What Are the Risks in a Paxil Pregnancy?

Boston, MAWhen it comes to prescribing medication to pregnant women, there are many concerns about side effects and how the medications will affect a fetus; but at what point should concerns about Paxil side effects come into play when dealing with someone who could potentially become pregnant? Some studies suggest a risk of Paxil birth defects—such as Paxil heart defects—in infants exposed to Paxil while in the womb, causing some concern about the risk of prescribing such an antidepressant to a woman who is pregnant. But what about a teenage female who could one day, well in the future, become pregnant?

In reviewing the book Dosed: The Medication Generation Grows Up (by Kaitlin Bell Barnett), Claudia Gold (writing for the blog Child in Mind; 4/14/12) notes that selective serotonin reuptake inhibitors (SSRIs) are the most common medications prescribed in pregnancy, even though it is not yet clear what impact exposure to SSRIs has on a developing fetus. Although some studies suggest a risk of birth defects, including persistent pulmonary hypertension of the newborn (PPHN), autism and other birth defects, other studies suggest there is no link between use of an SSRI while pregnant and an increased risk of serious birth defects.

Because there is a risk to the developing fetus when the mother has untreated depression, doctors must carefully weigh the pros and cons of prescribing an SSRI to a woman who is pregnant or who is of child-bearing age. But Dosed argues that such consideration must be given when teenage females are prescribed antidepressants, so they are not faced with the difficult decision of going off their medication when they decide they want to become pregnant.

Although it is vital that teenagers who have depression be given help, it has also been noted that discontinuing medication comes with its own challenges, and can be incredibly difficult for patients. Furthermore, "…other forms of intervention, including psychodynamic psychotherapy combined with self-regulating activities such as yoga, offer an alternative to medication," Gold writes in her review of the book. Not all patients who have depression necessarily require pharmaceutical intervention and, in some cases, other therapies are preferred.

Meanwhile, the American Academy of Pediatrics recently issued a revision of its policy on neonatal drug withdrawal (published in Pediatrics; 1/30/12). According to the academy, studies and adverse event reports have linked third-trimester use of SSRIs in pregnant women to "continues crying, irritability, jitteriness, and/or restlessness; shivering; fever; tremors; hypertonia or ridigity; tachypnea or respiratory distress; feeding difficulty; sleep disturbance; hypoglycemia; and seizures [in the infant]." The report noted, however, that it is not clear whether those symptoms were the result of SSRI withdrawal once the infant was born or serotonin syndrome.

The academy noted that SSRI treatment should only be given at the lowest effective dose once the mother becomes pregnant because of the risk of adverse effects on both the mother and infant.