Antidepressants and Pregnancy: Tips from an Expert

Antidepressant Use During Pregnancy: Current Controversies and Treatment Strategies

Antidepressants and Pregnancy: Tips from an Expert | Johns Hopkins Medicine

1. Andrade SE, Gurwitz JH, Davis RL, et al. Prescription drug use in pregnancy. Am J Obstet Gynecol. 2004;191(2):398–407. [PubMed] [Google Scholar]

2. Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499–507. [PubMed] [Google Scholar]

3. Cohen LS, Nonacs RM, Bailey JW, et al. Relapse of depression during pregnancy following antidepressant discontinuation: a preliminary prospective study. Arch Womens Ment Health. 2004;7(4):217–221. [PubMed] [Google Scholar]

4. O'hara MW, Swain AM. Rates and risk of postpartum depressionΓÇöa meta-analysis. International Review of Psychiatry. 1996;8(1):37–54. [Google Scholar]

5. Gaynes BN, Gavin N, Meltzer-Brody S, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ ) 2005;(119):1–8. [PMC free article] [PubMed] [Google Scholar]

6. Dietz PM, Williams SB, Callaghan WM, Bachman DJ, Whitlock EP, Hornbrook MC. Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry. 2007;164(10):1515–1520. [PubMed] [Google Scholar]

7. Yonkers KA, Ramin SM, Rush AJ, et al. Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry. 2001;158(11):1856–1863. [PubMed] [Google Scholar]

8. Mills JL. Depressing observations on the use of selective serotonin-reuptake inhibitors during pregnancy. N Engl J Med. 2006;354(6):636–638. [PubMed] [Google Scholar]

9. Cooper WO, Willy ME, Pont SJ, Ray WA. Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol. 2007;196(6):544–545. [PubMed] [Google Scholar]

10. Murray L, Sinclair D, Cooper P, Ducournau P, Turner P, Stein A. The socioemotional development of 5-year-old children of postnatally depressed mothers. J Child Psychol Psychiatry. 1999;40(8):1259–1271. [PubMed] [Google Scholar]

11. Marmorstein NR, Malone SM, Iacono WG. Psychiatric disorders among offspring of depressed mothers: associations with paternal psychopathology. Am J Psychiatry. 2004;161(9):1588–1594. [PubMed] [Google Scholar]

12. Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod. 2009;24(1):146–153. [PubMed] [Google Scholar]

13. Zuckerman B, Amaro H, Bauchner H, Cabral H. Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J Obstet Gynecol. 1989;160(5 Pt 1):1107–1111. [PubMed] [Google Scholar]

14. Orr ST, Blazer DG, James SA, Reiter JP. Depressive symptoms and indicators of maternal health status during pregnancy. J Womens Health (Larchmt ) 2007;16(4):535–542. [PubMed] [Google Scholar]

15. Davis EP, Glynn LM, Dunkel SC, Hobel C, Chicz-Demet A, Sandman CA. Corticotropin-releasing hormone during pregnancy is associated with infant temperament. Dev Neurosci. 2005;27(5):299–305. [PubMed] [Google Scholar]

16. Ashman SB, Dawson G, Panagiotides H, Yamada E, Wilkinson CW. Stress hormone levels of children of depressed mothers. Dev Psychopathol. 2002;14(2):333–349. [PubMed] [Google Scholar]

17. Diego MA, Field T, Hernandez-Reif M, Cullen C, Schanberg S, Kuhn C. Prepartum, postpartum, and chronic depression effects on newborns. Psychiatry. 2004;67(1):63–80. [PubMed] [Google Scholar]

18. Essex MJ, Klein MH, Cho E, Kalin NH. Maternal stress beginning in infancy may sensitize children to later stress exposure: effects on cortisol and behavior. Biol Psychiatry. 2002;52(8):776–784. [PubMed] [Google Scholar]

19. Halligan SL, Herbert J, Goodyer IM, Murray L. Exposure to postnatal depression predicts elevated cortisol in adolescent offspring. Biol Psychiatry. 2004;55(4):376–381. [PubMed] [Google Scholar]

