To treat or not to treat: Maternal depression, SSRI use in pregnancy and adverse neonatal effects

School of Psychiatry, University of New South Wales & Black Dog Institute, Prince of Wales Hospital, Sydney, Australia.
Psychological Medicine (Impact Factor: 5.94). 01/2007; 36(12):1663-70. DOI: 10.1017/S003329170600835X
Source: PubMed


Recent pharmaceutical company and regulatory body circulars warning against the use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy have left clinicians in somewhat of a quandary as to how to manage their more severely depressed patients in pregnancy. Conversely, up to 75% of depressed women ceasing their antidepressants periconceptually will relapse. Studies reporting on adverse neonatal outcomes following exposure to SSRIs in the latter half of pregnancy suggest that the fetus is exposed to significant concentrations of these medications during this time. Adverse neonatal effects affecting the respiratory, gastrointestinal and neurological systems are, however, predominantly mild and self-limiting. One small retrospective case study suggests that SSRI exposure in the latter half of pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the neonate (PPHN), however, the absolute risk of developing PPHN remains very small and these findings will require replication with a prospective study. While the studies to date suggest the need to closely monitor SSRI-exposed neonates in the immediate postnatal period, preferably with a neonatal withdrawal scale and access to neonatology services, there is currently no clear argument for women to be weaned off their SSRI in late pregnancy. The decision to use SSRIs at this time will have to be made on a case-by-case basis in close consultation with the mother and her partner.

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    • "infectious or neurological) and appropriate evaluations is essential. The average time of onset for PNAS symptoms ranges between birth to 3 days of age, and lasts for up to 2 weeks [86], with most infants having mild and transient symptoms. Neonatal medical management consists primarily of supportive care in special care nurseries [87]. "
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    ABSTRACT: Depression, anxiety, or both, during pregnancy are common complications during the perinatal period, with 15-20% of women experiencing depression at some point during their pregnancy. Considerable evidence suggests that untreated or undertreated maternal Axis I mood disorders can increase the risk for preterm birth, low birth weight, and alter neurobehavioral development in utero. Serotonin reuptake inhibitor antidepressants are often considered for antenatal therapy, with the goal of improving maternal mental health during pregnancy. Treatment with a serotonin-reuptake inhibitor, however, does not guarantee remission of depression, and in-utero serotonin reuptake inhibitor exposure has also been linked to increased risks for adverse infant outcomes. In this chapter, evidence linking serotonin reuptake inhibitor use with an increased risk for postnatal adaptation syndrome, congenital heart defects, and neonatal persistent pulmonary hypertension is reviewed. Management decisions should include attention to the continuum of depression symptoms, from subclinical to severe major depressive disorder and the long-term developmental risks that might also be associated with pre- and postnatal exposure.
    Full-text · Article · Sep 2013 · Best practice & research. Clinical obstetrics & gynaecology
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    • "Conversely, a relationship between maternal stress, anxiety and depressive disorder in pregnancy and increased risk for her baby's admission to NICU (related to premature delivery and low birth weight) (Austin and Leader 2000) has also been noted. Yet, other studies note an association between pregnancy exposure to antidepressants and NICU admission related to neonatal adaptation syndrome (Austin 2006). This study showed that mothers born in Australia or in advantaged socioeconomic quintile MDD: data linkage to inform perinatal mental health policy 339 "
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    ABSTRACT: This study aims to investigate hospital admission of major depressive disorders (MDD) before and after birth. Population data for all primiparous women admitted to the hospital with depressive disorders before and after birth were used. The comparison group consisted of 10 % of primiparous women not admitted to the hospital with a diagnosis of a psychiatric disorder or substance use. A total of 728 women had a first admission with depressive disorders (501 in the first postpartum year). The rate of first hospital admission for depressive disorders decreased during pregnancy and increased markedly in the first three months after birth (peaking in the second month with a rate of 10.74/1,000 person year and rate ratio of 12.56) compared with the 6 months prior to pregnancy. Admission remained elevated in the second postpartum year. Older maternal age, smoking, elective caesarian section and admission to a neonatal intensive care unit or special care nursery were associated with a higher rate of admission. Women born outside Australia and those most socioeconomically disadvantaged were less likely to be admitted to the hospital in the first postpartum year. Overall risk of hospital admission with depressive disorders rose significantly across the entire first postpartum year. This has significant implications for policy and service planning for women with mood disorders in the perinatal period.
    Full-text · Article · May 2012 · Archives of Women s Mental Health
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    • "Ideally, comorbid psychiatric conditions should be adequately treated, and the use of antidepressant drugs such as SSRI medication, which has been shown to be safe during pregnancy, may be indicated. However, a careful risk-benefit evaluation of pharmacological treatment by a psychiatric professional experienced in treating pregnant women is warranted [17]. It should be part of a multiprofessional team approach comprising psychiatrists, psychologists, gynecologists, midwifes, nurses, social workers, and anesthesiologists. "
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