|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.
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
“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.