Infants born to mothers who take antidepressants during the final months of pregnancy can suffer mild to severe symptoms of drug withdrawal, but the symptoms rarely last longer than the first few weeks of life, according to a newly published review.

Researchers reported that newborns exposed to antidepressants taken by their mother late in pregnancy have twice the risk of admission to special-care nurseries as newborns not exposed to these drugs.

They also have twice the risk of respiratory complications. Some were serious enough to require ventilation. Seizures were also reported in these infants.

The researchers say that many of the complications are self-limiting and can be managed with supportive care.

Researcher Eydie Moses-Kolko, MD, tells WebMD that these severe symptoms occur in less than 1% of babies exposed to antidepressants like Prozac, Paxil, Zoloft, and Celexa shortly before birth.

"The research does show an increased risk in babies born to mothers taking these antidepressants, but the symptoms tended to be mild and not long lasting," she says.

She added that the risks to newborns delivered to depressed mothers who need to be on antidepressants but don't take them may be just as great or greater.

"The decision about whether to continue treatment late in pregnancy or not has to be made on a case-by-case basis," she says.

A Mom's Story

Cranston, R.I., mom Lisa Kirshenbaum couldn't agree more, but she adds that finding a doctor who has experience treating women with depression during pregnancy is critical.

Kirshenbaum had struggled with depression for years when she stopped taking antidepressants on the advice of her psychiatrist during her first pregnancy eight years ago. She suffered few ill effects, but when she tried the same thing with her second pregnancy she quickly spiraled into a severe depression.

Her doctors pushed her to try alternative treatments like acupuncture and meditation, but nothing helped. She is convinced that her untreated depression led to her miscarriage nine weeks into her pregnancy.

"There is a lot out there about the dangers of antidepressants, but women need to know that there can be serious negative consequences associated with not taking antidepressants if they need them," she tells WebMD.

Withdrawal-Like Symptoms

Depression affects about 14 percent of women during childbearing years. Concern about the use of antidepressant drugs known as serotonin reuptake inhibitors (SRIs) late in pregnancy have grown in recent years with the publication of several studies linking them to withdrawal-like symptoms in newborns.

SRIs are the most widely prescribed antidepressants and include the drugs Prozac, Paxil, Zoloft, Celexa, and Effexor. Use of these medications during pregnancy is not associated with fetal malformation, say the researchers.

Infant jitteriness, irritability, feeding problems, respiratory distress, and stiffened muscle tone are among the symptoms associated with antidepressant exposure shortly before birth in the studies.

The newly published review included studies assessing newborn behavior in women taking antidepressants over the past decade. The report is published in the May 18 issue of The Journal of the American Medical Association.

Moses-Kolko and colleagues from the University of Pittsburgh School of Medicine report that infants exposed to SRI antidepressants shortly before birth were three times as likely to exhibit behaviors like jitteriness, respiratory distress, and fussiness as nonexposed infants and those exposed only during early pregnancy.

Most reports of antidepressant-related complications occurred in children exposed to Prozac and Paxil. Symptoms associated with Zoloft, Celexa, and Effexor exposure were less common but still significant.

Expert Still Skeptical

Boston psychiatrist Lee Cohen, MD, concedes that the clinical evidence suggests a link between SRI antidepressant exposure just before birth and infant jitteriness. But he remains skeptical about other symptoms supposedly caused by prebirth exposure.

He tells WebMD that the studies that have evaluated newborns exposed to antidepressants are highly flawed.

Cohen directs the Center for Women's Mental Health at Massachusetts General Hospital, one of the few treatment facilities in the country that specializes in treating depression during pregnancy.

He worries that pregnant women who are depressed will get the message that they will harm their babies if they get the treatment they need. Cohen has studied depression in pregnancy for two decades and is a consultant for Prozac manufacturer Lilly.

"What we have learned over the last 20 years is that at the end of the day the most important predictor of how a kid does long term is whether the mother is psychologically well during pregnancy," he says.

Kirshenbaum now knows that much of what she heard from doctors during her first two pregnancies was wrong. A psychiatrist told her that depression usually goes away during pregnancy, and other doctors warned her that taking antidepressants early in pregnancy caused birth defects.

Under Cohen's care, she took antidepressants during a third pregnancy and gave birth to a healthy baby.

"Women with depression need to educate themselves about this subject because there is still a lot of bad information out there," she says.

By Salynn Boyles, reviewed by Brunilda Nazario, MD


SOURCES: Moses-Kolko, E.L. The Journal of the American Medical Association, May 18, 2005; vol 293: pp 2372-2383. Eydie L. Moses-Kolko, MD, department of psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Lee Cohen, director, Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School. Lisa Kirshenbaum, Cranston, R.I.