Physicians are advised to discuss the following issues with patients for whom they prescribe Celexa.
Although in controlled studies Celexa has not been shown to impair psychomotor performance, any psychoactive drug
may impair judgment, thinking, or motor skills, so patients should be cautioned about operating hazardous machinery,
including automobiles, until they are reasonably certain that Celexa therapy does not affect their ability to engage
in such activities.
Patients should be told that, although Celexa has not been shown in experiments with normal subjects to increase
the mental and motor skill impairments caused by alcohol, the concomitant use of Celexa and alcohol in depressed
patients is not advised.
Patients should be advised to inform their physician if they are taking, or plan to take, any prescription or
over-the-counter drugs, as there is a potential for interactions.
Patients should be cautioned about the concomitant use of Celexa and NSAIDs, aspirin, or other drugs that affect
coagulation since the combined use of psychotropic drugs that interfere with serotonin reuptake and these agents has
been associated with an increased risk of bleeding.
Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during
Patients should be advised to notify their physician if they are breastfeeding an infant.
While patients may notice improvement with Celexa therapy in 1 to 4 weeks, they should be advised to continue
therapy as directed.
Prescribers or other health professionals should inform patients, their families, and their caregivers about the
benefits and risks associated with treatment with Celexa and should counsel them in its appropriate use. A patient
Medication Guide About Using Antidepressants in Children and Teenagers is available for Celexa. The prescriber
or health professional should instruct patients, their families, and their caregivers to read the Medication Guide
and should assist them in understanding its contents. Patients should be given the opportunity to discuss the
contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the
Medication Guide is reprinted at the end of this document.
Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking
Clinical Worsening and Suicide Risk: Patients, their families, and their caregivers should be encouraged to
be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness,
impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of
depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up
or down. Families and caregivers of patients should be advised to observe for the emergence of such symptoms on a
day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patients prescriber or health
professional, especially if they are severe, abrupt in onset, or were not part of the patients presenting symptoms.
Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a
need for very close monitoring and possibly changes in the medication.
About Using Antidepressants in Children and Teenagers What is the most important information I should
know if my child is being prescribed an antidepressant?
Parents or guardians need to think about 4 important things when their child is prescribed an antidepressant:
1.There is a risk of suicidal thoughts or actions
2.How to try to prevent suicidal thoughts or actions in your child
3.You should watch for certain signs if your child is taking an antidepressant
4.There are benefits and risks when using antidepressants
1.There is a Risk of Suicidal Thoughts or Actions
Children and teenagers sometimes think about suicide, and many report trying to kill themselves.
Antidepressants increase suicidal thoughts and actions in some children and teenagers. But suicidal thoughts and
actions can also be caused by depression, a serious medical condition that is commonly treated with
antidepressants. Thinking about killing yourself or trying to kill yourself is called suicidality or
A large study combined the results of 24 different studies of children and teenagers with depression or other
illnesses. In these studies, patients took either a placebo (sugar pill) or an antidepressant for 1 to 4 months.
No one committed suicide in these studies, but some patients became suicidal. On sugar pills, 2 out of every
100 became suicidal. On the antidepressants, 4 out of every 100 patients became suicidal.
For some children and teenagers, the risks of suicidal actions may be especially high. These include
· Bipolar illness (sometimes called manic-depressive illness)
· A family history of bipolar illness
· A personal or family history of attempting suicide
If any of these are present, make sure you tell your healthcare provider before your child takes an
2. How to Try to Prevent Suicidal Thoughts and Actions
To try to prevent suicidal thoughts and actions in your child, pay close attention to changes in her or his
moods or actions, especially if the changes occur suddenly. Other important people in your childs life can help by
paying attention as well (e.g., your child, brothers and sisters, teachers, and other important people). The
changes to look out for are listed in Section 3, on what to watch for.
Whenever an antidepressant is started or its dose is changed, pay close attention to your child.
After starting an antidepressant, your child should generally see his or her healthcare provider:
· Once a week for the first 4 weeks
· Every 2 weeks for the next 4 weeks
· After taking the antidepressant for 12 weeks
· After 12 weeks, follow your healthcare providers advice about how often to
· More often if problems or questions arise
You should call your childs healthcare provider between visits if needed.
3. You Should Watch for Certain Signs If Your Child is Taking an Antidepressant
Contact your childs healthcare provider right away if your child exhibits any of the following
signs for the first time, or if they seem worse, or worry you, your child, or your childs teacher:
· Thoughts about suicide or dying
· Attempts to commit suicide
· New or worse depression
· New or worse anxiety
· Feeling very agitated or restless
· Panic attacks
· Difficulty sleeping (insomnia)
· New or worse irritability
· Acting aggressive, being angry, or violent
· Acting on dangerous impulses
· An extreme increase in activity and talking
· Other unusual changes in behavior or mood
Never let your child stop taking an antidepressant without first talking to his or her healthcare provider.
Stopping an antidepressant suddenly can cause other symptoms.
4. There are Benefits and Risks When Using Antidepressants
Antidepressants are used to treat depression and other illnesses. Depression and other illnesses can lead to
suicide. In some children and teenagers, treatment with an antidepressant increases suicidal thinking or actions.
It is important to discuss all the risks of treating depression and also the risks of not treating it. You and your
child should discuss all treatment choices with your healthcare provider, not just the use of antidepressants.
Other side effects can occur with antidepressants.
Of all the antidepressants, only fluoxetine (Prozac™) has been FDA approved to treat pediatric
For obsessive compulsive disorder in children and teenagers, FDA has approved only fluoxetine (Prozac™),
sertraline (Zoloft™), fluvoxamine, and clomipramine (Anafranil™).
Your healthcare provider may suggest other antidepressants based on the past experience of your child or other
Is this all I need to know if my child is being prescribed an antidepressant?
No. This is a warning about the risk for suicidality. Other side effects can occur with antidepressants. Be sure
to ask your healthcare provider to explain all the side effects of the particular drug he or she is prescribing.
Also ask about drugs to avoid when taking an antidepressant. Ask your healthcare provider or pharmacist where to
find more information.
*Prozac™ is a registered trademark of Eli Lilly and Company
*Zoloft™ is a registered trademark of Pfizer Pharmaceuticals
*Anafranil™ is a registered trademark of Mallinckrodt Inc.
This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants.