The prenatal use of a widely prescribed class of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) can cause withdrawal reactions and convulsions in newborns, analysis of an international database suggests. The data indicate that paroxetine, marketed in the US as Paxil, is the SSRI mostly often linked to these problems.

There have been other reports tying antidepressant use in pregnancy to postnatal symptoms including convulsions, irritability, abnormal crying and tremor.

Dr. Emilio J. Sanz, at the University of La Laguna in Tenerife, Spain, and colleagues screened the World Health Organization’s database of adverse drug reactions, which includes reports from 81 countries. Their findings are published in The Lancet.

The first case of SSRI-related convulsions in a newborn was reported in 1995. By the end of 2003, there were 93 cases for which symptoms could not be ascribed to any other drugs. Sixty-four cases were attributed to paroxetine, 14 to fluoxetine (Prozac), 9 to sertraline (Zoloft) and 7 to citalopram (Celexa).

The risk of convulsions and withdrawal syndrome in newborns appears to increase with all SSRIs, the authors suggest, although paroxetine might be associated with higher risk.

Sanz’s group recommends that if used at all, paroxetine should be given at the lowest effective dose. “With the other SSRIs, especially citalopram and venlafaxine (Effexor), their use should be carefully monitored and new cases promptly communicated to the pharmacovigilance systems,” they add.

In a related editorial, Drs. Vladislav Ruchkin and Andres Martin, at Yale University School of Medicine in New Haven, Connecticut, recommend that clinicians not shift away precipitously from using SSRIs.

However, a necessary first step is for individual practitioners to use well-defined clinical guidelines before an antidepressant is prescribed.

They also advise doctors to make better use of non-pharmacological interventions that have been proven to be effective in treating depression.

SOURCE: The Lancet, February 5, 2005.