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First trimester antidepressant risk

By Tony James
THE antidepressant paroxetine should be avoided during pregnancy because it may double the rate of birth defects, the Therapeutic Goods Administration warns.

Details from a preliminary analysis of GlaxoSmithKline data showed a higher incidence of congenital malformations, particularly ventricular septal defects, in babies born to women taking the drug.

Babies of women taking paroxetine in the first trimester of pregnancy were 2.2 times more likely to be born with a congenital malformation and 2.08 times more likely to have a cardiovascular malformation than those born to women taking other antidepressants, the data showed.

A second population-based Danish study found a 60% increase in cardiac abnormalities among babies of mothers taking SSRIs.

Although the link may not be causal, the TGA has reclassified paroxetine from a pregnancy category C drug to a category D drug, recommending it be avoided in pregnancy.

Responding to the findings, psychiatrist Associate Professor Anne Buist, director of the beyondblue national postnatal depression program, emphasised the need to weigh up the risks of inadequately treated prenatal depression against the adverse effects of medications.

“Ideally, antidepressants should be avoided in pregnancy, but prenatal depression can also be associated with difficulties in child rearing, developmental delays and later depression in the child,” she said.

“Although rare, maternal suicide is a leading cause of maternal death.”

Data from thousands of women treated with fluoxetine suggested it might increase the risk of premature birth, so on current evidence sertraline (Zoloft) or citalopram (Celapram, Cipramil) were probably the best choices when an antidepressant was considered essential before or during pregnancy, Professor Buist said.

Venlafaxine (Efexor) should be avoided, because of withdrawal syndromes in newborns and unsuitability while breastfeeding, she said. Generally, SSRIs should be tapered — especially those with a short half-life such as paroxetine — to avoid a discontinuation syndrome unless immediately commencing another SSRI.

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