SSRIs are the most well-studied antidepressants in pregnancy. The experience is vast, however the quality of evidence from these studies is generally considered “low-quality” due to the fact that no randomized controlled trials have been conducted. National registries from multiple countries have examined information about type of SSRI, maternal, obstetric and neonatal outcomes. From these studies, the risks of stillbirth and infant mortality were no different from women who did not use SSRIs.
Typically, when women present to a Reproductive Endocrinologist to initiate treatment to establish pregnancy, a thorough medical history, including medication history is obtained. Generally, patients are not asked to discontinue their SSRIs during treatment, as there is no evidence to support negative outcomes if the medication is continued. The patient’s diagnosis, symptoms and severity of symptoms must be taken into consideration prior to discontinuing anti-depressant treatment at any time. This decision is usually made by the patient and the prescribing physician (her psychiatrist or medical doctor). Any treatment alternatives would be discussed with the patient by the prescribing physician, not her Reproductive Endocrinologist.
There is little to no risk of teratogenicity associated with SSRIs during the first trimester. Thorough literature reviews have found no single type of birth defect to be observed across studies in women who used them during pregnancy. Neonatal effects may differ in that late trimester exposure to SSRIs can lead to “poor neonatal adaptation.” The newborn may experience agitation, irritability, insomnia, poor feeding, hypoglycemia, respiratory distress and other transient behaviors that are monitored in the NICU setting. These symptoms are generally mild, self-limited and usually do not last more than two weeks. Women who have taken SSRIs in pregnancy are advised to deliver in a setting where the infant can be supported if necessary. There is little data to suggest that discontinuing or tapering the dose of the medication relates to the development of poor neonatal adaptation. Decisions about tapering or discontinuing SSRI treatment in pregnancy are made between the patient and her obstetrician, as well as the physician who prescribed the SSRI.