20. Brennan PA, Pargas R, Walker EF, Green P, Newport DJ, Stowe Z. Maternal depression and infant cortisol: influences of timing, comorbidity and treatment. J Child Psychol Psychiatry. 2008;49(10):1099–1107. [PMC free article] [PubMed] [Google Scholar]

21. O'Connor TG, Ben-Shlomo Y, Heron J, Golding J, Adams D, Glover V. Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children. Biol Psychiatry. 2005;58(3):211–217. [PubMed] [Google Scholar]

22. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health. 2005;8(2):77–87. [PubMed] [Google Scholar]

23. Akman I, Kuscu K, Ozdemir N, et al. Mothers’ postpartum psychological adjustment and infantile colic. Arch Dis Child. 2006;91(5):417–419. [PMC free article] [PubMed] [Google Scholar]

24. Flynn HA, Davis M, Marcus SM, Cunningham R, Blow FC. Rates of maternal depression in pediatric emergency department and relationship to child service utilization. Gen Hosp Psychiatry. 2004;26(4):316–322. [PubMed] [Google Scholar]

25. McLearn KT, Minkovitz CS, Strobino DM, Marks E, Hou W. The timing of maternal depressive symptoms and mothers’ parenting practices with young children: implications for pediatric practice. Pediatrics. 2006;118(1):e174–e182. [PubMed] [Google Scholar]

26. Einarson A. Introduction: reproductive mental health–Motherisk update 2008. Can J Clin Pharmacol. 2009;16(1):e1–e5. [PubMed] [Google Scholar]

27. Yonkers KA. The treatment of women suffering from depression who are either pregnant or breastfeeding. Am J Psychiatry. 2007;164(10):1457–1459. [PubMed] [Google Scholar]

28. Rubinow DR. Antidepressant treatment during pregnancy: between Scylla and Charybdis. Am J Psychiatry. 2006;163(6):954–956. [PubMed] [Google Scholar]

29. Frederiksen MC. The drug development process and the pregnant woman. J Midwifery Womens Health. 2002;47(6):422–425. [PubMed] [Google Scholar]

30. Boothby LA, Doering PL. FDA labeling system for drugs in pregnancy. Ann Pharmacother. 2001;35(11):1485–1489. [PubMed] [Google Scholar]

31. 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(1):14–20. [PubMed] [Google Scholar]

32. Hageman JR, Adams MA, Gardner TH. Persistent pulmonary hypertension of the newborn. Trends in incidence, diagnosis, and management. Am J Dis Child. 1984;138(6):592–595. [PubMed] [Google Scholar]

33. Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Mitchell AA. Risk factors for persistent pulmonary hypertension of the newborn. Pediatrics. 2007;120(2):e272–e282. [PubMed] [Google Scholar]

34. Bearer C, Emerson RK, O'Riordan MA, Roitman E, Shackleton C. Maternal tobacco smoke exposure and persistent pulmonary hypertension of the newborn. Environ Health Perspect. 1997;105(2):202–206. [PMC free article] [PubMed] [Google Scholar]

35. Chambers CD, Hernandez-Diaz S, Van Marter LJ, et al. Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn. N Engl J Med. 2006;354(6):579–587. [PubMed] [Google Scholar]

36. Kallen B, Olausson PO. Maternal use of selective serotonin re-uptake inhibitors and persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2008;17(8):801–806. [PubMed] [Google Scholar]

37. Andrade SE, McPhillips H, Loren D, et al. Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2009 [PubMed] [Google Scholar]

38. Webster PA. Withdrawal symptoms in neonates associated with maternal antidepressant therapy. Lancet. 1973;2(7824):318–319. [PubMed] [Google Scholar]

39. 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;293(19):2372–2383. [PubMed] [Google Scholar]

40. Oberlander TF, Misri S, Fitzgerald CE, Kostaras X, Rurak D, Riggs W. Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. J Clin Psychiatry. 2004;65(2):230–237. [PubMed] [Google Scholar]

41. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6. 782–786. [PubMed] [Google Scholar]

