Selective Serotonin Reuptake Inhibitors in Human Pregnancy: To Treat or Not to Treat?

Orna Diav-Citrin,Asher Ornoy

doi:10.1155/2012/698947

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are increasingly prescribed during pregnancy. The purpose of the present paper is to summarize and evaluate the current evidence for the risk/benefit analysis of SSRI use in human pregnancy. The literature has been inconsistent. Although most studies have not shown an increase in the overall risk of major malformations, several studies have suggested that SSRIs may be associated with a small increased risk for cardiovascular malformations. Others have noted associations between SSRIs and specific types of rare major malformations. In some studies, there appears to be a small increased risk for miscarriages, which may be associated with the underlying maternal condition. Neonatal effects have been described in up to 30% of neonates exposed to SSRIs late in pregnancy. Persistent pulmonary hypertension of the newborn has also been described with an absolute risk of <1%. The risk associated with treatment discontinuation, for example, higher frequency of relapse and increased risk of preterm delivery, should also be considered. The overall benefit of treatment seems to outweigh the potential risks.

Highlights

Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for the treatment of depression, anxiety, and other disorders
Clinicians are faced with the difficult cost-benefit consideration of either making a recommendation to treat or not to treat maternal depression or anxiety with SSRIs in pregnancy
In the field of teratology, decisions on new medications during pregnancy often need to be made with insufficient human pregnancy experience on their safety

Summary

Introduction

Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for the treatment of depression, anxiety, and other disorders. Estimates suggest that the lifetime risk for depression ranges between 10 and 25% with a peak prevalence occurring at childbearing age [1]. A number of SSRIs were introduced since the 1980s, including fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, and escitalopram. They have better efficacy, tolerability, and safety compared to first-generation antidepressants, for example, tricyclic antidepressants, and are safer in overdose. They exert their effects by inhibiting the presynaptic plasma membrane serotonin transporter. The serotonin transporter mediates the reuptake of serotonin into the presynaptic terminal; neuronal uptake is the primary process by which neurotransmission via 5-hydroxytryptamine (neuronal serotonin) is terminated

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