Neonatal venlafaxine discontinuation syndrome: A mini-review

During pregnancy, the developing fetal brain may be exposed to a range of psychotropic medications. The serotonin-noradrenergic reuptake inhibitor venlafaxine is one such drug, when used as a maternal antidepressant. Here we review the discontinuation phenomenon that may follow in exposed neonates following birth. Adults who abruptly stop taking venlafaxine can experience withdrawal symptoms. Venlafaxine and its metabolites cross the placenta and so the newborn can be exposed to this risk, as well as potential toxicity. Several case reports document features of encephalopathy following birth in exposed neonates. It is suggested that a possible combination of partial toxicity together with withdrawal may lead to these symptoms - a discontinuation syndrome. The underlying neurobiology is not yet established. Common symptoms and signs seen in affected neonates include poor feeding, jitteriness, respiratory distress and myoclonic seizure-like activity. Onset is typically between birth and day 4 of life with resolution by 2-21 days of life. Electroencephalography does not necessarily correlate with clinical seizures, or response to anticonvulsants. In limited follow-up data, no long-term consequences of this discontinuation syndrome are reported. We suggest where it is not possible for mothers to be switched from venlafaxine to other antidepressant drugs, that their infants are observed closely for 2-4 days following delivery. In symptomatic neonates, following exclusion of other causes, supportive care including breastfeeding may be sufficient for management. Clinicians should be vigilant to venlafaxine discontinuation as a cause for encephalopathy or paroxysmal episodes in exposed neonates.