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Should we stop using tricyclic antidepressants in pregnancy?

  • C. M. Pariante (a1) (a2), G. Seneviratne (a1) and L. Howard (a2) (a3)

Abstract

A new Swedish study by Reis & Källén describes approximately 15 000 women (and their babies) that, between 1995 and 2007, reported the use of antidepressants, or were prescribed such drugs, during pregnancy. In this study, pregnancy and teratogenic outcomes after exposure to tricyclic antidepressants are, for most measures, equal or worse than after exposure to selective serotonin reuptake inhibitors or other antidepressants. Based on this and on a review of the few other studies available (admittedly, a relatively small number of women on which conclusions can be based), the authors of this Editorial challenge the ‘perinatal myth’ that tricyclics are the safest choice in pregnancy.

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Copyright

Corresponding author

*Address for correspondence: Dr C. M. Pariante, Section of Perinatal Psychiatry and Stress, Psychiatry and Immunology, Room 2-055, The James Black Centre, 125 Coldharbour Lane, London SE5 9NU, UK. (Email: carmine.pariante@kcl.ac.uk)

References

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Chambers, C (2009). Selective serotonin reuptake inhibitors and congenital malformations. British Medical Journal 339, b3525.
Davis, RL, Rubanowice, D, McPhillips, H, Raebel, MA, Andrade, SE, Smith, D, Yood, MU, Platt, R (2007). Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy. Pharmacoepidemiology and Drug Safety 16, 10861094.
Kallen, B (2004). Neonate characteristics after maternal use of antidepressants in late pregnancy. Archives of Pediatrics and Adolescent Medicine 158, 312316.
National Institute for Health and Clinical Excellence (2007). Antenatal and Postnatal Mental Health. Alden Press: Leicester, UK.
Nutt, DJ (2005). Death by tricyclic: the real antidepressant scandal? Journal of Psychopharmacology 19, 123124.
Pedersen, LH, Henriksen, TB, Vestergaard, M, Olsen, J, Bech, BH (2009). Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study. British Medical Journal 339, b3569.
Reis, M, Källén, B (2010). Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data. Psychological Medicine. Published online: 5 January 2010. doi:10.1017/S0033291709992194.
Simon, GE, Cunningham, ML, Davis, RL (2002). Outcomes of prenatal antidepressant exposure. American Journal of Psychiatry 159, 20552061.
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Yonkers, KA, Wisner, KL, Stewart, DE, Oberlander, TF, Dell, DL, Stotland, N, Ramin, S, Chaudron, L, Lockwood, C (2009). The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. General Hospital Psychiatry 31, 403413.

Keywords

Should we stop using tricyclic antidepressants in pregnancy?

  • C. M. Pariante (a1) (a2), G. Seneviratne (a1) and L. Howard (a2) (a3)

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