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Rolling the Dice on SNRI Side Effects

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Scottsdale, AZAny woman either contemplating or having recently discovered she is pregnant must always consider the safest route to take when medications are involved. To that end, the Mayo Clinic is a trusted resource for information pertaining to, for example, SNRI side effects.

SNRIs, or Serotonin-Norepinephrine Reuptake Inhibitors, are newer-generation antidepressants and are closely related to SSRI medications similarly designed to treat depression. While SSRI antidepressants have been linked to birth defects, SNRI birth defects are an equal concern, according to the Mayo Clinic.

And yet, a look at the Mayo Clinic website with regard to depression and SSRI/SNRI antidepressants reveals that the web authors have a bit more to say about SSRIs than SNRIs, the latter often considered to treat major depression.

For example, the Mayo Clinic correctly identifies Venlafaxine (Effexor) as belonging to the SNRI family, and an approved drug by the US Food and Drug Administration (FDA) to treat depression. And yet, under the heading “Safety concerns,” the site acknowledges that some antidepressants may harm your child if taken during pregnancy or while breast-feeding. But there is no sense, or suggestion, as to which antidepressant might be worse or better than others.

Effexor, as a member of the SNRI class, appears to be known in the medical community as a potential risk for a developing fetus. Two infants in particular, appearing previously on, succumbed to the aftereffects of Effexor after their mothers continued taking Venlafaxine throughout their pregnancies.

One infant lived just two hours following birth. The other lasted a few weeks. In the latter case, the attending delivery room physician appeared surprised that the mother was continuing to take Effexor and notified the neo natal unit to prepare for “an Effexor baby” and the potential for SNRI side effects.

However, on the Mayo Clinic website, there is little mention of specifics with SNRI birth defects. For that, you have to go over to the SSRI section.

Here, you get the sense of what the Mayo Clinic advocates for pregnant women (or those intending on becoming pregnant) who are also being treated for depression. Amidst the usual debate as to the dangers of stopping an antidepressant for the mother - and the potential for harm to the fetus if antidepressants are continued - are recommendations, in the Mayo Clinic’s view, of what is an acceptable risk and what isn’t.

Paxil is generally a no-no, the Mayo Clinic notes. “The SSRI paroxetine (Paxil) is generally discouraged during pregnancy. Paroxetine has been associated with fetal heart defects when taken during the first three months of pregnancy.”

Among the drugs that ARE okay, generally speaking, are citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft).


“Some research associates use of citalopram, fluoxetine and sertraline with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy, as well as heart defects affecting the septum - the wall of tissue that separates the left side of the heart from the right side of the heart,” the Mayo Clinic says. “Other rare birth defects have been suggested as a possible risk in some studies, but not others.”

This is correct. The studies have been inconclusive, keeping the FDA on the fence and forcing women and their doctors to play Solomon in an effort to figure out the risk/benefit ratio.

It’s a tough debate, and one that has no end in sight as antidepressant use continues to rise amongst American women. And while studies do not agree on the absolute risk for SNRI birth defects and those of SSRI drugs, most will agree that more studies need to be done - larger and more comprehensive studies. This is happening - together with a continued dialogue between a pregnant woman and her doctor on the best course of action for minimal risk.

Most agree that what risks there are for SNRI side effects to the infant, remain low. But a risk nonetheless. And any parent having had to personally face SNRI birth defects, for them the risk is absolute. For them, a minimal risk became reality. And for them, an SSRI lawsuit is a despairing cry for help…


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