to try and get it in a panic when baby came but if they are the same class and i know i now have the drugs to hand i think, like you say, i may be better of staying on citalopram until the last minute.  

Thanks again

GGx


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## mazv (Jul 31, 2006)

Hi GG,

Interestingly the FDA (US regulatory body for drugs) have just published a review of SSRIs and PPHN and concluded that the evidence is contradictory so it is premature to jump to the conclusion that these drugs definitely cause this condition. If they do then the risk is very small anyway.

In terms of switching there are various options that can be utilised and it pretty much depends on individual patient, how they handle dose reductions, how important it is to switch quickly (depending on clinical condition). I think what your obs is suggesting in terms of stopping one day and starting the next is reasonable. The switch is between the same class of drug, the dose you are on is relatively low anyway and you'd build up the sertraline dose if needed. I'm assuming you haven't had significant withdrawal when cutting down before?

I double checked the info on breastfeeding and I was right yesterday, citalopram is not preferred due to the length of time it lasts in the body for. Sertraline is a better option so would make sense to switch to this when baby is born.

Hope this helpful?

Maz x


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## greatgazza (May 27, 2010)

Thanks Maz, yes it's very helpful, thank you.

Will switch to sertraline when the baby is here i think, rather than now.  I don't remember having any withdrawal before but tbh I can't remember if I tapered down from 20 as well.  I'm sure i'll be fine.

Thanks

GG xx


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