Neurobehavioral effects of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) extend beyond the first 7 to 10 days of life, a new study suggests.
The findings also suggest that use of a benzodiazepine plus an SSRI is associated with more significant problems in infant neurologic functioning than use of an SSRI alone. This could be because of the underlying disorder and symptom severity or the neonate’s inefficiency in metabolizing multiple drugs, the investigators note.
Importantly, they point out, “in agreement with the current practice guidelines of the American Psychiatric Association and the American College of Obstetricians and Gynecologists, these findings do not support discontinuing SSRI medication in the third trimester of pregnancy for those women who have been successfully managing their depressive symptoms with SSRIs throughout pregnancy.”
“We did not find evidence that stopping the medication early changed outcomes, so stopping the medication to prevent infant difficulties is unfounded at this time (and not stopping is the current ACOG/APA recommendation),” first author Amy L. Salisbury, PhD, associate professor, Departments of Pediatrics and Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, Rhode Island, told Medscape Medical News.
However, “more consideration may need to be given to women who require the use of a concomitant benzodiazepine,” she said.
The study was published online October 30 in the American Journal of Psychiatry.
The investigators examined the course of infant neurobehavioral functioning during the first month after birth, using a standardized assessment tool. The infants’ mothers either were depressed during pregnancy and did not choose to take medication (n = 78); were depressed and chose to take an SSRI (n = 65) or an SSRI and a benzodiazepine (n = 14); or were not depressed and did not take any medication (n = 86).
“Prior studies suggested that 30% of infants have difficulty adapting to withdrawal of SSRI medication after delivery and that this lasts up to 7 to 10 days. Our main findings suggest that the difficulties last at least 14 days and may last through the first month, especially for infants whose mothers also took a benzodiazepine. The difficulties included more startling, tremors, low muscle tone, and high irritability,” said Dr Salisbury.
Infants with concomitant benzodiazepine exposure had the “least favorable” neurobehavioral assessment scores and highest number of central nervous system stress signs. Nearly all of the women (90%) who used benzodiazepines reported using them through delivery; 80% used them during the first postpartum month.
The researchers note that limitations of their study include a relatively small sample size of women with concomitant benzodiazepine-SSRI use and heterogeneity in depression characteristics. The study only included full-term, healthy infants across all groups, and therefore the findings may not be generalizable to infants born earlier in gestation or to mothers with more varying health conditions, they add.
“Overall, this study suggests that the difficulties some infants have after prenatal exposure to an SSRI may not be due solely to adaptation or withdrawal but to the more direct effect of the medication on their development”