The Use of Selective Serotonin Reuptake Inhibitors in Pregnancy and Lactation: A Review

Abstract

The selective serotonin reuptake Inhibitor (SSRI) type of antidepressants which include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine (Luvox), are valued for their efficacy, safety and side effect profile when prescribed to treat depression and co-morbid anxiety disorders. However, when a pregnant or nursing mother becomes depressed, treatment with the SSRIs is controversial because conflicting findings have been reported in the literature. A paucity of data exists on this subject. This could partly be because many women refuse medication however severe their illness may be. Another reason for the scarcity of research could be because the treating physician may not feel at ease administering these medicines in the light of insufficient information on the topic. Consequently, several crucial questions remain unanswered, the most important of them being the long-term neurodevelopmental effect of these medicines on the growing infant. The SSRIs travel through the placenta and breast milk and can be measured in the infants’ serum. The U.S. Food and Drug Administration or the Health Protection Branch of Canada has not yet approved SSRIs for use in pregnancy and lactation. This contradiction further adds to the dilemma of the treating physician of whether or not to prescribe SSRIs to pregnant and nursing women. This article reviews the use of SSRIs in pregnmuy and lactation.