Infants receive citalopram in breastmilk, and it is detectable in low levels in the serum of some. The dosage that the infant receives and serum level achieved are probably related to the genetic metabolic capacity of the mother and infant. A few cases of minor behavioral side effects such as drowsiness or fussiness have been reported, but no adverse effects on development have been found in infants followed for up to 5 years. Infants exposed in utero can have withdrawal effects postpartum despite breastfeeding and continued maternal citalopram use.[1,2] If citalopram is required by the mother, it is not a reason to discontinue breastfeeding. Some experts do not recommend citalopram during nursing,[3] but a safety scoring system finds citalopram to be acceptable during breastfeeding.[4] If the mother was taking citalopram during pregnancy or if other antidepressants have been ineffective, most experts recommend against changing medications during breastfeeding. Otherwise, agents with lower excretion into breastmilk may be preferred, especially while nursing a newborn or preterm infant. Monitor the infant for excess drowsiness, restlessness, irritability, poor feeding and poor weight gain, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs.
Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding, although this might be a reflection of their disease state.[5] These mothers may need additional breastfeeding support. Breastfed infants exposed to an SSRI during the third trimester of pregnancy have a lower risk of poor neonatal adaptation than formula-fed infants.