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Increase in congenital malformations with some antidepressants, in particular paroxetine

Antidepressants are implicated in the risk of congenital malformation. Given the extent of the risk, especially with paroxetine, the treatment of pregnant women should be carefully weighed.

Data gathered from five studies show that there is a risk of congenital malformation in newborns if mothers are exposed in early pregnancy to certain antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs). All antidepressants in this family are implicated in an increased risk of congenital malformations, especially cardiac. However, the data concerning paroxetine is even more worrying.

Given the extent of the risk of foetal malformation, the decision whether or not to prescribe antidepressants for a woman in the early stages of pregnancy should be very carefully weighed up: the seriousness of the level of depression, expected benefits of the treatment, adverse effects, possible alternatives (especially non-drug treatments).

Furthermore, taken in late pregnancy, these antidepressants expose 20% to 30% of newborns to neonatal disorders: agitation, convulsions, muscle tone problems, sucking disorders, etc.

©Prescrire July 2006

Source: "Antidépresseurs IRS et malformations congénitales" Rev Prescrire 2006 ; 26 (273) : 430-431.

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