From parents to offspring: a comprehensive review of antidepressant-linked reproductive risks†

While antidepressants are routinely prescribed to manage depression, their long-term ramifications on reproductive health and the well-being of offspring are still shrouded in ambiguity. This review meticulously sifted through clinical trials pinpointing antidepressant usage among individuals of childbearing potential, highlighting safety concerns regarding reproductive health and the subsequent effects on offspring. We delved into studies spanning from January 1, 2000, to December 30, 2023, inclusively analyzing randomized controlled trials, cohort studies, and case-control studies. Our synthesis illuminates a concerning correlation between antidepressant intake and an array of sexual dysfunction. Among pregnant users, an alarming connection was noted with heightened incidences of miscarriage, preterm births, postpartum hemorrhage, and gestational diabetes mellitus. Newborns subjected to antidepressant exposure faced an elevated risk of low birth weight, more frequent admissions to neonatal intensive care units, being small for gestational age, malformation, and other adverse outcomes in newborns. The underpinning mechanisms triggering these adverse outcomes seem to intertwine with GABA receptor interactions, induced oxidative stress, and disruptions in mitotic spindle assembly. The surfacing evidence of antidepressants' potential reproductive toxicity underscores the need for circumspection in their prescribing practices. It becomes crucial to not only clearly communicate these risks to patients but also to tailor treatment decisions to meticulously balance individual needs against potential risks. Looking ahead, future endeavors should pivot toward a deeper understanding of the detrimental effects antidepressants may harbor reproductive health and offspring vitality. This necessitates devising innovative strategies that mitigate these risks, safeguarding treatment efficacy for generations to come.