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Information for Physicians on Prescription Products to Treat Perinatal Depression – February 2006
Reported Side Effects
to Breastfeeding
No behavioral studies in human pregnancy (WellbutrinR;
Can cause insomnia Higher rate of spontaneous abortions Few interactions with other medications No behavioral studies in human pregnancy (CelexaR)
● Possible risk of pulmonary hypertension Maternal side effects additive to pregnancy effects (sedation, (NorpraminR)
Orthostatic hypotension, risking decreased placental perfusion Fetal and neonatal side effects: tachycardia, urinary retention Few interactions with other medications No systematic studies in human pregnancy (LexaproR)
Possible increased risk of neonatal toxicity due to long half-life
1.2% - 12.0%
Vomiting, watery
(ProzacR)
(tachypnea, respiratory distress, tremors, agitation, motor
stools, excessive
automatisms)
crying, difficulty
sleeping, tremor,
Possible risk of pulmonary hypertension somnolence,
hypotonia,
Expert Consensus Guidelines top
decreased weight
choice during pregnancy (if not
planning to breastfeed)
No systematic studies in human pregnancy (RemeronR)
Maternal side effects additive to pregnancy effects(sedation, (PamelorR)
Orthostatic hypotension, risking decreased placental perfusion Fetal and neonatal side effects: tachycardia, urinary retention None (but may be more effective than
No behavioral studies in human pregnancy (PaxilR)
Possible increased risk of neonatal side effects (respiratory distress, tremor, hypoglycemia, changes in sleep pattern and behavioral state, convulsions, cardiac arrhythmias) • Possible risk of pulmonary hypertension Expert Consensus Guidelines top
No behavioral studies in human pregnancy (ZoloftR)
choice during pregnancy (if planning
to breastfeed)
Possible risk of pulmonary hypertension No behavioral studies in human pregnancy (EffexorR)
* Developed by the University of Illinois at Chicago (UIC) Perinatal Depression Project. Treatment decisions should be based on patient characteristics and clinical judgment. * = Physicians may consider initiating treatment with these agents at half of the lowest recommended therapeutic dose. Treatment decisions should be based on patient characteristics and clinical judgement. Recommended dosages can be found in the Physician’s Desk Reference, 60th ed. Table based on Wisner et al Postpartum Depression Article in N Eng J Med, Vol. 347, No. 3, July 18, 2002, pg. 196 & related articles ** These are weight-adjusted estimates. General notes: About 70% of women with recurrent major depression relapse during pregnancy if they discontinue antidepressant medication. Untreated major depression during pregnancy is associated with increased risk of preterm birth, lower birth weight, pre-eclampsia and neonatal irritability. All antidepressants, if abruptly discontinued during pregnancy or at the time of birth, can lead to discontinuation signs in the fetus or neonate. These signs can include irritability, excessive crying, difficulty sleeping, difficulty feeding, increased tone, hyperreflexia, shivering, tachypnea, and convulsions. Discontinuation side effects can be minimized by a partial dose taper during the last month of pregnancy, if the patient is asymptomatic, with a return to full dose after delivery to prevent postpartum recurrence. Pharmacokinetic changes during pregnancy can affect antidepressant dosing. For SSRI (citalopram, escitalopram, fluoxetine, paroxetine, sertraline) and tricyclic (desipramine, nortryptiline) antidepressants, many women need increased doses towards the second half of pregnancy to maintain a therapeutic effect.

Source: http://www.publichealthne.org/PHN-Meds-07-08.pdf