Depression Tips

A newborn’s risk of exhibiting drug withdrawal symptoms and respiratory abnormalities appears to increase with prenatal exposure to certain antidepressants, according to two new studies.

Before prescribing this type of medication to pregnant women, the doctors are urged by researchers to carefully consider these findings. The risk of a respiratory disorder in pregnant women is increased by the use of SSRI antidepressants. The respiratory disorder includes persistent pulmonary hypertension (PPHN) in the newborn by 600%. This was the finding of a new retrospective study, and it included 377 women whose infants had the disorder.

Pharmacotherapy for depression is often necessary during pregnancy. The information available about use of the newer antidepressants in pregnant women is limited by trial design and lack of long-term follow-up of exposed infants. Selective serotonin reuptake inhibitors (SSRIs) are not generally thought to be major teratogens. Some recent studies, however, have suggested that paroxetine may be associated with a small increase in risk of congenital abnormalities, particularly cardiac defects. Data on the effect of SSRIs on the incidence of preterm birth, spontaneous abortion, and fetal death are conflicting. Third-trimester exposure to newer antidepressants, including SSRIs and serotonin-nor epinephrine reuptake inhibitors (e.g., venlafaxine), has been associated with a poor neonatal adaptation syndrome. In addition, SSRI use may be associated with an increased risk of persistent pulmonary hypertension of the newborn. Preliminary evidence suggests that SSRI exposure in utero does not have significant long-term effects on cognition or behavior. Based on limited information, mirtazapine, bupropion, and venlafaxine do not appear to be major teratogens. Little or no information is available on duloxetine.

Treatment options for depression include psychotherapy, bright-light therapy, antidepressant drugs, and electroconvulsive therapy.[2] The optimal treatment for depression during pregnancy varies from woman to woman, but pharmacotherapy is often necessary.[2] A study of 201 women with a history of major depressive disorder before pregnancy found that 68% of those who discontinued treatment relapsed during pregnancy compared with 26% of those who continued treatment.[4] Affected women and their clinicians may be concerned about the effects of drug treatment on the fetus and the neonate.

Prenatal exposure to certain antidepressants appears to increase a newborn’s risk of exhibiting drug withdrawal symptoms and respiratory abnormalities, according to two new studies. Researchers behind the studies urge doctors to carefully consider these findings before prescribing this type of medication to pregnant women.

The use of SSRI antidepressants in pregnant women increased the risk of a respiratory disorder – persistent pulmonary hypertension (PPHN) – in the newborn by 600%. This was the finding of a new retrospective study which included 377 women whose infants had the disorder.

SSRIs, or selective serotonin-reuptake inhibitors, work by increasing the availability of the chemical messenger serotonin in the body.

Mothers of infants with PPHN were interviewed by Christina Chambers at the University of California, San Diego, US, and colleagues to determine how many of them used SSRIs during pregnancy. The team then compared this with the use of SSRIs among mothers of healthy babies.

Balance of care

But medical experts estimate that 10% to 15% of women of reproductive age suffer from major depressive disorders. And many of these doctors stress that pregnant women should receive treatment for depression, even if that means taking SSRIs. “They’re so many issues that are involved,” says Chambers. “The risks and benefits have to be weighed. There are risks without [the antidepressants] as well.”

A study that recently appeared in the Journal of the American Medical Association suggested that women with major depression can suffer a recurrence of their condition if they stop taking their medication during pregnancy