Safety issues

SSRIs are generally safe for most people. But some can cause safety issues. For example, citalopram can cause dangerous irregular heart rhythms if the dose is too high. The FDA and the manufacturer recommend that the dose should be no more than 40 milligrams (mg) a day, but no more than 20 mg of citalopram a day for people over age 60.

Before you take an SSRI, talk with your healthcare professional about:

• Interactions with other medicines and supplements. When taking an antidepressant, tell your healthcare professional about any other prescription or nonprescription medicines, herbs, or other supplements you're taking. Some antidepressants can interfere with the effectiveness of other medicines. Some antidepressants can cause dangerous reactions when combined with certain medicines or herbal supplements.

  For example, SSRIs may raise your risk of bleeding. The risk is higher when you also take other medicines that raise the risk of bleeding, for example, a nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen (Advil, Motrin IB, others), or warfarin (Jantoven) and other blood thinners.

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

  Symptoms of serotonin syndrome include anxiety, being nervous or jittery, high fever, sweating, confusion, shaking, restlessness, lack of coordination, major changes in blood pressure, and a fast heartbeat. Get medical help right away if you have any of these symptoms.

• Antidepressants and pregnancy. Talk to your healthcare professional 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 breastfeeding. If you're taking an antidepressant and you're thinking about getting pregnant, talk with your healthcare professional about the possible risks. Don't stop taking your medicine without talking with your healthcare professional first, as stopping puts you at risk.