Most citalopram side effects are the same for everyone. A few are specific to women or change with life stage: menstrual changes, sexual effects, pregnancy and breastfeeding, and a higher low-sodium risk in later life. Here is what the Celexa label actually says about each, and what to ask.
Six weeks into citalopram, a woman notices her period arrived late, her interest in sex has faded, and she and her partner have started talking about trying for a baby. Her mood is better, and she does not want to lose that. Which of these changes might be the medicine? Which are worth a call? And does a future pregnancy mean she has to come off it?
Those questions do not fit neatly into a general side-effect list. Our overview of common Celexa side effects and safety warnings covers nausea, sleep changes and the heart-rhythm warning that apply to everyone. This page sticks to the parts of the Celexa prescribing information on DailyMed that matter most at different points in a woman’s life.
Life stage by life stage
| Life stage | What the Celexa label says | Question to ask |
|---|---|---|
| Periods and cycle | Painful periods (dysmenorrhea) in 3% of women on Celexa vs. 2% on placebo in short-term trials. Absent periods (amenorrhea) listed as “frequent” in wider premarketing data; breast pain, breast enlargement, milky nipple discharge and vaginal bleeding listed as “infrequent.” Raised prolactin reported after approval. | Could this change be the medicine, or should pregnancy, thyroid or another cause be checked first? |
| Sex and desire | SSRIs may cause decreased libido and delayed or absent orgasm in women. The label says sexual side effects are probably underreported and asks prescribers to raise the subject. | Is this change from the medicine, the depression, or something else, and what options exist? |
| Trying to conceive and pregnancy | Studies have not established a higher risk of major birth defects or miscarriage with citalopram. Late-pregnancy SSRI exposure is linked with persistent pulmonary hypertension of the newborn (PPHN) and newborn adaptation problems. Untreated depression also carries risks. | What is my plan if I become pregnant, and who should I tell first? |
| Delivery, postpartum and breastfeeding | SSRI exposure in the month before delivery is associated with a less than 2-fold increase in postpartum hemorrhage risk. Citalopram passes into breast milk; some breastfed infants had irritability, sleepiness, poor feeding or weight loss. | Does my delivery team know I take citalopram, and what should I watch for in the baby? |
| Perimenopause and older age | Low sodium is more likely in older adults, people on diuretics and people who are volume-depleted. The maximum recommended dose is lower from age 60. Hot flushes listed as “infrequent.” | Should my sodium be checked, and does my age or another medicine change my dose limit? |
The “frequent” and “infrequent” labels come from a premarketing list without a placebo comparison. The label defines frequent as at least 1 in 100 patients and infrequent as 1 in 100 to 1 in 1,000. A listing does not prove the drug caused the event.
Periods: what is listed and what is not known
The clearest placebo-controlled number is for painful periods: 3% of women on Celexa against 2% on placebo, calculated only among female participants (638 on Celexa, 252 on placebo). That is a small difference. Missed periods and breast changes appear in the broader list drawn from 2,955 female subjects, which shows that they were reported, not how often the drug itself caused them. After approval, raised prolactin (hyperprolactinemia) was reported for citalopram or its close relative escitalopram, without a frequency, so it is one more thing a clinician may check if periods stop or nipple discharge appears.
A late or missed period still has other explanations, starting with pregnancy. If your cycle changes after starting citalopram, a pregnancy test and a call to the prescriber or gynecologist are reasonable steps; heavy or unexpected bleeding also links to the bleeding warning below.
Sex: lower desire and harder orgasm
The label is direct: “In female patients, SSRI use may result in decreased libido and delayed or absent orgasm.” In the pooled depression trials, the label reports an incidence of decreased libido and anorgasmia in women of 1.3% and 1.1%. It warns that numbers like these “may underestimate their actual incidence,” because patients and clinicians often do not bring the subject up, and depression itself can dampen desire.
The label asks prescribers to ask about sexual function before treatment and specifically during it, and to discuss management strategies. MedlinePlus lists “decreased sex drive, or delayed orgasm or inability to have an orgasm” among citalopram side effects to report. Bring it up even if no one asks. What helps depends on timing and cause, and that conversation belongs with the prescriber; do not stop or skip doses to test it.
Bleeding, including heavy periods and postpartum
Drugs that affect serotonin reuptake, including Celexa, increase bleeding risk. The label lists events from bruising and nosebleeds to life-threatening hemorrhage, and says aspirin, NSAIDs such as ibuprofen or naproxen, other antiplatelet drugs and anticoagulants such as warfarin may add to it. That matters for women who use an NSAID for period pain each month. Ask the pharmacist whether your pain reliever is a sensible choice alongside citalopram.
For delivery, the label states that SSRI exposure, “particularly in the month before delivery,” has been associated with a less than 2-fold increase in the risk of postpartum hemorrhage. That is a reason to make sure the obstetric team knows, not a reason to stop on your own.
