Depression during pregnancy has been a perplexing problem for psychiatry. Medicating the mother must be weighed against the potential risk to her fetus. Generally speaking, physicians and nurses have felt comfortable prescribing selective serotonin reuptake inhibitors (SSRIs) for pregnant women. There is no evidence that SSRIs cause birth defects. Many women are already taking SSRIs at the time they become pregnant. Some have been maintained for quite awhile on drugs such as Zoloft or Prozac. Considering the risk for exacerbation of a debilitating depression during the pregnancy or postpartum, most health care providers hesitate to take these women off their SSRIs.
Complicating prescribers' decision-making, however, is new evidence of“neonatal SSRI syndrome,” in which the birth is more likely to be premature, with the baby having symptoms such as respiratory distress, restlessness, tremor, hypoglycemia, and muscle rigidity ([Carlat, Citation2004]). These symptoms are said to disappear within two weeks, and there are no known long-term effects. However, there is a clear need for longitudinal studies tracking the growth and development of the infants over time.
In June of 2004, the Food and Drug Administration (FDA) requested drug manufacturers to issue warnings about using SSRIs during the third trimester of pregnancy. The studies that precipitated this action appeared in Archives of Pediatric and Adolescent Medicine and Archives of General Psychiatry (cited in [Carlat, Citation2004]). Citation[Viguera (2004)] reports that pregnant women (understandably) are quite concerned when learning of this FDA warning, although she seldom observes the neonatal SSRI syndrome in her practice at Massachusetts General Hospital. When she does observe the syndrome, its duration is brief, resolving within a day or two. Her report is somewhat reassuring, but prescribers may still wonder what action to take with regard to the FDA warning.
I have not seen discussions in the nursing literature about SSRIs during pregnancy. I would welcome papers about experiences with SSRIs (or other antidepressants) from nurses who prescribe these drugs—and from nurses who monitor their effects on pregnant patients.
REFERENCES
- Carlat D. J. SSRIs and pregnancy Troubling questions remain. The Carlat Report 2004; 2(9)1–6
- Viguera A. On peripartum mood disorders. The Carlat Report 2004; 2(9)4–5