[Antidepressant use in pregnancy: a critical review of the risk and benefits]

Pregnancy is considered a high-risk period for the development of a depressive disorder in women, particularly in those with a pre-existing affective disorder. The use of antidepressants in pregnancy may be responsible for congenital malformations and neonatal toxicity. The aim of the study is to review the literature examining the various antidepressants used in pregnancy and their relationship with the development of congenital malformation and neonatal diseases; in particular, we have focused on the evaluation of the risk/benefit in the administration of specific drugs, the possible teratogenicity and placental transfer.

We performed a computerized search of PubMed through the papers published from 1996 to 2014, identifying the studies that have showed a relationship between treatment with antidepressants in pregnancy and teratogenic effects and toxicity in the short and long term.

The revision of the pharmacovigilance studies indicate that most of the selective serotonin reuptake inhibitors have a teratogenic risk substantially similar to that of unexposed controls. For other antidepressants (tricyclics, mirtazapine, venlafaxine, escitalopram, duloxetine) the evidences on the level of risk are still numerically inconsistent and need to be clarified by further research.

Despite the lack of guidelines for the treatment of depressive disorders during pregnancy, clinically relevant data are continuing to accumulate in the literature. For many medications, compared to the past, we are now able to make a more rational and less approximate estimate of the risk/benefit ratio.