Selective Serotonin Reuptake Inhibitors in Human Pregnancy: To Treat or Not to Treat?

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are increasingly prescribed during pregnancy. The purpose of the present paper is to summarize and evaluate the current evidence for the risk/benefit analysis of SSRI use in human pregnancy. The literature has been inconsistent. Although most studies have not shown an increase in the overall risk of major malformations, several studies have suggested that SSRIs may be associated with a small increased risk for cardiovascular malformations. Others have noted associations between SSRIs and specific types of rare major malformations. In some studies, there appears to be a small increased risk for miscarriages, which may be associated with the underlying maternal condition. Neonatal effects have been described in up to 30% of neonates exposed to SSRIs late in pregnancy. Persistent pulmonary hypertension of the newborn has also been described with an absolute risk of <1%. The risk associated with treatment discontinuation, for example, higher frequency of relapse and increased risk of preterm delivery, should also be considered. The overall benefit of treatment seems to outweigh the potential risks.

A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report

“…About 30% of newborns exposed to SSRIs in the third trimester experience transitory adaptation problems after birth (Diav-Citrin & Ornoy, 2012) with symptoms ranging from mild (tremor, irritability, poor feeding) to more severe, including seizures, respiratory symptoms, temperature dysregulation or hypo- or hypertonia. These symptoms generally resolve within a few days without long-term effects.…”

“…These symptoms generally resolve within a few days without long-term effects. Of all the SSRIs, only paroxetine has been consistently linked to congenital anomalies and should therefore be avoided during pregnancy (Diav-Citrin & Ornoy, 2012; Udechuku et al, 2010). Sertraline and fluoxetine are associated with less severe symptoms than newer agents such as the serotonin norepinephrine reuptake inhibitors (Udechuku et al, 2010).…”

“…Given the well-documented adverse perinatal effects of untreated psychiatric disease, there is consensus among both obstetrical and psychiatric providers that the benefits of treating significant psychiatric symptoms in women outweigh the risks presented by SSRI exposure (Na, 2008). Clinicians should engage in shared decision making with pregnant women regarding the use of SSRIs, in particular sertraline and fluoxetine, for treating symptomatic PTSD (Diav-Citrin & Ornoy, 2012; Ray & Stowe, 2014; Steiner, 2012b). …”

Effects of neonatal fluvoxamine administration to white rats and their correction by semax treatment

“…As much as 30% of infants who prenatally received SSRIs had signs of neonatal abstinence syndrome (Marsella et al, 2010). In addition, SSRI exposure during preg nancy (especially in the last trimester) reduces the neonatal Apgar scores and causes psychomotor retar dation, sleep disorders, pulmonary hypertension, and cardiovascular disorders (Casper et al, 2003(Casper et al, , 2011Oliver et al, 2011;Diav Citrin and Ornoy, 2012). The most frequent observations of children who prenatally received SSRI were performed mainly in early life (up to 6 years).…”

Safety of escitalopram in pregnancy: a case series

“…Further, women with untreated major depressive disorder can be at risk of self-harm or suicide 3. High rates of relapse were reported by women with depression who discontinued antidepressant therapy at the time of conception, compared with women who continued therapy throughout the pregnancy, in a study conducted by Cohen et al4 There is an unwillingness among physicians and patients to use antidepressant drugs during the gestational period, because there are conflicting results about the use of such drugs, and the risk of major congenital malformations 5–8. The Canadian Paediatric Society recommends that satisfactory treatment of depression in pregnancy is important for the well-being of both the mother and infant, and that individual risk-benefit assessment must be made when a selective serotonin reuptake inhibitor needs to be prescribed during pregnancy 9…”