The new antidepressants

Antidepressants have not been shown to be teratogenic, but can affect the neonate.

Fluoxetine has not been associated with an increased incidence of abnormality in retrospective studies, nor have there been adverse reports with the other SSRI antidepressants. Neither moclobemide nor the older monoamine oxidase inhibitors have been associated with abnormalities in humans. Excessive caution or suspension of treatment with these medications is not indicated if the depression is significant.

Reports of toxic effects in babies born to mothers taking SSRIs are infrequent, but include acrocyanosis, tachypnoea and jitters. Because of their long half lives, if the SSRI antidepressants were used during pregnancy, they would be best stopped, possibly abruptly, well in advance of delivery. This would reduce any risks of toxic effects in neonates.

For lactating women, the SSRI antidepressants may be of some concern for the baby and, in addition, have been associated with sore breasts and gynaecomastia. Because of lack of experience, medical literature advises against their use. Moclobemide appears more acceptable for lactating women as very low concentrations have been measured in breast milk. Due to its short half life, the general advice of taking the drug after breastfeeding would be appropriate.

Neil Hotham

Senior Pharmacist, Drug Information Service, Women's and Children's Hospital, Adelaide