42. Mosher WD, Bachrach CA. Understanding U.S. fertility: continuity and change in the National Survey of Family Growth, 1988-1995. Fam Plann Perspect. 1996;28(1):4–12. [PubMed] [Google Scholar]

43. ACOG Practice Bulletin Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111(4):1001–1020. [PubMed] [Google Scholar]

44. Weissman AM, Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004;161(6):1066–1078. [PubMed] [Google Scholar]

45. Eberhard-Gran M, Eskild A, Opjordsmoen S. Use of psychotropic medications in treating mood disorders during lactation : practical recommendations. CNS Drugs. 2006;20(3):187–198. [PubMed] [Google Scholar]

46. Rampono J, Hackett LP, Kristensen JH, Kohan R, Page-Sharp M, Ilett KF. Transfer of escitalopram and its metabolite demethylescitalopram into breastmilk. Br J Clin Pharmacol. 2006;62(3):316–322. [PMC free article] [PubMed] [Google Scholar]

47. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996;153(9):1132–1137. [PubMed] [Google Scholar]

48. Kristensen JH, Ilett KF, Rampono J, Kohan R, Hackett LP. Transfer of the antidepressant mirtazapine into breast milk. Br J Clin Pharmacol. 2007;63(3):322–327. [PMC free article] [PubMed] [Google Scholar]

49. Chaudron LH, Schoenecker CJ. Bupropion and breastfeeding: a case of a possible infant seizure. J Clin Psychiatry. 2004;65(6):881–882. [PubMed] [Google Scholar]

50. Gracious BL, Wisner KL. Phenelzine use throughout pregnancy and the puerperium: case report, review of the literature, and management recommendations. Depress Anxiety. 1997;6(3):124–128. [PubMed] [Google Scholar]

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749677/

Can You Take Antidepressants While Pregnant?

Antidepressants and Pregnancy: Tips from an Expert | Johns Hopkins Medicine

From the WebMD Archives

June 12, 2015 — If you're pregnant (or are trying to be) and you have depression, you might wonder if it's safe to take medicine to boost your mood. Will antidepressants harm your baby? Spend a day online and the ping-pong reports of their safety during pregnancy could make your head spin.

The issue has long been a topic of debate. Some studies suggest antidepressants are dangerous for babies in the womb. Others say the risks are extremely small, and that untreated depression poses a bigger threat to both the baby and mom.

Also, “there's an idea that antidepressants are a luxury medicine, and women should be pulling up their socks and getting through their pregnancy without taking them,” says Jennifer Payne, MD, director of the Women's Mood Disorders Center at Johns Hopkins. “But what most people do not understand is the risk of untreated depression to both the mother and baby is substantial.”

Depression affects millions of pregnant women. It's due in part to changes in the mood-boosting chemicals in the brain. Commonly used antidepressants can help balance these chemicals.

“Roughly about 1 in 10 women [takes] an antidepressant during pregnancy,” says Krista Huybrechts, PhD, an assistant professor of medicine at Brigham and Women's Hospital. She's written research on the topic, including a recent report.

Use of such meds by pregnant women has skyrocketed in the last two decades. One type, called selective serotonin reuptake inhibitors (SSRIs), now ranks among the top 20 drugs prescribed during pregnancy.

In 1998, no antidepressants made that list, according to a recent commentary in the Journal of Nervous and Mental Disease.

Despite the wide use, there is limited data on the drugs' dangers, because pregnant women are typically excluded from safety trials.

“It's an ethical dilemma,” says Siobhan Dolan, MD, an OB/GYN and medical advisor to the March of Dimes. “We understand why we exclude pregnant women from medication trials, but we don't have data to counsel them. So are we really helping them?”

Before you look at the potential dangers of antidepressants during pregnancy, it's important to understand how to interpret the information in research on the subject. Negative news always tends to spread more swiftly, particularly on social media.

Instead, ask this question: Did the researchers consider other health conditions — such as smoking or obesity — that could also affect study results?

Also, “women who take antidepressants are different than women who don't. They have other risk factors that can lead to problems during pregnancy. So is it the mental illness or the actual medication that causes the risks?” Dolan says.

