THE EFFECTS OF ANTIDEPRESSANT MEDICATIONS ON MOTHERS AND BABIES
Main Article Content
Keywords
Pregnancy, depression, antidepressants, risk:benefit discussions, poor neonatal adaptation syndrome, persistent pulmonary hypertension of the newborn
Abstract
Depression during pregnancy may be undertreated for a variety of reasons, one of which is concern regarding the safety of antidepressant medication. Dr. Grigoriadis leads a program of research to develop a reference guide to facilitate perinatal treatment discussions. The clinical group has published systematic reviews and meta-analyses on various potential outcomes following antidepressant exposure (i.e., congenital anomalies, spontaneous abortion, delivery outcomes, immediate neonatal outcomes and persistent pulmonary hypertension) in addition to outcomes associated with maternal depression. Some of the results of this program of research are presented together with a case example to start your thinking on the issues.
References
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8. Judd LL. The clinical course of unipolar major depressive disorders. Arch Gen Psychiatry 1997;54:989- 991.
9. Antenatal and postnatal mental health: the NICE guideline on clinical management and service guidance. London (UK): National Institute for Health and Clinical Excellence; 2007 (cited 2014 Sep 9). Available from: https://ww w.nice.org.uk/Guidance/CG45 (or https://www.nice.org.uk/Guidance/CG45# )
10. Patten SB. A major depression prognosis calculator based on episode duration. Clin Pract Epidemiol Ment Health 2006 [cited 2014 Jun 28];2:13- 20. Available from: http://www.cpementalhealth.com/content/pdf/174 5-0179- 2-13.pdf
11. Gelenberg AJ, Freeman MP, Markowitz JC, et al. APA Practice Guidelines. Practice guideline for the treatment of patients with major depressive disorder. Third edition, 2010 [cited 2014 Jun 28]. Available from: http://psychiatryonline.org/pb /assets/raw/sitewide /practice_guidelines/guidelines/mdd.pdf
12. Grote NK, Bridge JA, Gavin AR, et al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 2 010;67(10):1012- 1024.
13. Bar -Oz B, Einarson T, Einarson A, et al. Paroxetine and congenital malformations: meta-analysis and consideration of potential confounding factors. Clin Ther 2007;29(5):918- 926.
14. Wurst KE, Poole C, Ephross SA, et al. First trimester paroxetine use and the prevalence of congenital, specifically cardiac, defects: a meta-analysis of epidemiological studies. Birth Defects Res A Clin Mol Teratol 2010;88(3):159- 170.
15. Hemels ME, Einarson A, Koren G, et al. Antidepressant use during pregnancy and the rates of spontaneous abortions: a meta -analysis. Ann Pharmacother 2005; 39(5):803- 809.
16. Nikfar S, Rahimi R, Hendoiee N, et al. Increasing the risk of spontaneous abortion and major malformations in newborns following use of serotonin reuptake inhibit ors during pregnancy: A systematic review and updated meta -analysis. Daru. 2012 [cited 2014 Jun 28];20(1):75. Available from: http://www.darujps.com/content/20/1/75
17. Rahimi R, Nikfar S, Abdollahi M. Pregnancy outcomes following exposure to serotonin reuptake inhibitors: a meta-analysis of clinical trials. Reprod Toxicol 2006; 22(4):571- 575.
18. Addis A, Koren G. Safety of fluoxetine during the first trimester of pregnancy: a meta-analytical review of epidemiological studies. Psychol Med 2000;30(1):89- 94.
19. Einarson TR, Einarson A. Newer antidepressants in pregnancy and rates of major malformations: a meta-analysis of prospective comparative studies. Pharmacoepidemiol Drug Saf 2005;14(12):823- 827.
20. Lattimore KA, Donn SM, Kaciroti, et al. Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis. J Perinatol 2005;25(9):595- 604.
21. Koren G, Nordeng H. Antidepressant use during pregnancy: the benefit-risk ratio. Am J Obstet Gynecol 2012; 207(3):157- 163.
22. Armstrong C. ACOG Guidelines on psychiatric medication use during pregnancy and lactation. Am Fam Physician 2008;78(6):772- 778. (Based on: American College of Obstetricians and Gynecologists. Use of psychiatric m edications during pregnancy and lactation. ACOG Practice Bulletin No. 87. Obstet Gynecol 2007;110:1179- 1198.
23. Weissman MM, Olfson M. Depression in women: implications for health care research. Science 1995;269(5225):799- 801.
24. Gotlib IH, Whiffen VE, Mount JH, et al. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 1989;57(2):269- 274.
25. Marcus SM. Depression during pregnancy: rates, risks and consequences --Motherisk Update 2008. Ca n J Clin Pharmacol 2009;16(1):e15- e22.
