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  4. Information for Providers on Antidepressants During Pregnancy and Breast Feeding - September 2011

Information for Providers on Antidepressants During Pregnancy and Breast Feeding - September 2011 

 

This chart is produced by the University of Illinois at Chicago (UIC) Perinatal Mental Health Project as a summary of research on antidepressants in human pregnancy and breastfeeding.

Sources of data:
 

*Specific references are available on request.

General guideline:
 

Antidepressants as a group may be associated with following risks:
 

SSRI antidepressants as a group (citalopram, escitalopram, fluoxetine, paroxetine, sertraline) may be associated with the following risks: 
 

Information for Providers On Antidepressants During Pregnancy & Breast Feeding - September 2011 
 

Antidepressant Advantages
During
Pregnancy
Teratogenicity Other Disadvantages
During
Pregnancy
Estimated %
of
Maternal
Dose to
Breastfeeding
Baby
Reported
Side Effects
to Breastfeeding Babies
Bupropion Morphologic- limited evidence of cardiac malformations; increased risk for pulmonary hypertension
Behavioral- limited evidence of increased risk of ADHD
2.0% Seizures
Citalopram Morphologic- risk of neural tube defect
Behavioral- none found
0.7% - 9.0% Uneasy sleep, drowsiness, irritability, weight loss
Desipramine Morphologic- none found
Behavioral- none found
1.0% Agitation of newborn, potential triggering of seizure activity if there is a history of seizures
Duloxetine Morphologic- unknown
Behavioral- unknown
0.1% Unknown
Escitalopram Morphologic- unknown
Behavioral- unknown
3.9% - 7.9% Enterocolitis
Fluoxetine Morphologic- increased risk of cardiovascular malformations*
Behavioral- none found
1.2% - 12.0% Excessive crying,
irritability, vomiting, watery stools, difficulty sleeping, tremor, somnolence, hypotonia, decreased weight gain, hyperglycemia
Mirtazapine Morphologic- none found
Behavioral- unknown
0.6% - 2.8% None
Nortriptyline Morphologic- none found
Behavioral- none found
1.3% None
Paroxetine Morphologic- possible increased risk of cardiovascular malformations
Behavioral- unknown
0.1% - 4.3% Irritability, sleepiness, constipation, SIADH
Sertraline Morphologic- unlikely increased risk of omphalocele and septal defects*
Behavioral- none found
0.4% - 2.3% Drug of choice by OBs & Pediatricians
Venlafaxine Morphologic- none found
Behavioral- unknown
5.2% - 7.6% Decreased weight gain
Desvenlafaxine Morphologic- unknown
Behavioral- unknown
Unknown Unknown

* Findings from one study at variance with other data, perhaps due to methodological flaws

 

© 2011 The Board of Trustees of the University of Illinois, UIC Perinatal Mental Health Project. All rights reserved.

 

For questions, references, or permission to reprint, call the UIC Perinatal Mental Health Project at 1-800-573-6121

 

1. Physician's Desk Reference. Thomson Reuters. Montvale, NJ. 2. Toh et al. Selective serotonin reuptake inhibitor use and risk of gestational hypertension. Am J Psychiatry. 2009 Mar;166(3):320-8. 3. Alwan, S. et al. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med. 2007 Jun 28; 356(26):2684-92. 4. Wogelius et al. Maternal use of selective serotonin reuptake inhibitors and risk of congenital malformations. Epidemiology. 2006 Nov;17(6):701-4. 5. Suri et al. Effects of Antenatal Depression and Antidepressant treatment on gestationl age at birth and risk of preterm birth. Am J Psychiatry. 2007 Aug; 164:1206-1213. 6. Figueroa. Use of antidepressants during pregnancy and risk of Attention-Deficit/Hyperactivity Disorder in the offspring. JDBP. 2010 Oct. Vol 31, No.8. 7. Alwan et al. Maternal use of Bupropion and risk of congenital heart defects. Am J Obstet Gynecol 2010.