Among the most publicized risks of taking an antidepressant during pregnancy is persistent pulmonary hypertension of the newborn (PPHN). It's a life-threatening condition in which a baby has high blood pressure in the lungs, causing severe breathing problems.

Scientists first linked it to the use of SSRIs in 2006, prompting the FDA to issue a warning about it.

Five years and five conflicting studies later, the FDA revised its statement, saying “it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN.

” Since then, a handful of reviews, including one in June, have further reassured pregnant women that the risk is “statistically insignificant.”

“Our study by no means says that antidepressant use is safe during pregnancy. It is just that, for this outcome, we do not find an increased risk of PPHN,” says Huybrechts, who co-authored the study.

Another concern for moms-to-be taking these meds is the chance of heart defects in the baby. The FDA warned in 2005 that paroxetine (Paxil) could lead to holes and other structure problems in a newborn's heart. But a study published last year didn't confirm the risk.

About 3 in 10 babies born to moms who have taken SSRI have a temporary condition called poor neonatal adaption syndrome. Symptoms include:

  • Jitteriness
  • Low blood sugar
  • Poor muscle tone
  • Seizures
  • Weak cry

Still, in at least one study, researchers say they don’t believe it causes long-lasting effects in a child.

Lots of research shows that depression during pregnancy can be bad for the health of mom and baby. If you have a mental illness and become pregnant, it's considered a high-risk pregnancy.

Pregnant moms who are depressed are:

  • Less ly to get proper prenatal care
  • Less ly to eat healthfully
  • More ly to smoke and drink alcohol

Depression during pregnancy also raises your chances of conditions that can lead to infant death and illness, including:

  • High blood pressure and organ damage during pregnancy (preeclampsia)
  • High blood sugar during pregnancy (gestational diabetes)
  • Baby being born too soon (preterm birth)
  • Baby weighing less than 5 pounds, 8 ounces at birth (low birth weight)

There is no clear-cut answer. Using any medicine while you're expecting can be risky. “We tend to use older antidepressants, Prozac or Zoloft, because they've been around for a long time and if there's going to be an issue we would have seen it,” Payne says.

If you're pregnant and depressed, make extra time to weigh the risks and benefits of medication with your doctor.

“It's not a black and white issue. There's a lot to consider,” Dolan says. “Risk and benefits. Timing in pregnancy. Optimal medical management. Maybe you're on two or three antidepressants. Can you get down to one? A woman and her doctor need to personalize treatment. There's not a one-size-fits all answer. “

If you've been taking medicine for depression and become pregnant, don't stop taking it until you get your doctor's OK.

About 90% of women who quit their meds often see their depression come back during the last 3 months of pregnancy.

If a particular medicine has worked for you, experts in this article encourage you to stick with it and get regular tests to check the baby's growth and heart rate.

“The best antidepressant to use during pregnancy is the one that keeps the moms well,” Payne says.

SOURCES:

Osborne, L. Journal of Nervous and Mental Disease, 2015.

Casper, R. Journal of Nervous and Mental Disease, 2015. 

Robinson, G.  Journal of Nervous and Mental Disease, 2015. 

March of Dimes website: “Depression in Pregnancy.”

Women's health.gov website: “Depression during and after pregnancy.”

Grote, N. Archives of General Psychiatry, October 2010. 

Krista Huybrechts, PhD, Assistant Professor of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston.

Siobhan Dolan, MD, obstetrician gynecologist (OB/GYN), clinical geneticist, and medical advisor to the March of Dimes.

Jennifer Payne, MD, director, Women's Mood Disorders Center,  Associate Professor of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, Baltimore, MD.

News release, The JAMA Network. 

Huybrechts, K. JAMA. June 2, 2015.

FDA.

Koren G. Canadian Medical Association Journal, May 24, 2005.

Huybrechts, K. New England Journal of Medicine. June 19, 2014. 

© 2015 WebMD, LLC. All rights reserved.

