anafranil / cloimpramine vs. celexa / citalopram

[expatsp]

My wife has been taking cloimpramine 25 mg for years to fight panic attacks. Her gynecologist said it was unsafe for pregnancy. A psychiatriast is suggesting 40 mg of citalopram, but she is frightened to leave a medication that works.

What are the risks of her remaining on cloimpramine during pregnancy? Is citalopram much safer? My research via google makes me wonder if there really much of a difference in the risk profile...

[admin-james]

These two drugs are both assigned pregnancy category C by the FDA. I think it is fair to say that they have similar risk profiles in pregnancy, but that there are some significant gaps in the scientific knowledge of how these drugs affect a pregnant woman.

The biggest known risk with both drugs is withdrawal symptoms after the baby is born. This risk can be reduced by decreasing your dosage for a couple of weeks before delivery. This is NOT a worthwhile strategy if you find that temporarily decreasing your dosage leads to crippling anxiety. Remember, a healthy mom makes a healthy baby.

[expatsp]

Dr. Abbey,

Am I correct in assuming that if all these medicines have a similar risk profile, our priority should be on choosing the lowest possible dosage? My wife has in the past been fine with 10 mg of Anafranil and thinks she can do that again. That is a tiny dose (75 mg is normal, I believe.) Probably that would be a safer bet than 40 mg of Celexa, which is a large dose, yes? (20 mg is standard for Celexa, according to the pamphlet.)

I very much appreciate your time and am sorry to ask so many questions. I would make an appointment, but we live in Brazil.

[admin-james]

I consulted with an OB/GYN colleague on this question. She said that she tries not to change a woman's medication if what she takes is working for her. In this case, there is not an overwhelming reason to switch from 10mg Arafranil to 40mg Celexa in order to ensure the baby's safety. Switching between these two medications will probably involve some nausea and may leave your wife without good relief of her anxiety for a few weeks.

On the other hand, SSRIs (like Celexa) are much better studied in pregnant women than drugs like Arafranil. This is likely the reason that your doctors would feel more comfortable with this medication. Celexa is also better at managing symptoms of depression which tend to go along with anxiety disorders or even just with pregnancy itself.

In other words, I would consider these two drugs, at the dosages you describe, to be about equal in terms of pregnancy safety. This biggest issue in deciding which one to use will be how well it works for her.

-James Abbey, MD