Trying to conceive and pregnancy
Section 8.1 of the label weighs several things at once. Published studies and postmarketing reports with citalopram “have not established an increased risk of major birth defects or miscarriage.” Citalopram levels in cord blood and amniotic fluid are similar to the mother’s.
Two newborn risks are described. Late-pregnancy SSRI exposure may increase the risk of persistent pulmonary hypertension of the newborn, which the label says occurs in 1 to 2 per 1,000 live births in the general population and is associated with substantial newborn illness and death. Separately, newborns exposed late in the third trimester have had problems such as breathing difficulty, feeding difficulty, low blood sugar, jitteriness and constant crying, sometimes requiring prolonged hospital care.
The label also describes the other side: in a study of 201 pregnant women with a history of major depression, those who stopped antidepressants were more likely to relapse than those who continued. It asks prescribers to consider the risk of untreated depression when stopping or changing treatment during pregnancy and postpartum. The FDA’s own depression medicines page for women says women should talk to their healthcare provider about the risks of antidepressants in pregnancy and adds: “Do not stop taking your medicine without first talking to your healthcare provider.”
The label points to the National Pregnancy Registry for Antidepressants, which the FDA lists among its pregnancy exposure registries. The American College of Obstetricians and Gynecologists covers medication choices in its 2023 Clinical Practice Guideline No. 5 on mental health conditions during pregnancy and postpartum; we could not open its full recommendation text, so we do not quote it here. Our guide to using medicines during pregnancy and breastfeeding explains how to plan these conversations.
Breastfeeding
Published data cited in section 8.2 found citalopram in breast milk at relative infant doses of 0.7% to 9.4% of the mother’s weight-adjusted dose. Some breastfed infants exposed to citalopram had irritability, restlessness, excessive sleepiness, decreased feeding and weight loss. There is no information about effects on milk supply. The label asks that the benefits of breastfeeding be weighed with the mother’s need for the medicine, and that breastfed infants be watched for those signs. If the baby is unusually sleepy, fussy, or not feeding or gaining well, call the pediatrician or your prescriber.
Perimenopause and later life
Midlife brings symptoms that overlap with side effects. In short-term trials, increased sweating affected 11% of people on Celexa and 9% on placebo, and hot flushes appear in the “infrequent” list. Night sweats in your late 40s may be the medicine, the menopause transition, or both, and a prescriber can help sort out which.
Low sodium (hyponatremia) is the more serious later-life issue. The label says older adults, people taking diuretics and people who are volume-depleted may be at greater risk. Early signs include headache, difficulty concentrating, memory problems, confusion, weakness and unsteadiness that can lead to falls. From age 60 the label lowers the maximum recommended dose, because citalopram exposure was 23% to 30% higher in people 60 and over in two studies.
Weight is a frequent worry at this stage too. In controlled trials, people on Celexa lost about 0.5 kg on average while placebo patients did not change, but individual experience varies; see citalopram and weight gain for how to sort appetite, fluid and other causes.
Does citalopram act differently in women’s bodies?
Possibly, but the evidence is mixed. In three small studies (32 people in total), citalopram blood levels (AUC) in women were one and a half to two times those in men. Five other studies with 114 people found no such difference, and in clinical trials steady-state levels did not differ between 237 men and 388 women. Analyses did not suggest that response differed by gender. The label sets no separate dose for women.
Get same-day medical advice, or emergency care if severe, for:
- Possible serotonin syndrome: agitation, hallucinations, fast heartbeat, sweating, fever, muscle stiffness or twitching, loss of coordination, nausea, vomiting or diarrhea, especially after adding a triptan, tramadol or another serotonergic drug.
- Unusual bleeding: heavy bleeding, vomiting blood, black stools, or bruising without a cause.
- Signs of low sodium: new confusion, headache, weakness, unsteadiness or falls; fainting or a seizure needs emergency care.
- Mood changes: new or worse depression, agitation, or thoughts of suicide or self-harm, especially early in treatment or after a dose change. In the U.S., call or text 988.
- A baby who is very sleepy, not feeding well or not gaining weight while breastfed.
Whatever the life stage, do not stop citalopram on your own. The label warns that stopping abruptly can cause symptoms such as dizziness, irritability, electric-shock sensations and anxiety, and any change is planned with the prescriber. If you are comparing citalopram with another SSRI, see Celexa vs. Prozac.
Sources
- DailyMed: Celexa (citalopram) prescribing information
- MedlinePlus: Citalopram
- FDA Office of Women’s Health: Depression medicines
- FDA: List of pregnancy exposure registries
- ACOG Clinical Practice Guideline No. 5 (2023), PubMed record
Evidence checked November 2, 2026. General information only; it does not replace advice from your prescriber, obstetric team or pharmacist.