Antidepressants and Pregnancy

Specific Risks

Most of the recent concerns about pregnancy and antidepressants concern selective serotonin reuptake inhibitors (SSRIs), the most commonly used type of antidepressant. Specifically, paroxetine (Paxil®, Paxil CR®) has been associated with heart defects when used in the first trimester.
Also, there have been reports that SSRI use in the third trimester may cause complications that require hospitalization, respiratory support, and/or tube feeding. These newborns experienced a number of symptoms, including:
  • Difficulty breathing
  • Seizures
  • Lack of oxygen in the blood
  • Feeding difficulties
  • Tremors
  • Irritability
  • Constant crying.
Also, babies who are exposed to SSRIs during late pregnancy are also at increased risk for developing persistent pulmonary hypertension of the newborn (PPHN), a very serious lung condition. PPHN is associated with significant complications and even death. Women who take an SSRI after week 20 of pregnancy have a 6-fold increase of delivering a baby with PPHN.
Other types of antidepressants may also have risks. SNRIs (serotonin-norepinephrine reuptake inhibitors) are probably associated with the same risks as SSRIs, although there is less information since these medications are newer (and less studied) than SSRIs.
There is little information about the safety of tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) during pregnancy, as these older medications are not used much anymore. Bupropion (Wellbutrin® SR, Wellbutrin® XL, Wellbutrin®, Zyban®), an NDRI (norepinephrine and dopamine reuptake inhibitor), appears to be at least as safe as the SSRIs, although the full risks are not currently known.
(For more information about the safety of your particular antidepressant during pregnancy, see the specific antidepressant within eMedTV.)
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