Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence

Abstract

Currently, it is impossible for most of the evaluated outcomes to distinguish between the effects related to the mother's underlying disease and those inherent to SSRI treatment. In women suffering from major depression and responding to a pharmacological treatment, introduction or continuation of an SSRI should be encouraged in order to prevent maternal complications and to preserve maternal-infant bonding. The choice of the right drug depends above all on individual patient characteristics such as prior treatment response, diagnoses and comorbid conditions.

Patterns of antidepressant use during pregnancy: a nationwide population‐based cohort study

“…Switching to another antidepressant was more frequently observed than associations of antidepressants. In such cases, sertraline or es‐/citalopram was the preferred drug, which is in line with clinical guidelines recommending these antidepressants as first‐choice drugs when starting treatment in pregnant women, especially if breastfeeding is planned . Coprescribing mirtazapine/mianserin with an SSRI now belongs to the best evidence‐based associations , and this association was one of the most frequently found in the present study.…”

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1—exercise in women planning pregnancy and those who are pregnant

“…The decision to use antidepressants in pregnancy is based on the mental health needs of the mother during pregnancy and the postpartum period balanced against any theoretic concern for the fetus. That being said, most antidepressants are not contraindicated in pregnancy 181. Any medication used by an elite athlete should fit within the WADA guidelines 182…”

Fluoxetine effects on periodontogenesis: histomorphometrical and immunohistochemical analyses in rats

“…In this context, fluoxetine - an SSRI, is one of the most prescribed drugs for the treatment of depressive disorders, even during pregnancy and lactation 30 . However, significant plasma levels of fluoxetine have been reported in newborns, due to its long half-life and clinically active metabolites 28 .…”