26. Die tz PM, Williams SB, Callaghan WM, et al. Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry 2007;164(10):1515- 1520.
27. Ramos E, Oraichi D, Rey E, et al. Prevalence and predictors of antidepressant use in a cohort of pregnant women. BJOG 2007;114(9):1055- 1064.
28. Ross LE, Grigoriadis S, Mamisashvili L, et al. Quality assessment of observational studies in psychiatry: an example from perinatal psychiatric research. Int J Methods Psychiatr Res 2011; 20:224- 234.
29. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370:1453- 1457.
30. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008(7650);336:924- 926.
31. Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. Antidepressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta - analysis of the best evidence. J Clin Psychiatry 2013;74(4):e293- e308.
32. Ross LE, Grigoriadis S, Mamisachvili L, et al. Selected pregnancy and delivery outcomes after exposu re to antidepressant medication: A systematic review and meta -analysis. JAMA Psychiatry 2013 [cited 2014 Jun28];70(4):436- 443. Available from: http://archpsyc.jamanetwork.com/article.aspx?arti cleid=1656691
33. Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The effect of prenatal antidepressant exposure on neonatal adaptation: a systematic review and meta -analysis. J Clin Psychiatry 2013;74(4):e309- e320.
34. Grigoriadis S, VonderP orten EH, Mamisashvili L, et al. Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta -analysis. BMJ. 2014 [cited 2014 Jun 28];348:f6932. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3 898424/
35. Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta -analysis. J Cli n Psychiatry 2013;74(4):e321- e341.
36. Moses -Kolko EL, Bogen D, Perel J, et al. Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications. JAMA. 2005 [cited 2014 Jun 28];293:2372- 2383. Available from: http://jama.jamanetwork.com/data/Journals/JAM A/4976/JRV50000.pdf
37. Chambers CD, Johnson KA, Dick LM, et al. Birth outcomes in pregnant women taking fluoxeti ne. N Engl J Med 1996;335:1010- 1015.
38. Costei AM, Kozer E, Ho T, et al. Perinatal outcome following third trimester exposure to paroxetine. Arch Pediatr Adolesc Med 2002;156:1129- 1132.
39. Källén B. Neonate characteristics after maternal use of antidepressants in late pregnancy. Arch Pediatr Adolesc Med 2004;158:312- 316.
40. Zeskind PS, Stephens LE. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pedi atrics 2004;113:368- 375.
41. Jefferies AL. Selective serotonin reuptake inhibitors in pregnancy and infant outcomes. Paediatr Child Health 2011 [cited 2014 Jun 28];16(9):562. Abridged version, 2014, A vailable from: http://www.cps.ca/documents/position/SSRI - infant -outcomes
42. Oberlander TF, Misri S, Fitzgerald CE, et al. Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. J Clin Psychiatry 2004;65:230 -237.
43. Koren G, Matsui D, Einarson A, et al. Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates? CMAJ 2005;172(11):1457- 1459.
44. Walsh -Sukys MC, Tyson JE, Wright LL, et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics 2000;105:14 - 20.
45. Ding XX, Wu YL, Xu SJ, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta- analysis of prospective cohort studies. J Affect Disord 2014;159:103- 110.
46. Myles N, Newall H, Ward H, et al. Systematic meta -analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations. Aust N Z J Psychiatry 2013;47(11):1002- 1012.
47. Riggin L, Frankel Z, Moretti M, et al. The fet al safety of fluoxetine: a systematic review and meta -analysis. J Obstet Gynaecol Can 2013;35(4):362- 369.
48. Huang H, Coleman S, Bridge JA, et al. A meta- analysis of the relationship between antidepressant use in pregnancy and the risk of preterm birth and l ow birth weight. Gen Hosp Psychiatry. 2014 [cited 2014 Jun 28];36(1):13- 18. Available from: http://download.journals.elsevierhealth.com/pdfs/ journals/ 0163- 8343/PIIS0163834313002399.pdf
49. Huybrechts KF, Sanghani RS, Avorn J, et al. Preterm birth and antidepressant medication use during pregnancy: a systematic review and meta - analysis. PLoS One. 2014 [cited 2014 Jun 28]; 9(3):e92778. Available from: http://www.plosone.org/article/info%3Adoi%2F1 0.1371%2Fjournal.pone.0092778
50. Yonkers KA, Wisner KL, Stewart DE, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry. 2009 [cited 2014 Jun 28];31(5):403- 413. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3 094693/pdf/nihms293837.pdf
2. Bakker MK, K?lling P, Van den Berg PB, et al. Increase in use of selective serotonin reuptake inhibitors in pregnancy during the last decade, a population-based cohort study from the Netherlands. Br J Clin Pharmacol 2008;65(4):600 - 606.
