Linking citalopram, serotonin reuptake inhibitors, and depressed pregnant women

SSRIs are drugs that selectively inhibit the serotonin transporter (SERT) and prevent the recapture of 5-HT into the neuron. They are frequently used for the treatment of the major depressive disorder (MDD) in pregnant women. Neuronal development and behavior are critically dependent on optimal levels of 5-HT in the fetus. Citalopram, the most selective SERT inhibitor, reaches the fetus in relatively higher concentrations than the other SSRIs. Inhibition of SERT by SSRIs in pregnant rats can reduce birth weight and adversely affect behavior. Maternal treatment with SSRIs can also reduce birth weight in human infants. More craniosynostosis and musculoskeletal system defects occur with citalopram than other SSRIs. Anxiety, depression, internalizing and externalizing behavior, attention deficit hyperactivity disorder (ADHD) and autism can occur in children of women with MDD. Maternal treatment with SSRIs appears to reduce externalizing behavior and ADHD, but not other behaviors. SSRIs may even induce working memory deficits.