Pregnant women told to avoid Paxil
Last Updated: 2006-11-30 13:32:45 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Unless treatment is absolutely required and no other options exist, women who are pregnant should note take selective serotonin reuptake inhibitors (SSRIs) and other related antidepressants, a group of obstetricians said on Thursday.
The American College of Obstetricians and Gynecologists' (ACOG) Committee on Obstetric Practice particularly advises that the SSRI Paxil (also known as paroxetine) be discontinued if possible when patients become pregnant, with the proviso that withdrawal symptoms be avoided by weaning the patient off the drug.
According to ACOG, there is increasing evidence that SSRIs taken during pregnancy may cause harm to the developing baby. In addition to Paxil, other antidepressants in the SSRI class include Prozac, Zoloft, and Lexapro.
The advisory highlights recent findings that Paxil use during the first trimester may increase the risk of congenital heart defects. Committee members also note that neonatal complications -- including persistent pulmonary hypertension (high blood pressure) as well as irritability, difficulty feeding, and heart rhythm disturbances -- may occur when women use SSRIs in their third trimester.
However, the Committee recognizes that untreated depression is associated with low weight gain, sexually transmitted diseases and substance abuse, which are also harmful to the fetus. Committee members cite one study in which the risk of relapse was increased 5-fold when women discontinued using antidepressants during their pregnancies.
They propose that decisions regarding the use of SSRIs during pregnancy be made after weighing the risk of fetal harm against the mother's risk of depression relapse.
"We can't make a blanket statement regarding SSRI use in pregnancy," Dr. Susan Ramin said in an interview with Reuters Health. "Patients are on these drugs for a reason. So what we recommend is that a pregnant woman on SSRIs needs to be evaluated by a mental health specialist, to determine whether or not she needs to be on that specific treatment or if other options are available."
Ramin is chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of Texas Medical School of Houston and a member of ACOG's Committee on Obstetric Practice.
She pointed out that some patients with depression respond to only one medication, so they can't be automatically switched to a different drug.
Ramin mentioned that possible options aside from medication to treat depression include psychotherapy. Furthermore, she added, "There are case reports of electroconvulsive treatment being used in pregnancy, for those who are profoundly depressed if not treated."
The bottom line, she added, is that "health care providers need to screen their patients for depression. In an ideal world, physicians would identify women with depression before they become pregnant and try to get it under the best control possible."
SOURCE: Obstetrics and Gynecology December 2006.