3. Cooper WO, Willy ME, Pont SJ, et al. Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol 2007;196(6):544.e1- 544.e5.
4. Patten SB, Beck CA. Major depression and mental health care utilization in Canada: 1994 to 2000. Can J Psychiatry 2004;49(5):303- 309.
5. National Center for Health Statistics. Health, United States, 20 10: With special feature on death and dying. Table 95. Hyattsville, MD. 2011 [cited 2014 Jun 27]. Available from: www.cdc.gov/nchs/data/hus/hus10.pdf
6. Pratt LA, Brody DJ, Gu Q. NCHS Data Brief, Number 76. Antidepressant Use in Persons Aged 12 and Over: United States, 2005– 2008 Hyattsville, MD: National Center for Health Statistics. 2011 [cited 2014 Jun 28]. Available from: http://www.cdc.go v/nchs/data/databriefs/db76.htm
7. Stewart DE. Clinical practice. Depression during pregnancy. New Engl J Med 2011;365(17);1605- 1611.
8. Judd LL. The clinical course of unipolar major depressive disorders. Arch Gen Psychiatry 1997;54:989- 991.
9. Antenatal and postnatal mental health: the NICE guideline on clinical management and service guidance. London (UK): National Institute for Health and Clinical Excellence; 2007 (cited 2014 Sep 9). Available from: https://ww w.nice.org.uk/Guidance/CG45 (or https://www.nice.org.uk/Guidance/CG45# )
10. Patten SB. A major depression prognosis calculator based on episode duration. Clin Pract Epidemiol Ment Health 2006 [cited 2014 Jun 28];2:13- 20. Available from: http://www.cpementalhealth.com/content/pdf/174 5-0179- 2-13.pdf
11. Gelenberg AJ, Freeman MP, Markowitz JC, et al. APA Practice Guidelines. Practice guideline for the treatment of patients with major depressive disorder. Third edition, 2010 [cited 2014 Jun 28]. Available from: http://psychiatryonline.org/pb /assets/raw/sitewide /practice_guidelines/guidelines/mdd.pdf
12. Grote NK, Bridge JA, Gavin AR, et al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 2 010;67(10):1012- 1024.
13. Bar -Oz B, Einarson T, Einarson A, et al. Paroxetine and congenital malformations: meta-analysis and consideration of potential confounding factors. Clin Ther 2007;29(5):918- 926.
14. Wurst KE, Poole C, Ephross SA, et al. First trimester paroxetine use and the prevalence of congenital, specifically cardiac, defects: a meta-analysis of epidemiological studies. Birth Defects Res A Clin Mol Teratol 2010;88(3):159- 170.
15. Hemels ME, Einarson A, Koren G, et al. Antidepressant use during pregnancy and the rates of spontaneous abortions: a meta -analysis. Ann Pharmacother 2005; 39(5):803- 809.
16. Nikfar S, Rahimi R, Hendoiee N, et al. Increasing the risk of spontaneous abortion and major malformations in newborns following use of serotonin reuptake inhibit ors during pregnancy: A systematic review and updated meta -analysis. Daru. 2012 [cited 2014 Jun 28];20(1):75. Available from: http://www.darujps.com/content/20/1/75
17. Rahimi R, Nikfar S, Abdollahi M. Pregnancy outcomes following exposure to serotonin reuptake inhibitors: a meta-analysis of clinical trials. Reprod Toxicol 2006; 22(4):571- 575.
18. Addis A, Koren G. Safety of fluoxetine during the first trimester of pregnancy: a meta-analytical review of epidemiological studies. Psychol Med 2000;30(1):89- 94.
19. Einarson TR, Einarson A. Newer antidepressants in pregnancy and rates of major malformations: a meta-analysis of prospective comparative studies. Pharmacoepidemiol Drug Saf 2005;14(12):823- 827.
20. Lattimore KA, Donn SM, Kaciroti, et al. Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis. J Perinatol 2005;25(9):595- 604.
21. Koren G, Nordeng H. Antidepressant use during pregnancy: the benefit-risk ratio. Am J Obstet Gynecol 2012; 207(3):157- 163.
22. Armstrong C. ACOG Guidelines on psychiatric medication use during pregnancy and lactation. Am Fam Physician 2008;78(6):772- 778. (Based on: American College of Obstetricians and Gynecologists. Use of psychiatric m edications during pregnancy and lactation. ACOG Practice Bulletin No. 87. Obstet Gynecol 2007;110:1179- 1198.