Source: https://www.webmd.com/baby/news/20150612/antidepressants-while-pregnant

Antidepressants in Pregnancy: Balancing Needs and Risks in Clinical Practice

Antidepressants and Pregnancy: Tips from an Expert | Johns Hopkins Medicine

A practical approach to antidepressant use in pregnancy

How do we integrate all the information about the risks of both treatment and lack of treatment into a practical clinical approach? The ideal situation is to begin planning for pregnancy before conception.

The patient’s psychiatric history, severity of illness, past medication response, and wishes for treatment during pregnancy should be taken into account. Every case should be considered individually.

Ultimately, there is no set approach: just the weighing of risks and benefits of the various options for the individual patient.

The primary goal of treatment in pregnancy is to minimize the number of exposures. This means not only minimizing the number of medications but also limiting exposure to psychiatric illness.

When determining which antidepressant to use during pregnancy, remember that in general we have more information about older antidepressants than newer ones. This fact is reflected in the old FDA pregnancy categories.

Categories include A, B, C, D, and X, and the hierarchy is the amount of evidence for safety in animal and human studies, not on the level of risk.

Medications in category B simply have not been studied adequately in humans to warrant placing them in category A as safe (or in C, D, or X), and most medications new to the market will therefore be in category B.

Prescribers may make the mistake of prescribing a category B medication over an older medication in category C or D, thinking it is safer, when in fact less is known about its safety during pregnancy. While these categories are being phased out, they will still apply to drugs approved before 2001 for some time.

Should women switch to better-studied medications before pregnancy? If decisions are being made well in advance, and the woman does not have a history of non-response to the better-studied medication, she can attempt a switch.

Switching to another antidepressant during pregnancy rarely makes sense (unless the woman is not responding), since the baby has already been exposed and switching would increase the number of exposures to medications and potentially depressive illness.

What if the patient is already pregnant? The same principles apply, with an important addition: don’t stop all psychiatric medications immediately. Stopping precipitously can cause great distress, precipitate withdrawal, and induce a relapse of mental illness.

The best approach is to review the medication list the principles outlined above.

Keep in mind that the baby has already been exposed, and while stopping some medications may make sense to minimize the impact on the child, doing so in a controlled and logical fashion is ideal.

Despite increasing evidence of safety, many patients decide not to take psychiatric medications during pregnancy. Many feel guilty about taking any medication during pregnancy, and most women overestimate the risks of medication and underestimate the risks of untreated mood disorders during pregnancy.

In this situation, it is appropriate to offer close follow-up care so that relapses are identified early and treatment can be offered.

Evidence-based nonpharmacological treatments, including psychotherapy, yoga, and acupuncture, should be incorporated whenever possible (whether the patient is receiving medication or not!).

It is also important to keep in mind that the patient and her family must feel comfortable with the treatment used during pregnancy, so they do not look back and regret decisions made during this critical period.

Educating the family about the risks and benefits of treatment, the risks of untreated psychiatric illness to both mother and child, as well as signs and symptoms of relapse, is essential to providing good clinical care.

Conclusion

Interpretation of the literature on in utero antidepressant exposure is complicated by confounding variables associated with psychiatric illness. Current evidence is generally reassuring and indicates that the absolute risks of negative infant outcomes are small except for PNAS, which largely appears to be self-limited.

In contrast, the risks associated with exposure to significant maternal depression are substantial. A plan to minimize the number of exposures both to medication and to illness, along with close psychiatric follow-up and communication with all involved parties, serves to maximize outcomes for both mothers and their children.

Dr. Osborne is Assistant Director, Women’s Mood Disorders Center, Johns Hopkins School of Medicine, Baltimore, MD, and Assistant Professor of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine. Dr.

McEvoy is a Postdoctoral Fellow in Women’s Mental Health in the Department of Psychiatry, Johns Hopkins School of Medicine. Dr.

Payne is Director, Women’s Mood Disorders Center, Johns Hopkins School of Medicine, and Associate Professor of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine.

Dr. Osborne reports no conflicts of interest concerning the subject matter of this article. Dr. Payne receives research support from and is a consultant for Sage Therapeutics; she has provided expert testimony for Eli Lilly, Astra Zeneca, Johnson and Johnson, and Abbott Pharmaceuticals.

