July 14, 2003 -- Infants born to mothers taking the most widely prescribed antidepressants seem to have more early problems adapting to life outside the womb, but there is little evidence that these problems persist after the first few days.
In a newly reported study, researchers in Finland found that newborns whose mothers took the selective serotonin reuptake inhibitors (SSRIs) Prozac or Celexa during pregnancy were four times as likely to experience early problems such as restless, tremors, and irritability compared with babies whose mothers did not take them. But by the time they were 2 weeks old, the SSRI-exposed babies had no apparent exposure-related problems.
Writing in the July issue of the journal Archives of Psychiatry, researcher Kari Laine, MD, and colleagues from Turku University suggest that taking pregnant women off SSRIs during the last few weeks of pregnancy might keep their babies from developing these neurological symptoms. But an expert on the treatment of depression in pregnancy tells WebMD that the risks of doing this greatly outweigh the potential benefits.
"In my mind, that is the most counterintuitive intervention imaginable," Lee S. Cohen, MD, says. "In our center we would never discontinue medication right before delivery because when you do that you increase the risk of postpartum depression. You are taking away the medication just when the woman needs it most."
Cohen says it is still not clear that SSRI use during pregnancy causes short-term problems among their offspring because the studies investigating the issue have been flawed. He says there is no evidence that SSRI use during pregnancy is linked to any long-term health or developmental problems. Cohen directs the Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital.
Restless, Irritable Infants
The Finnish study included 20 women who took Prozac or Celexa during pregnancy and while breastfeeding and another 20 women who did not. Newborns were assessed for neurologic symptoms that might be related to taking SSRIs, which increase the availability of the neurotransmitter serotonin in the brain, during the first four days of life and again at 2 weeks and 2 months of age. Fetal brain ultrasounds and magnetic resonance imaging (MRI) were also conducted shortly before birth and again at the age of 2 months.
Though they found no major differences in vital signs such as blood pressure, heart rate, and body temperature between the two infant groups, there was a fourfold difference in serotonin-related symptoms during the first four days of life. The most commonly reported symptoms in the SSRI-exposed infants were tremors, restlessness, and rigidity.
University of Toronto pediatrics Professor Gideon Koren, MD, has conducted several studies examining the effects of maternal antidepressant use in newborns. Last year, his research team reported that prenatal exposure to the SSRI Paxil appears to be associated with more postnatal problems than exposure to other antidepressants.
Koren says it is not clear why more newborns exposed to Paxil in the womb end up in special-care nurseries. But he agrees that the risks of taking women who need antidepressants off them while pregnant may far outweigh the potential benefits to their offspring.
"The need for therapeutic intervention has to be weighed against the potential risk to the fetus," he says. "But most SSRIs seem to be generally well tolerated."