Last Updated: 2006-11-30 19:12:31 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Because of increasing evidence of fetal harm from exposure to selective serotonin reuptake inhibitors (SSRIs) and other related antidepressants, the American College of Obstetricians and Gynecologists (ACOG) recommends against their use during pregnancy, unless treatment is absolutely required and no other options exist.

ACOG's Committee on Obstetric Practice emphasizes that the SSRI 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 its summary in December issue of Obstetrics and Gynecology, ACOG proposes 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.

The advisory highlights recent findings that paroxetine use during the first trimester may increase the risk of congenital cardiac malformations. Committee members also note that neonatal complications -- including persistent pulmonary hypertension as well as irritability, difficulty feeding, and tachypnea -- may occur when women use SSRIs or selective norepinephrine reuptake inhibitors in their third trimester.

However, the panel 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.

"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."

Dr. 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.

Dr. 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."

Obstet Gynecol 2006;108:1601-1603.