Safety issues

SSRIs are generally safe for most people. However, in some circumstances they can cause problems. For example, high doses of citalopram may cause dangerous abnormal heart rhythms, so doses over 40 milligrams (mg) a day should be avoided according to the FDA and the manufacturer. They also recommend a maximum daily dose of 20 mg of citalopram for people over age 60.

Issues to discuss with your doctor before you take an SSRI include:

• Drug interactions. When taking an antidepressant, tell your doctor about any other prescription or over-the-counter medications, herbs or other supplements you're taking. Some antidepressants can interfere with the effectiveness of other medications, and some can cause dangerous reactions when combined with certain medications or herbal supplements.

  For example, SSRIs may increase your risk of bleeding, especially when you're taking other medications that increase the risk of bleeding, such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, warfarin (Coumadin, Jantoven) and other blood thinners.

• Serotonin syndrome. Rarely, an antidepressant can cause high levels of serotonin to accumulate in your body. Serotonin syndrome most often occurs when two medications that raise the level of serotonin are combined. These include, for example, other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort.

  Signs and symptoms of serotonin syndrome include anxiety, agitation, high fever, sweating, confusion, tremors, restlessness, lack of coordination, major changes in blood pressure and a rapid heart rate. Seek immediate medical attention if you have any of these signs or symptoms.

• Antidepressants and pregnancy. Talk to your doctor about the risks and benefits of using specific antidepressants. Some antidepressants may harm your baby if you take them during pregnancy or while you're breast-feeding. If you're taking an antidepressant and you're considering getting pregnant, talk to your doctor about the possible risks. Don't stop taking your medication without contacting your doctor first, as stopping might pose risks for you.