Citalopram withdrawal from

Of 93 cases of neonatal symptoms associated with the use of SSRIs in mothers around the time of delivery 64 were associated with paroxetine but reactions were also reported in infants whose mothers had taken citalopram, fluoxetine, and sertraline (87). It is unclear from these data whether paroxetine is actually most likely to provoke the neonatal syndrome, but in adults its use is associated with more severe withdrawal reactions than other SSRIs. It should also be noted that it is not clear whether the syndrome described in neonates is due to SSRI withdrawal or a form of serotonin toxicity. 

Withdrawal symptoms in the 2 weeks after sudden discontinuation of citalopram have been examined in a double-blind, placebo-controlled study (24). Withdrawal symptoms were overall mild, but neurological and psychiatric disturbances were 2-3 times as common in patients randomized to placebo than in those randomized to continue with citalopram. The authors pointed out that withdrawal symptoms were particularly common in patients who were randomized to placebo who also had depressive relapses. This shows the difficulty of disentangling the effects of depressive relapse from those of pure treatment withdrawal. However, it is also possible that acute withdrawal of medication induces an abnormal neu-robiological state, in which both depression and abstinence symptoms are more likely to occur. It would be wise to warn patients about the possible effects of missing doses of the shorter-acting SSRIs. 

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