The full, clinically endorsed recommendation should be obtained from Lareb [link].   

Clinical Overview  

Citalopram is a selective serotonin reuptake inhibitor (SSRI) used in pregnancy to treat depressive, panic, and anxiety disorders. Untreated depression significantly affects maternal quality of life and is linked to preterm birth, foetal growth restriction, and postpartum depression. Because pregnancy alters the activity of drug metabolizing enzymes and foetal exposure occurs, dose-adjustments may be necessary to maintain effective concentrations during pregnancy.  

Pharmacokinetics of citalopram in pregnancy 

Citalopram is mainly metabolized by the hepatic enzymes CYP2C19, CYP3A4 and CYP2D6. While the activity of CYP2C19 decreases during pregnancy, the activity of CYP3A4 and CYP2D6 is significantly elevated. Studies confirm that citalopram concentrations decrease by approximately 40% during pregnancy, particularly in the second and third trimesters. Citalopram crosses the placenta, with neonatal levels averaging 60–70% of maternal concentrations.  

Efficacy and safety of Citalopram in pregnancy 

There is extensive experience with the use of citalopram in pregnancy. However, evidence for dose-related efficacy in pregnancy is lacking. Safety data are extensive and generally reassuring as there is no clear evidence in overall congenital malformations, though a small increase in specific cardiac defects cannot be ruled out.  Long-term use of SSRIs during pregnancy may sometimes result in poor neonatal adaptation syndrome (PNAS) in newborns. This condition is usually mild and temporary. There is also a possible link between late-pregnancy SSRI exposure and an increased risk of persistent pulmonary hypertension in the newborn (PPHN). However, the available research is not conclusive. 

Conclusion  

Pregnancy reduces maternal citalopram plasma concentrations and foetal exposure mirrors maternal levels. While overall safety experience is reassuring, evidence for dose-related efficacy and safety is limited.