In contrast, the risks associated with untreated depression during pregnancy are much higher and more frequent.72 Withdrawal/toxicity symptoms The first report of find more withdrawal symptoms in babies exposed to antidepressants occurred in 1973 .84 It is unclear if “neonatal withdrawal syndrome” is actually a result of withdrawal from the antidepressant medication or is due to a toxicity mechanism. Thus, an alternative term such as “poor neonatal adaptation,” or “neonatal neurobehavioral syndrome” may be a better
Inhibitors,research,lifescience,medical description. Although there are a number of limitations in the available literature in this area, including inconsistent definitions, regardless, the FDA instituted a class labeling change in 2004 for both SSRI and SNRI (serotonin-norepinephrine reuptake
inhibitors) antidepressants warning that third trimester exposure to antidepressants may be associated with signs and symptoms consistent with the syndrome. According to the label change, “reported clinical findings Inhibitors,research,lifescience,medical have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying.” The subsequent result has been that many practitioners have recommended tapering antidepressants prior to labor and Inhibitors,research,lifescience,medical delivery even though most cases of the neonatal syndrome appear to be very mild, self-limited, and do not appear to be associated with lasting repercussions85 Recently, investigators in British Columbia studied whether adverse neonatal outcomes were reduced by stopping SSRI use before the end of pregnancy in a large cohort Inhibitors,research,lifescience,medical study that linked maternal health and prenatal SSRI prescription claims data to more than 119 000 neonatal birth records.86 Inhibitors,research,lifescience,medical After controlling for possible confounding
factors, including severity of maternal illness, the results showed neonatal outcomes did not improve when SSRI medications were stopped before the last 2 weeks of gestation and provided evidence that some adverse neonatal outcomes may not be consequent to an acute pharmacological condition such as toxicity or withdrawal.86 Oberlander and Gingrich have reported on animal model literature describing neurobehavioral consequences of prenatal SSRI exposure.87 This preclinical Vasopressin Receptor work shows that in animal models, early changes in serotonergic tone have molecular, neuroanatomical,and functional consequences, which are dependent on the timing (critical periods) and direction (increased or decreased) of change.87 Clearly, larger, prospective human studies of the syndrome as well as strategies to minimize the incidence rate of the syndrome are needed. However, to date, there is no evidence from a safety perspective to recommend tapering of antidepressants in the third trimester, particularly in cases of moderate to severe maternal mental illness.