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Serotonergic Symptoms in SSRI-Exposed Infants

Compared with controls, SSRI-exposed infants had higher serotonin-symptom scores at 4 days but not at 2 weeks; still, long-term implications remain unknown.

Researchers continue to investigate the effects of prenatal exposure to SSRIs (see summaries of research on several SSRIs and on fluoxetine). These Finnish authors looked for evidence of serotonergic overstimulation or withdrawal symptoms among 20 full-term newborns whose mothers had taken fluoxetine or citalopram for major depressive or panic disorder during at least the third trimester of pregnancy. Twenty matched, unexposed newborns with healthy mothers were also examined. Cord blood and infant blood were assayed, and pediatricians rated serotonin symptoms (myoclonus, restlessness, tremor, shivering, hyperreflexia, incoordination, and rigidity) at 4 days, 2 weeks, and 2 months after delivery.

Neuroimaging identified self-resolving neonatal thalamic cysts in 6 SSRI-exposed infants. Compared with controls, SSRI-exposed infants had significantly lower Apgar scores at 15 minutes and higher serotonin-symptom scores at 4 days. When serotonin symptoms were analyzed by medication, fluoxetine, but not citalopram, was associated with higher scores. Compared with controls, fluoxetine-exposed and citalopram-exposed infants had, respectively, 49% and 14% lower prolactin cord-blood levels. Cord-blood levels of serotonin metabolite correlated inversely with serotonin-symptom scores, and between-group differences disappeared by 2 weeks.

Comment: Although these findings are limited by small sample size, the data can help clinicians educate pregnant patients about the pros and cons of using SSRIs for depression or other SSRI-responsive disorders. Because infant-blood drug levels decreased as serotonin-symptom ratings decreased, the symptoms were probably due to serotonin stimulation, not serotonin withdrawal. Low prolactin levels may be important clinically because they are associated with an increased risk for respiratory distress syndrome. Overall, citalopram may affect infants less than fluoxetine on the study measures, but this issue requires further study. The actual implication of these findings for long-term infant well-being is still unclear.

— Barbara Geller, MD

Published in Journal Watch Psychiatry September 18, 2003

Citation(s):

Laine K et al. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry 2003 Jul; 60:720-6.

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