Posted by SLS on February 11, 2006, at 19:53:51
In reply to Depression and use of antidepressants in pregnancy, posted by ed_uk on February 11, 2006, at 12:01:43
This is a complex issue with no easy answers.
First of all, it has been my observation that pregnancy can produce a true antidepressant effect in unremitted individuals. However, this is not the same thing as subjecting the system to an abrupt discontinuation of a medication. Pregnancy might not be protective against a depressive rebound when drugs are discontinued too quickly.
There is little doubt that infants who are born to mothers taking SRIs suffer an intense withdrawal syndrome that can result in critical complications. Symptoms include irritability, constant crying, shivering, increased tonus, eating and sleeping difficulties and convulsions. I would be inclined to gradually taper and discontinue a SRI in the third trimester, particularly paroxetine and venlafaxine.
There is also the issue of birth defects occurring when SSRIs are taken during the first trimester. The US FDA recently asked that the manufacturer of Paxil (paroxetine) add warnings to their package labelling.
http://www.fda.gov/cder/drug/advisory/paroxetine200512.htm
SSRIs are not guaranteed to be safe to continue during pregnancy. However, neither is a relapse into depression. Most investigations into this issue conclude that the risks of relapse outweigh the risks of gestational complications. Perhaps it would be worth attempting a switch to a non-SRI drug like Wellbutrin, Remeron, or nortriptyline when beginning a pregnancy.
- Scott
poster:SLS
thread:608632
URL: http://www.dr-bob.org/babble/20060205/msgs/608729.html