Maternal antidepressant use can trigger withdrawal in newborns

Pregnant women who take selective serotonin reuptake inhibitor antidepressants such as Celexa, Paxil, Prozac and Zoloft could boost the risk of withdrawal symptoms for their newborns, a new study suggests.

However, the Israeli researchers add that these symptoms are usually gone within 48 hours and appear to pose no long-term threat to the infant's health.

Another expert notes that stopping antidepressant therapy during pregnancy poses its own risk to the health of a mother and her child.

"At present, probably the effect of not treating the women's clinical depression is a much bigger issue for mothers and their infants," says Dr. Tim Oberlander, an associate professor of pediatrics at the University of British Columbia and a developmental pediatrician at Children's and Women's Health Centre of British Columbia, Vancouver, Canada.

In the study, published in the February issue of the Archives of Pediatrics and Adolescent Medicine, a team at the Schneider Children's Medical Center of Israel studied the health of 120 newborns. Sixty of these babies' mothers took a selective serotonin reuptake inhibitor antidepressant to treat depression during their pregnancy, while the other 60 mothers did not.

The researchers assessed each infant's behavior two hours after birth and again at regular intervals to see if they displayed withdrawal symptoms.

Among the 60 infants exposed to SSRIs in the womb, 18 displayed what experts call "neonatal abstinence syndrome." In a minority of cases, this syndrome "may be severe enough to cause seizures," says senior researcher Dr. Gil Klinger, a neonatologist at the hospital. Of the 18 cases noted, eight were severe. The most common symptoms were tremors, gastrointestinal problems, an abnormal increase in muscle tone, sleep disturbances and high-pitched cries.

However, Klinger adds that "signs of neonatal abstinence subside usually within a few days," and notes that none of the babies required treatment.

Based on the findings, Klinger advises that "infants born to mothers treated with SSRIs must be observed for a minimum period of 48 hours or longer if signs of a neonatal abstinence syndrome are evident."

Both mothers and their doctors should become aware of the possible effects of SSRIs on newborns, Klinger says. However, he says the findings don't mean women shouldn't take the drugs to ease depressive symptoms. "It must be made clear that depression during pregnancy entails risk to the mother and her fetus, thus we are not suggesting cessation of medication," he says.

In view of the widespread use of SSRIs, the risk-benefit ratio for treatment must be considered, Klinger says. "It should also be stressed that although we have demonstrated short-term effects to drug exposure, it is far more important to assess the long-term effects (to infants), and these are yet unknown."

Oberlander agrees that women who need them should not stop taking their SSRIs during pregnancy. "These findings are consistent with what others have found," he says.

The Canadian expert believes that doctors should be sensitive to long-term behavioral outcomes in infants exposed to SSRIs. "We don't know enough about the long-term effects of SSRIs," he says.

However, in his own research, Oberlander found that a mom's emotional state seems to be the biggest predictor of her child's long-term behavior. "It's the mother's mood that seems to have the greatest long-term effect, not prenatal exposure to SSRIs.

"The concern should not just be with (neonatal) withdrawal behavior," Oberlander says. "We should be sensitive to special needs of these babies, not because they were drug exposed, but because the mothers were depressed. That is the biggest risk factor these babies have."

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