| nospam@nospam.org 2005-04-27, 5:54 pm |
| SSRIs and neonatal disorders ......
The selective serotonin reuptake inhibitors (SSRIs) fluoxetine (Erocap, Lovan,
Prozac, Zactin), fluvoxamine (Luvox), paroxetine (Aropax) and sertraline
(Zoloft) are now the most widely used class of antidepressants in the Australian
community. With this increasing use has come a relatively large number of
reports to ADRAC (fluoxetine, 803; fluvoxamine, 5; paroxetine, 887; sertraline,
1243) including reports of effects on the neonate.
....... withdrawal reactions
Four reports to ADRAC describe withdrawal reactions in neonates whose mothers
had taken SSRIs throughout their pregnancies. One case, in which the mother had
taken fluoxetine, involved a three day old baby who developed tachypnoea,
irritability, jitteriness, fever, anorexia, cyanosis and possible fitting. The
second case, in which the mother had taken sertraline, concerned the smaller of
a set of twins, who, at three days, became jittery and unsettled. The third case
describes a baby who was treated for irritability and rapid breathing for two
days after birth to a mother who had taken sertraline. The fourth case involved
a mother who had taken fluoxetine and whose baby had a good Apgar score at birth
but then became lethargic and fed poorly. The effects in all four cases appeared
to resolve spontaneously.
....... breast milk transfer
A further four reports relate to probable breast milk transfer. In one report, a
5 month old breast fed baby whose mother was taking fluoxetine for post-partum
depression, was found to have hyperglycaemia and glycosuria which resolved after
the cessation of breast feeding. A second report describes a breast fed baby who
became agitated, unsettled and had difficulty feeding while its mother was
taking paroxetine. The outcome is unknown in this case. The third report
describes a 5 month old baby who became agitated for a few days when her mother
began taking sertraline for post-partum depression. This settled spontaneously
while the mother continued with the drug. In the fourth report, a breast feeding
mother took sertraline for about three months from the time her baby was 10 days
old. During this time, the baby was somnolent, with low muscle tone, hearing
problems and suspected developmental difficulties. When the mother discontinued
the drug, the baby's condition improved dramatically and is now considered
normal.
These reports suggest that adverse reactions to SSRIs can occur in neonates,
through either placental or breast milk transfer. Practitioners should consider
this possibility when prescribing to depressed patients who are pregnant or
breastfeeding.
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