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Psychomotor developmental disorders: a link to antidepressants?

It is best to avoid prescribing SSRI antidepressants (paroxetine and others) as a first-line treatment for pregnant women.

Pregnant women are sometimes prescribed antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs) such as citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline.

Around 20 to 30% of newborns exposed towards the end of pregnancy have disorders at birth: restlessness, poor muscle tone, convulsions, pulmonary arterial hypertension etc. Various studies have led to serious doubts as to the risk of malformation, especially cardiac, after exposure in early pregnancy.

Other studies also suggest a risk to the infant’s neurological development. One study has shown a significant delay in psychomotor development in infants aged 6 to 40 months who have been exposed to SSRI antidepressants in the womb.

Findings from other studies have been more reassuring. However, the overall results are not convincing. Above all it is clear that not enough is known about the long-term and potentially severe consequences of exposure to antidepressants during pregnancy.

This evidence is a strong incentive to use non-drug treatments for women who are or may be pregnant and suffering from depression. And SSRI antidepressants should only be envisaged when non-drug therapies are ineffective and the condition is sufficiently debilitating to warrant drug therapy.

©Prescrire 1 February 2013

"SSRI antidepressants: altered psychomotor development following exposure in utero?" Prescrire Int 2013; 22 (135): 43-44. (Pdf, subscribers only).
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