SSRIs during pregnancy may cause neonatal withdrawal syndrome

The risks of neonatal convulsions and neonatal withdrawal syndrome seem to increase when a pregnant women uses selective serotonin reuptake inhibitors (SSRIs), with paroxetine being the worst offender, according to cases reported by 72 countries to the World Health Organization's Collaborating Centre for International Drug Monitoring in Uppsala, Sweden.

Of 93 suspected cases of SSRI-induced neonatal withdrawal syndrome (including 13 cases of seizures) reported by November 2003, 64 were associated with paroxetine, 14 with fluoxetine, nine with sertraline, and seven with citalopram.

As a result, the investigators recommend that paroxetine not be used during pregnancy or, if it must be used, that it be given at the lowest effective dose. They also recommend that the use of other SSRIs during pregnancy be carefully monitored, and that physicians report any new cases of neonatal withdrawal syndrome promptly to appropriate authorities.