Infants and Antidepressant Withdrawal

1 in 3 Newborns Exhibited Symptoms From SSRIs

Reviewed by Louise Chang, MD on February 06, 2006

Feb. 6, 2006 -- There is growing evidence that babies born to mothers who take antidepressants during pregnancy often experience symptoms of drug withdrawal shortly after birth.

In a new study from Israel, about one out of three newborn infants exposed to antidepressants in the womb showed signs of neonatal drug withdrawal, which included high-pitched crying, tremors, and disturbed sleep.

Researchers concluded that expectant moms who take selective serotonin reuptake inhibitor (SSRI) antidepressants and their doctors should be warned about the potential risk.

"Because maternal depression during pregnancy also entails a risk to the newborn, the risk-benefit ratio of continuing SSRI treatment should be assessed," Rachel Levinson-Castiel, MD, and colleagues wrote.

Confusing Picture

The report comes less than a week after the publication of a major study finding that pregnant women who stop taking antidepressants run a high risk of relapsing into depression.

And it comes just months after the FDA warned that a widely prescribed SSRI may be associated with an increased risk of birth defects in babies born to mothers who take the drug in their first trimester.

The mixed messages from the research have left many pregnant women who suffer from depression wondering what to do.

Diana Dell, MD, who is both an ob-gyn and a psychiatrist, says it is increasingly clear that abruptly stopping depression treatment carries significant risks for both mother and baby.

Dell is an assistant professor of obstetrics and gynecology and psychiatry at Duke University in Durham, N.C.

"Moms need to be well during pregnancy, and moderate to severe depression certainly has an impact on a developing fetus," she tells WebMD. "We also know that a woman's chance of being hospitalized for psychiatric reasons is greater during the first four weeks after giving birth than at any other time in her life."

'Vulnerable Period'

The Israeli study involved 60 newborns whose mothers took SSRI antidepressants throughout their pregnancies up until the time they delivered. The infants were assessed for signs of withdrawal during the first two hours after birth, and then again at regular intervals if they exhibited withdrawal symptoms.

A second group of 60 newborns who were not exposed to SSRIs in the womb were also assessed.

The researchers reported that 18 of the 60 SSRI-exposed newborns (30%) showed signs of drug withdrawal in the hours after birth, and in eight cases the symptoms were considered severe.

The most common symptoms were tremors, gastrointestinal problems, muscle tensing, sleep disturbances, and high-pitched crying. None of the exposed infants with symptoms required treatment.

None of the infants without exposure to SSRIs in the womb showed evidence of the withdrawal symptoms.

The researchers concluded that babies born to mothers taking SSRIs at the time of delivery should be watched carefully in the hospital setting for at least 48 hours after birth.

Dell points out that in this study, and in several others, symptoms that might be associated with antidepressant exposure in the womb resolved quickly after birth.

She says findings from a study published last week in The Journal of the American Medical Association highlight the importance of carefully weighing the risks and benefits of antidepressant treatment during pregnancy.

In that study, two-thirds of the women with a history of major depression who stopped taking SSRIs during pregnancy relapsed into serious depression, compared with one in four women who kept taking the drugs.

"We now have proof that pregnancy does not protect against depression," she says. "Just like the post-partum period, pregnancy is a biologically vulnerable period for this disease."

Show Sources

SOURCES: Levinson-Castiel, R. Archives of Pediatric and Adolescent Medicine, February, 2006; vol 160: pp 173-176. Rachel Levinson-Castiel, MD, Children's Medical Center of Israel, Petah Tiqwa, Israel. Sanz, J. "Selective Serotonin Reuptake Inhibitors in Pregnant Women and Neonatal Withdrawal Syndrome." The Lancet, Feb. 5, 2005; vol 365: pp 482-487. Cohen, L. The Journal of the American Medical Association, Feb. 1, 2006; vol 295: pp 499-507.
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