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More on SSRI and pregnancy


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Heya,

Two articles reported in McMan's weekly:

Levinston-Castiel et al.  Arch Pediatr Adolesc Med 2006 Feb; 160(2):173-6.

Neonatal abstinence syndrome after in utero exposure to SSRIs in term infants.

60 depressed moms on SSRI and 60 not on SSRI.

Of 60 treated moms, 8 babies had severe abstinence syndrome and 10 had mild.

No babies in either group of moms needed treatment.

So, withdrawals in babes was okay.

Small numbers, but no smaller that the big study I analyzed before.

Cohen LS et al.  JAMA 2006 Feb 1; 295(5):  499-507.

Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment.

201 women with history of MDD.

Remission until at least three months before last period.

And less than 12 weeks before last period had antidepressants.

82 women continued antidepressants into pregnancy, and 21 relapsed.

65 women stopped antidepressants, and 44 relapsed.

(Not sure I scribbled this down right, no, evidently not b/c the numbers don't add up, but the conclusion is the same.)

So risk of relapse into MDD and all its risks to mom and babe is much higher if we stop antidepressants.

Still small numbers.

-------

I dunno.

Looks like on balance, so far, with small and/or crummy studies, continuing SSRIs is a more acceptable choice than stopping them.

But I as a family doc would just review risks and benefits with the patient and go from there.

But these are interesting articles at any rate.

--ncc--

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Heya,

Weird coincidence.  But all coincidences are somewhat weird.

Dunno why, but today this crossed my inbox:

Citalopram not teratogenic

Clinical question

Is citalopram teratogenic?

Bottom line

Like other selective serotonin reuptake inhibitors (SSRIs), citalopram (Celexa)does not appear to be teratogenic. Exposure near the time of birth, however, was associated with increased risk of a diagnosis of fetal distress in labor and neonatal admission to special care nursery. (LOE = 1b)  [my comment:  LOE is Level of Evidence.  1b is the second-best level.  Good enough to guide therapy.]

Reference

Sivojelezova A, Shuhaiber S, Sarkissian L, Einarson A, Koren G. Citalopram use in pregnancy: Prospective comparative evaluation of pregnancy and fetal outcome. Am J Obstet Gynecol 2005;193:2004-09.

Study design: Cohort (prospective)

Funding: Government

Allocation: N/A

Setting: Population-based

Synopsis

Previous studies of other SSRIs have suggested that they are not teratogens, but are associated with a poor neonatal adaptation syndrome. In this study, 125 women who contacted the Motherisk Program in Toronto, Canada, with questions regarding their use of citalopram were enrolled if they took the medication during pregnancy. These women were matched with 2 control patients on the basis of maternal and gestational age at the time of first call. One control group consisted of women taking other SSRIs. The other group was unexposed to SSRIs or any known potentially teratogenic substances. Among women exposed to citalopram were 114 (86%) live births, 14 (11%) spontaneous abortions, 2 (1.5%) elective terminations, and 2 (1.5%) stillbirths. Of 108 infants exposed to citalopram in first trimester, 1 (0.9%) had a major malformation, which is no different than in the control groups. The rates of live birth, median birth weights, and length of pregnancy did not differ between groups. There was an increased incidence of admission to a special care nursery among infants exposed to citalopram throughout pregnancy (relative risk = 4.2; 95% CI, 1.7-10.3). The admissions were typically associated with a diagnosis of fetal distress during labor.

[all bold-emphasis mine]

Note that fetal distress is more likely to be dx'd if mom is taking any kind of meds, so that in itself doesn't lead to any conclusions.

So, SSRIs in general seem okay.  If it was me, I would think my baby was better off with an SSRI than with me being suicidally depressed the whole time.

--ncc--

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All drugs are given safety classifications that relate to pregnancy.

From memory, SSRIs were recently reclassified.

Zoloft is now the only one with a cat B, the rest are now C's ane one or two got a D.  prozac used to have a B but it got dropped to a C.

B is considered safe during prreganacy, C is relatively safe - D is a no go.  All benzos are a D I think; the big ones anyone (eg xanax, valium, klonopin). 

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