The Safety of Newer Antidepressants in Pregnancy and Breastfeeding

  title={The Safety of Newer Antidepressants in Pregnancy and Breastfeeding},
  author={Salvatore Gentile},
  journal={Drug Safety},
  • S. Gentile
  • Published 2005
  • Medicine, Psychology
  • Drug Safety
The pregnancy and postpartum periods are considered to be relatively high risk times for depressive episodes in women, particularly for those with pre-existing psychiatric illnesses. Therefore, it may be necessary to start or continue the pharmacological treatment of depression during these two timeframes. Hence, the aim of this review is to examine the effects on the fetus and infant of exposure, through the placenta and maternal milk, to the following drugs: fluoxetine, fluvoxamine… 
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The revision of the pharmacovigilance studies indicate that most of the selective serotonin reuptake inhibitors have a teratogenic risk substantially similar to that of unexposed controls.
Antidepressants During Breastfeeding
In accordance with the Breastfed Infant-Antidepressant Safety Index classification, sertraline and paroxetine should be considered as first-line medications in women who need to start antidepressant treatment during the postpartum period and wish to continue breastfeeding.
Psychopharmacotherapy in Pregnancy and Breastfeeding
The learner should be better able to identify the main categories of psychiatric drugs used during pregnancy and breastfeeding, discuss side effects for the mother and the newborn associated with these drugs, and use the most appropriate drug according to different clinical situations.
Drug treatment for mood disorders in pregnancy
  • S. Gentile
  • Medicine, Psychology
    Current opinion in psychiatry
  • 2011
Avoiding the use of clorimipramine, paroxetine, valproate, and atypical antipsychotics during pregnancy is advisable, however, when starting or continuing pharmacological treatment during pregnancy, clinicians should consider not only the intrinsic iatrogenic risk of birth defects or perinatal complications, but also the general safety profile for the expectant mother.
Prophylactic treatment of bipolar disorder in pregnancy and breastfeeding: focus on emerging mood stabilizers.
  • S. Gentile
  • Medicine, Psychology
    Bipolar disorders
  • 2006
This review compares information from the literature on the safety of lamotrigine, oxcarbazepine, risperidone, olanzapine, and quetiapine to the safety data on classic mood stabilizers during pregnancy and the postpartum period to suggest thatUntreated pregnant bipolar women are at an increased risk of poor obstetrical outcomes and relapse of affective symptoms.
Use of Antidepressants to Treat Postpartum Depression, During Breast Feeding
Studies are needed with larger samples to properly evaluate the short and long-term effects of antidepressants on infants exposed through breast milk, so that clinicians can create standard decisions regarding the treatment of postpartum depression, without putting infants at risk.
Maternal use of SSRIs, SNRIs and NaSSAs: practical recommendations during pregnancy and lactation
Limited data are available about the long-term neurodevelopmental outcomes after SSRI exposure during pregnancy and lactation, but currently, cognitive development seems normal, while behavioural abnormalities may be increased.
Pharmacological Aspects of Neonatal Antidepressant Withdrawal
The reader should be able to explain the importance of antidepressant therapy during pregnancy and postpartum, summarize the important neonatal effects of antidepressants, and describe the potential teratogenic effects ofidepressants.
The use of psychotropic medication during pregnancy: how about the newborn?
Infants are at risk of developing symptoms of Poor Neonatal Adaptation after exposure to psychotropic drugs in utero, breastfeeding is presumably protective for development of PNA, and Phenobarbital is a safe therapeutic option.
Breastfeeding and antidepressants.
  • T. Field
  • Psychology, Medicine
    Infant behavior & development
  • 2008


Assessment and treatment of depression during pregnancy: an update.
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The fact that up ntil now no adverse effects of paroxetine on the infant have been reported can be attributed to the relatively crude methods of infant investigation, but it is still unknown whether maternally ingested parxetine reaches the infant’s brain.
Selective Serotonin‐Reuptake Inhibitors in Pregnancy and Lactation
Clinically, a conservative approach is encouraged, minimizing the use of SSRIs in pregnancy, avoiding such drugs during the first trimester, tapering them prior to delivery, and discouraging breast‐feeding during their use.
Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations.
Infants exposed to SSRIs during late pregnancy are at increased risk for serotonergic central nervous system adverse effects, and the severity of these symptoms is significantly related to cord blood 5-HIAA levels.
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With the exception of the known risk for depression to worsen in the postpartum period, there is little consistent evidence of the effects of pregnancy on the natural history of mental illness.
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Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome p450 genotypes.
Serum drug levels in breastfed infants of antidepressant-treated mothers were undetectable or low, adding further evidence to previously published data indicating that breastfeeding should not be generally discouraged in women using serotonin reuptake inhibitor anti-depressants.
Dose of selective serotonin uptake inhibitors across pregnancy: Clinical implications
Novel data on SSRI daily dose in pregnancy parallels the extant literature with tricyclic antidepressants (TCA).
Tricyclic Drugs in Pregnancy and Lactation: A Preliminary Report
The results to date indicate that there have been no fetal malformations, no greater frequency of complications during labor and delivery than in the normal population, only short-term withdrawal symptoms in the neonate, and no adverse effects on the breast-fed infants of mothers on TCAs.
Serum Concentrations of Antidepressants and Benzodiazepines in Nursing Infants: A Case Series
The data support the low incidence of infant toxicity and adverse effects associated with antidepressant and benzodiazepine use during breastfeeding and suggest that infant serum monitoring is helpful in the assessment of medication exposure in children of mothers who breastfeed while using psychotropic medications.