Infants Exposed to Antidepressants May Experience Effects for Up to a Month After Delivery

Pregnant women with major depressive disorder face a challenging decision when considering treatment over the course of their pregnancy. While there is evidence to suggest infants born to mothers whose depression goes untreated can experience behavioral problems, studies have also found that infants exposed to selective serotonin reuptake inhibitors (SSRIs) may experience adverse behavioral symptoms that typically resolve within the first two weeks following birth.

A study published in AJP in Advance now suggests some infants exposed to SSRIs and benzodiazepines may continue to experience the effects of the medications throughout their first month of life.

Researchers at Brown University assessed 184 pregnant women at two points during their pregnancy and classified them into four groups: no exposure, depression only (no medication taken), SSRI exposure, and SSRI plus benzodiazepine exposure. The infants born to these women were then examined with a structured neurobehavioral assessment (Neonatal Intensive Care Unit Network Neurobehavioral Scale) in the first week after delivery, with follow-up assessments on days 14 and 30.

Infants in the SSRI and SSRI plus benzodiazepine groups had lower movement quality and more CNS stress signs across the first postnatal month compared with infants in the no exposure or depression groups; there were no differences seen whether or not the mother discontinued SSRI use in the third trimester. In addition, infants in both SSRI groups showed lower self-regulation and higher arousal at day 14 compared with the other two groups. Infants in the SSRI plus benzodiazepine group had the least favorable scores on the Neonatal Intensive Care Unit Network Neurobehavioral Scale.

“In agreement with the current practice guidelines of the American Psychiatric Association and the American College of Obstetricians and Gynecologists, these findings do not support discontinuing SSRI medication in the third trimester of pregnancy for those women who have been successfully managing their depressive symptoms with SSRIs throughout pregnancy,” the study authors wrote. “Furthermore, our data suggest that concomitant use of benzodiazepines in conjunction with SSRIs is associated with more significant problems in infant neurological functioning than SSRI use alone. This may be a result of the underlying disorder and symptom severity or the neonate’s inefficiency in metabolizing multiple drugs.”

For related information, see the Psychiatric News article “Study Reports on Risks, Benefits of SSRIs Taken During Pregnancy.”

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