Prenatal depression and selective serotonin reuptake inhibitors

A review of the literature suggests mixed findings on the effects of prenatal antidepressants. Although the critical question is the relative effects of depression versus antidepressants during pregnancy, randomized control studies do not exist for this comparison. Instead, nondepressed, nontreated control groups have been used for comparisons. Separate studies suggest that both untreated depression and exposure to antidepressants have been associated in some cases with unfavorable outcomes. Studies on long-term neurodevelopmental outcomes for children have also been inconclusive. Another problem for the mother and fetus is the discontinuation of antidepressants. Research on the selective serotonin reuptake inhibitors (SSRIs) suggests that late pregnancy exposure may have worse effects than first and second trimester exposure, leading to the neonatal abstinence syndrome. Still other data suggest a dual syndrome of abstinence/withdrawal and of serotonergic overstimulation, with symptoms of the two syndromes being very similar. Several confounding factors have contributed to this mixed literature including the already mentioned lack of a depressed, nonantidepressant control group as well as group variability on the types of SSRIs taken and severity of their effects, and limited longitudinal follow-up data. Future research would not only need to correct these problems but also further explore the different trimester effects and the withdrawal versus serotonin activity effects on the infant. In addition, alternative therapies need to be explored for their potential antidepression effects on the pregnant woman, the fetus, and the neonate.