Celexa (citalopram hydrobromide) is the brand name of a prescription antidepressant belonging to a family of drugs called selective serotonin reuptake inhibitors (SSRIs.) This class of drugs also includes Zoloft, Prozac and Paxil.
Celexa is available in 10mg, 20mg and 40mg tablets or as an oral solution. The drug was approved by the Food and Drug Administration (FDA) in 1998 and is manufactured by Forest Laboratories. Doctors prescribed Celexa to 7.2 million adults in 2011; it is not approved for use in children.
Forest Laboratories has seen controversy over Celexa in recent years. In 2010, Forest paid $313 million to settle civil and criminal complaints that it had illegally marketed Celexa to children. The company denied the Justice Department’s allegations, but as part of the settlement agreed to plead guilty to obstruction of justice, admitting its workers lied to FDA officials during a plant inspection.
The FDA also recently issued new health warnings about Celexa regarding the drug’s potential to disrupt normal heart function, especially in those taking higher dosages. Labels are now marked to warn people with heart conditions of this possibility.
Studies link Celexa and other SSRIs to an increased risk of depressive and suicidal thoughts and actions, and several birth defects when taken during pregnancy. Lawsuits claim that Forest knew about these risks but failed to warn consumers.
Uses of Celexa
Celexa and other SSRIs work by essentially increasing levels of a brain chemical called serotonin, which is linked to mood, sleep regulation and emotions. Celexa is approved for the treatment of major depression, but is also used off-label to treat anxiety disorders, obsessive-compulsive disorder, eating disorders and diabetic neuropathy.
|Major depression is diagnosed based on the following symptoms:|
|Loss of interest in usual activities||Change in appetite|
|Constant fatigue||Insomnia or sleeping too much|
|Loss of concentration||Feelings of guilt and worthlessness|
Patients who use Celexa can begin to see significant changes in their mood after several weeks. Doctors generally expect to see remission in a patient’s depression after a couple of months.
Celexa and Birth Defects
The FDA divides prescription drugs into five categories based on their risk if taken during pregnancy: A, B, C, D and X. A is the least harmful, and X is the most dangerous. Celexa and most other SSRIs fall under Class C, which means they have shown harm to animal fetuses but there are insufficient studies of damage to human fetuses.
First-trimester usage of SSRIs is linked to a slight increase in the risk of miscarriage. Studies also suggest that women who take SSRIs during that window may experience premature delivery or a baby with low birth weight. Late-pregnancy SSRI use can lead to withdrawal symptoms in the baby, including seizures, feeding difficulty and behavioral problems like constant crying. These symptoms are typically short-lived.
Several studies have shown an increased risk of birth defects when SSRIs are taken during pregnancy. Some doctors continue to prescribe Celexa during pregnancy, believing that untreated maternal depression could have even more serious effects.
In 2009, researchers from the American Psychiatric Association and the American College of Obstetricians and Gynecologists linked SSRI usage in the first three months of pregnancy to an increased risk of septal heart defects in babies. These holes in the wall separating the two sides of the heart allow extra blood to pump to the lungs, forcing the heart and lungs to work harder. This can lead to heart failure, high blood pressure, irregular heartbeat or stroke. The study found the highest occurrence of these defects when mothers took more than one SSRI during the first trimester.
Persistent Pulmonary Hypertension of the Newborn (PPHN)
Usage of Celexa late in pregnancy also is linked to birth defects. In 2006, a study in the New England Journal of Medicine found that third-trimester usage of Celexa increased the risk of a potentially deadly lung condition called persistent pulmonary hypertension of the newborn (PPHN). This condition prevents a baby’s lungs from moving oxygen to the rest of the body. It can be fatal or cause long-term health problems. That same year, the FDA released a public health alert about the findings and called on SSRI manufacturers to include the potential risk of PPHN in their prescribing information.
Anencephaly, Craniosynostosis and Omphalocele
A study published in the New England Journal of Medicine in 2007 found SSRIs (including Celexa) were associated with a small increased risk of three birth defects.
Anencephaly and craniosynostosis are cranial birth defects. While craniosynostosis (a condition causing a child’s skull to fuse too early) can be repaired with surgery, most children born with anencephaly (an absence of a major portion of the brain and skull) die shortly after birth.
Omphalocele occurs when a baby is born with some abdominal organs outside of the body. Treatment depends on the size of the omphalocele. If only a portion of the intestines are protruding, surgeons will return them to the abdomen during surgery. If most of the organs are outside of the body, the repairs are done in stages. Long-term complications depend on the size of the omphalocele and the extent of other abnormalities.
Side Effects of Celexa
Serious side effects associated with Celexa require emergency medical attention. They include an increased risk of suicide, changes in heart activity, serotonin syndrome and allergic reactions.
Suicide Risk and Worsening Depression
Celexa and other antidepressants can increase suicidal thoughts and actions in users. People may experience dangerous impulses, violent or aggressive behavior, or anxiety and panic attacks. This risk is especially high in teens and young adults. Celexa users should watch for sudden changes in mood, behavior or thoughts at the beginning of treatment or following a change in dosage.
People who exhibit these symptoms should call a doctor for close monitoring and to discuss alternative treatment options. It is important to consult with a health care provider before stopping antidepressants, since this can cause extreme reactions and worsening depression.
Changes in Heart Activity
Celexa can cause chest pain, shortness of breath, changes in heart rate or dizziness and fainting. In 2011, the FDA warned that Celexa shouldn’t be used at doses greater than 40 mg per day because of the risks it poses to heart activity. Doctors may choose to lower dosages of Celexa and order regular electrocardiograms (EKGs) to monitor heart function in patients.
This potentially fatal condition occurs when too much serotonin exists in the brain. This generally occurs when two drugs that increase serotonin levels are taken together. Symptoms can include changes in mental condition (agitation or hallucinations), coma, muscle twitching, racing heartbeat, changes in blood pressure, fever, nausea or diarrhea, and stiff muscles.
Patients with this condition need to go to the hospital and may be admitted for observation. Doctors may prescribe a drug like Valium to decrease seizure-like movements and muscle stiffness and an additional drug to block serotonin production. Patients likely will receive IV fluids and be taken off of the medications that caused the problem.
Severe Allergic Reaction
People allergic to Celexa may experience trouble breathing, facial swelling, or itchy welts or hives, accompanied by a fever and joint pain. People who have allergic reactions to Celexa seek medical attention right away.
|People who use Celexa often suffer from less serious side effects that are common to all SSRIs:|
|Sleepiness or constant yawning||Trouble sleeping|
|Nausea||Weakness, dizziness, shaking or anxious feelings|
|Loss of sexual interest or impotence||Dry mouth|
|Constipation or diarrhea||Respiratory infections|
|Weight gain or weight loss||Loss of appetite|
Families are suing Forest Laboratories after Celexa use during pregnancy led to birth defects. Women say they would not have taken the antidepressant during pregnancy if they had been properly warned of the risks. Plaintiffs are seeking to hold Forest Laboratories responsible for their children’s injuries.
If your child has been injured because of Celexa, you may have legal options. A Celexa birth defect attorney can help you determine whether you have a claim and also help you file a lawsuit.