SSRI Antidepressant Withdrawal Syndrome in Newborns

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http://depts.washington.edu/druginfo/DTT/2002_Vol31_Files/V31N2.pdf

 

 

A University of Washington / Harborview Medical Center

Drug Information Center publication

Distributed monthly by authority of the Pharmacy and

Therapeutics Committee

Editor: Nelda A. Murri, Pharm.D. (206) 598-6612 –

Asst. Editor: Elizabeth Rudy, D.V.M., R.Ph.

Department of Pharmacy Services / School of Pharmacy

2002 by the University of Washington

Also published on the World Wide Web at

http://uw.prnrx.org/therapyTopics.asp

No material may be reproduced in whole or in part

without written permission from the editor.

Vol. 31 No. 2 - Feb. 2002

University of Washington Medical Center / Harborview

Medical Center ISSN 0882-6684

drug therapy topics

(Continued on page 8)

SSRI Antidepressant Withdrawal Syndrome

in Newborns

by Elizabeth Rudy, D.V.M., R.Ph.

 

Editor’s Note: Adverse drug reactions experienced by

UWMC or HMC patients and reported to

the pharmacy are reviewed quarterly by the Pharmacy &

Therapeutics Committee. Following the

Committee’s review, a summary is published in this

newsletter (see page 9) along with a companion

article regarding some aspect of adverse drug

reactions. It is hoped that these articles will be

useful

tools to remind prescribers of the fundamental

principle of pharmacology that states, “No drug has

only one action.” By reminding prescribers to be alert

to the appearance of undesired and

unintended actions of drugs, therapeutic outcomes may

be improved and adverse events minimized.

If you have a patient you feel is experiencing an

Adverse Drug Reaction, report it by calling the

A.D.R. Phone Line, HMC: 731-3802; UWMC: 598-6837;

SCCA: 288-6336.

 

The use of selective serotonin reuptake inhibitors

(fluoxetine, paroxetine, sertraline,

fluvoxamine, and citalopram) to treat depression

during pregnancy has become

increasingly popular, in part due to studies that

indicate that these antidepressants are

unlikely to be teratogenic at therapeutic doses.1

However, case reports have appeared

sporadically in the medical literature describing

withdrawal symptoms in neonates

whose mothers took these medications during pregnancy.

The purpose of this Focus is

to explore what potential adverse effects prenatal

exposure to SSRI antidepressants may

have on the newborn.

 

A variety of symptoms, most commonly involving the

central nervous system and

the gastrointestinal system, have been observed in

neonates experiencing selective

serotonin reuptake inhibitor (SSRI) antidepressant

withdrawal.2 Nordeng et al. described

withdrawal symptoms in five infants exposed to SSRI

antidepressants prenatally.

 

2 These neonates exhibited symptoms of irritability,

constant crying, shivering,

increased tonus, eating and sleeping difficulties, and

seizures. Stiskal et al. described

jitteriness, vomiting, irritability, hypoglycemia, and

necrotizing enterocolitis in four

infants exposed prenatally to paroxetine.3 In adults,

similar SSRI withdrawal symptoms

have been observed.3 In the above prenatal exposures,

most of the pregnant women took

the SSRI antidepressant throughout the pregnancy or

started taking it in the second or

third trimester and continued through term.

 

In their 1996 study on birth outcomes in pregnant

women taking fluoxetine

(ProzacR), Chambers et al. reported that of the 73

infants exposed to the drug in the third

trimester, 31.5% exhibited symptoms of “poor neonatal

adaptation” that included

respiratory difficulties, irritability, jitteriness,

and cyanosis on feeding.4 As of March

2001, there were a total of 13 reports to the

Australian Drug Reaction Advisory

Committee that were described as neonatal withdrawal

syndrome in conjunction with

maternal use of an SSRI antidepressant.5 Additionally,

there are scattered case reports

in the medical literature describing neonatal

withdrawal symptoms in infants exposed

prenatally to SSRI antidepressants: 10 reports

involved paroxetine, 2 reports involved

sertraline, 1 report involved citalopram, and 3

reports involved fluoxetine.2,3,6-12