Antidepressants during Pregnancy & Newborns
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Q:  Antidepressants during Pregnancy & Newborns

I am 17 weeks pregnant and I am back on medication Effexor XR. I read that newborns after this medication cant eat and breath by themself. How much possibility is that will happend to my child. thank you

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:
Simon .   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 in scope: Buitelaar (you or your doctor can ask a librarian to dig up the full text document).

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. 

Dr. Phelps

Published April 2005


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