23. Weissman MM, Olfson M. Depression in women: implications for health care research. Science 1995;269(5225):799- 801.
24. Gotlib IH, Whiffen VE, Mount JH, et al. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 1989;57(2):269- 274.
25. Marcus SM. Depression during pregnancy: rates, risks and consequences --Motherisk Update 2008. Ca n J Clin Pharmacol 2009;16(1):e15- e22.
26. Die tz PM, Williams SB, Callaghan WM, et al. Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry 2007;164(10):1515- 1520.
27. Ramos E, Oraichi D, Rey E, et al. Prevalence and predictors of antidepressant use in a cohort of pregnant women. BJOG 2007;114(9):1055- 1064.
28. Ross LE, Grigoriadis S, Mamisashvili L, et al. Quality assessment of observational studies in psychiatry: an example from perinatal psychiatric research. Int J Methods Psychiatr Res 2011; 20:224- 234.
29. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370:1453- 1457.
30. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008(7650);336:924- 926.
31. Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. Antidepressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta - analysis of the best evidence. J Clin Psychiatry 2013;74(4):e293- e308.
32. Ross LE, Grigoriadis S, Mamisachvili L, et al. Selected pregnancy and delivery outcomes after exposu re to antidepressant medication: A systematic review and meta -analysis. JAMA Psychiatry 2013 [cited 2014 Jun28];70(4):436- 443. Available from: http://archpsyc.jamanetwork.com/article.aspx?arti cleid=1656691
33. Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The effect of prenatal antidepressant exposure on neonatal adaptation: a systematic review and meta -analysis. J Clin Psychiatry 2013;74(4):e309- e320.
34. Grigoriadis S, VonderP orten EH, Mamisashvili L, et al. Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta -analysis. BMJ. 2014 [cited 2014 Jun 28];348:f6932. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3 898424/
35. Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta -analysis. J Cli n Psychiatry 2013;74(4):e321- e341.
36. Moses -Kolko EL, Bogen D, Perel J, et al. Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications. JAMA. 2005 [cited 2014 Jun 28];293:2372- 2383. Available from: http://jama.jamanetwork.com/data/Journals/JAM A/4976/JRV50000.pdf
37. Chambers CD, Johnson KA, Dick LM, et al. Birth outcomes in pregnant women taking fluoxeti ne. N Engl J Med 1996;335:1010- 1015.
38. Costei AM, Kozer E, Ho T, et al. Perinatal outcome following third trimester exposure to paroxetine. Arch Pediatr Adolesc Med 2002;156:1129- 1132.
39. Källén B. Neonate characteristics after maternal use of antidepressants in late pregnancy. Arch Pediatr Adolesc Med 2004;158:312- 316.
40. Zeskind PS, Stephens LE. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pedi atrics 2004;113:368- 375.
41. Jefferies AL. Selective serotonin reuptake inhibitors in pregnancy and infant outcomes. Paediatr Child Health 2011 [cited 2014 Jun 28];16(9):562. Abridged version, 2014, A vailable from: http://www.cps.ca/documents/position/SSRI - infant -outcomes
42. Oberlander TF, Misri S, Fitzgerald CE, et al. Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. J Clin Psychiatry 2004;65:230 -237.
43. Koren G, Matsui D, Einarson A, et al. Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates? CMAJ 2005;172(11):1457- 1459.
44. Walsh -Sukys MC, Tyson JE, Wright LL, et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics 2000;105:14 - 20.
45. Ding XX, Wu YL, Xu SJ, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta- analysis of prospective cohort studies. J Affect Disord 2014;159:103- 110.
46. Myles N, Newall H, Ward H, et al. Systematic meta -analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations. Aust N Z J Psychiatry 2013;47(11):1002- 1012.
47. Riggin L, Frankel Z, Moretti M, et al. The fet al safety of fluoxetine: a systematic review and meta -analysis. J Obstet Gynaecol Can 2013;35(4):362- 369.
48. Huang H, Coleman S, Bridge JA, et al. A meta- analysis of the relationship between antidepressant use in pregnancy and the risk of preterm birth and l ow birth weight. Gen Hosp Psychiatry. 2014 [cited 2014 Jun 28];36(1):13- 18. Available from: http://download.journals.elsevierhealth.com/pdfs/ journals/ 0163- 8343/PIIS0163834313002399.pdf
49. Huybrechts KF, Sanghani RS, Avorn J, et al. Preterm birth and antidepressant medication use during pregnancy: a systematic review and meta - analysis. PLoS One. 2014 [cited 2014 Jun 28]; 9(3):e92778. Available from: http://www.plosone.org/article/info%3Adoi%2F1 0.1371%2Fjournal.pone.0092778
50. Yonkers KA, Wisner KL, Stewart DE, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry. 2009 [cited 2014 Jun 28];31(5):403- 413. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3 094693/pdf/nihms293837.pdf