Q: Antidepressants during Pregnancy & Newborns
I am 17 weeks pregnant and I am back on medication Effexor XR. I read that
after this medication cant eat and breath by themself. How much possibility is
will happend to my child.
Dear Ms. L' --
True there are concerns about infants born to mothers on antidepressants.
"Can't breath" is fortunately a bit overstated but not incorrect: infants seem
to have a withdrawal syndrome not unlike what happens to adults when they stop
serotonergic antidepressants (Effexor is partly serotonergic and partly works
through another neurotransmitter, norepinephrine; but it definitely has a
withdrawal syndrome in adults). Here is one of the recent articles describing
how kids behave when they've been exposed to serotonergic antidepressants during
pregnancy, compared to those who don't:
. The bottom line: it's not terribly dramatic, but there is a difference.
A recent article on this concern tried to come up with
a rough idea of how common this is (Lancet Feb 5, 2005; here's a
press release about the article). Note that the article refers to
"convulsions, irritability, abnormal crying and tremor" but that the frequency
was 93 cases after looking in the medical literature of 81 countries.
You definitely will want to talk to your doctor about
your joint strategy for handling Effexor near the end of your pregnancy. Right
now, it's not clear what doctors should be recommending. There are several
mood/pregnancy experts who emphasize the risk of untreated mood symptoms as
well, certainly after pregnancy (post-partum depression in particular) but even
during pregnancy. Psychiatrist Lee Cohen of Massachusett General Hospital is
one of them. He has been researching this topic for almost 20 years -- but he is
also a consultant to Eli Lilly, which manufactures the antidepressant Prozac, so
you have to be a bit cautious in how you interpret his remarks. However, there
are some recent data about how kids do after birth, when exposed to mom's
symptoms during pregnancy.
For example, there is evidence that children exposed to
mother's severe mood or anxiety symptoms have more trouble with their own
development, though this research is just getting going and should be
interpreted with great caution. Here's one study by
Huizink along those lines, which describes relatively minor changes in kids
behavior, among those exposed to mother's anxiety symptoms; in fact the changes
are of such small size it's easy to wonder how else they might be explained. If
you'd like to add this research to a discussion of Effexor with your doctor,
here is a review of this topic by the same research team that's a little broader
Buitelaar (you or your doctor can ask a librarian to dig up the full text
I guess my main point, in reply to your question, is
that how to handle this issue remains almost completely unanswered (and
thus I find myself wanting to refer you to the most precise literature on the
topic, not just hearsay or news articles or TV programs (such as
this one). I hope you and your doctor create time for some extended
discussion of your options.
Published April 2005