Common Mental Disorders Depression - New Zealand Doctor

There is also some evidence that the use of SSRIs increases the risk of preterm birth.
An observational study reported a preterm birth rate of 14% among 49 women
with depression taking antidepressants (in most cases SSRIs), while among women
with depression not taking antidepressants (n=22) there were no preterm births
(p = 0.004). 463 A dose-response relationship was also noted in this study between
antidepressant dose and gestational age at birth. 463
Selective serotonin reuptake inhibitors and breastfeeding
Pharmacokinetic studies have found that the excretion of SSRIs into breast milk is
generally low, though it appears to be slightly higher for fluoxetine and citalopram
than for other SSRIs. Data on potential adverse effects are scarce. There have been
a few case reports of adverse effects (such as increased crying, decreased sleep,
irritiability, gastrointestinal distress and reduced weight gain) in infants of mothers
who breastfed while receiving fluoxetine or citalopram. 470 Observational studies have
reported no adverse effects in infants exposed to paroxetine (n=70 infants), sertraline
(n=102) and fluvoxamine (n=10). 470
Tricyclic antidepressants in pregnancy
Animal studies and observational case series have reported that TCAs appear to be
relatively safe in pregnancy, and long-term studies of children exposed to TCAs have
shown no association with developmental problems. 498-500 However, some case studies
have reported neonatal toxicity, including urinary retention, bowel obstruction and
transient withdrawal symptoms such as irritability and tremor. 455
Tricyclic antidepressants while breastfeeding
The excretion of TCAs into breast milk appears to be generally low. Doxepin is
contraindicated in lactation, due to case reports of drowsiness and hypotonia in the
breastfed infants of mothers taking this drug. 501 Otherwise most case reports have
observed no immediate adverse effects in infants exposed to TCAs through breast
milk and no adverse long-term effects have been reported. 470,502,503 However, there is
limited data.
Venlafaxine in pregnancy
There has been one multicentre case-control study evaluating pregnancy outcome
following exposure to venlafaxine. 504 It found no evidence that venlafaxine increased
the risk of major fetal malformations. The doses used were relatively low (≤ 20 mg
daily for most women). 504 Evidence on neonatal symptoms following exposure to
venlafaxine is very limited but it is likely that infants will experience similar effects to
those exposed to SSRI’s. 468
Venlafaxine while breastfeeding
The few studies available suggest venlafaxine is safe in breastfeeding. The dose
received by the infant is higher than for SSRIs and may approach notional safe limits in
some infants. No adverse effects have been noted in infants exposed to venlafaxine via
the breast milk. 505-507
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Identification of Common Mental Disorders and Management of Depression in Primary Care