1. Andersson L, Sundstrom-Poromaa I, Bixo M, et al. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol. 2003;189:148-154.

2. Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295:499-507.

3. Brunton RJ, Dryer R, Saliba A, Kohlhoff J. Pregnancy anxiety: a systematic review of current scales. J Affect Disord . 2015;176:24-34.

4. Kim HG, Mandell M, Crandall C, et al. Antenatal psychiatric illness and adequacy of prenatal care in an ethnically diverse inner-city obstetric population. Arch Womens Ment Health. 2006;9:103-107.

5. 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:e309-e320.

6. Field T. Prenatal depression effects on early development: a review. Infant Behav Dev . 2011;34:1-14.

7 . Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004; 26:289-295.

8. Akman I, Kuscu K, Ozdemir N, et al. Mothers’ postpartum psychological adjustment and infantile colic. Arch Dis Child . 2006;91:417-419.

9. McLearn KT, Minkovitz CS, Strobino DM, et al. The timing of maternal depressive symptoms and mothers’ parenting practices with young children: implications for pediatric practice. Pediatrics. 2006;118:e174-e182.

10. Grace SL, Evindar A, Stewart DE. The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health. 2003;6:263-274.

11. Jarde A, Morais M, Kingston D, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry. 2016;73:826-837.

12. Kimmel M, Hess E, Roy PS, et al. Family history, not lack of medication use, is associated with the development of postpartum depression in a high-risk sample. Arch Womens Ment Health. 2015;18:113-121.

13. Cha AE. Maternal exposure to anti-depressant SSRIs linked to autism in children. Washington Post. December 17, 2015.

14. Almendrala A. Major study links autism to antidepressant use during pregnancy. Huffington Post. December 15, 2015.

15. Boukhris T, Sheehy O, Mottron L, Berard A. Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatrics. 2016;170:117-124.

16. Huybrechts KF, Sanghani RS, Avorn J, Urato AC. Preterm birth and antidepressant medication use during pregnancy: a systematic review and meta-analysis. PloS One. 2014;9:e92778.

17. Sit D, Perel JM, Wisniewski SR, et al. Mother-infant antidepressant concentrations, maternal depression, and perinatal events. J Clin Psychiatry. 2011;72:994-1001.

18. Louik C, Lin AE, Werler MM, et al. First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. N Engl J Med. 2007;356:2675-2683.

19. Alwan S, Reefhuis J, Rasmussen SA, et al. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med. 2007; 356:2684-2692.

20. Pedersen LH, Henriksen TB, Vestergaard M, et al. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study. BMJ. 2009;339:b3569.

21. Huybrechts KF, Palmsten K, Avorn J, et al. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med. 2014;370:2397-2407.

22. Wang S, Yang L, Wang L, et al. Selective serotonin reuptake inhibitors (SSRIs) and the risk of congenital heart defects: a meta-analysis of prospective cohort studies. J Am Heart Assoc. 2015;4:e001681.

23. Huybrechts KF, Bateman BT, Palmsten K, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA. 2015;313:2142-2151.

24. Kieler H, Artama M, Engeland A, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries. BMJ. 2012;344:d8012.

25. Harrington RA, Lee LC, Crum RM, et al. Serotonin hypothesis of autism: implications for selective serotonin reuptake inhibitor use during pregnancy. Autism Res. 2013;6:149-168.

26. Brown HK, Hussain-Shamsy N, Lunsky Y, et al. The association between antenatal exposure to selective serotonin reuptake inhibitors and autism: a systematic review and meta-analysis. J Clin Psychiatry. 2017;78:e48-e58.

27. Salisbury AL, O’Grady KE, Battle CL, et al. The roles of maternal depression, serotonin reuptake inhibitor treatment, and concomitant benzodiazepine use on infant neurobehavioral functioning over the first postnatal month. Am J Psychiatry. 2016;173:147-157.

28. 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.

Source: https://www.psychiatrictimes.com/antidepressants-pregnancy-balancing-needs-and-risks-clinical-practice/page/0/2