[india-drug] Treatment Challenges of Depression in Pregnancy

["Pal, Shanthi N." <pals@who.int>]

Treatment Challenges of Depression in Pregnancy
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Dear Colleagues,

Below is a message from the US FDA on the use of antidepresants in
pregnancy. 

Best wishes,

Shanthi Pal
WHO
Geneva
"Pal, Shanthi N." <pals@who.int>

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MedWatch - The FDA Safety Information and Adverse Event Reporting
Program

FDA notified healthcare professionals and consumers of important
information from two recent studies that should be considered when
making treatment decisions in pregnant women who take antidepressants.
The studies included pregnant women who were treated with selective
serotonin reuptake inhibitors (SSRIs), or in a few cases, other
antidepressant medications.

One study illustrated the potential risk of relapsed depression after
stopping antidepressant medication during pregnancy.  In this study,
women who stopped their medicine were five times more likely to have a
relapse of depression during their pregnancy than were women who
continued to take their antidepressant medicine while pregnant.  

The second study suggests there may be additional, though rare, risks of
taking SSRI medications during pregnancy. This study focused on newborn
babies with persistent pulmonary hypertension (PPHN), which is a serious
and life-threatening lung condition that occurs soon after birth.
Babies born with PPHN have high pressure in their lung blood vessels and
are not able to get enough oxygen into their bloodstream.  In this
study, PPHN was six times more common in babies whose mothers took an
SSRI antidepressant after the 20th week of pregnancy compared to babies
whose mothers did not take an antidepressant.  The study was too small
to compare the risk of one drug compared to another.  The finding of
PPHN in babies of mothers who used a SSRI antidepressant in the second
half of pregnancy adds to concerns from previous reports that infants of
mothers taking SSRIs late in pregnancy may experience difficulties such
as irritability, difficulty feeding and in very rare cases, difficulty
breathing. 

Additionally, the labeling for paroxetine (Paxil) was recently changed
to add information about findings in an epidemiologic study that
suggests that exposure to the drug in the first trimester of pregnancy
may be associated with an increased risk of cardiac birth defects. 

Women who are pregnant or thinking about becoming pregnant should not
stop any antidepressant medication without first consulting their
physician.  The FDA is seeking additional information about the possible
risk of PPHN in newborn babies of mothers who took SSRI antidepressants
in pregnancy.  FDA has asked the sponsors of all SSRIs to change
prescribing information to describe the potential risk for PPHN.

Read the complete MedWatch 2006 Safety summary, including links to the
FDA Public Health Advisory at:

http://www.fda.gov/medwatch/safety/2006/safety06.htm#SSRIpreg

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