Abstract
A recently published study [1] describes clinically significant symptoms of serotonergic over-stimulation in 20 neonates whose mothers took either fluoxetine or citalopram in late pregnancy, compared to 20 matched control infants. These effects were no longer present at 2 weeks. It is crucially important to note that only neonates whose mothers took fluoxetine were affected, and citalopram-exposed infants did not differ from controls. The authors do not sufficiently emphasize this point, and imply that the findings apply to SSRIs in general. Fluoxetine has an extremely long half-life, and the authors seem to omit this from their interpretation of the findings.
This is essentially a pilot study and requires replication with a larger sample size. There are already papers warning about fluoxetine in late pregnancy and suggesting a 15–30% dose reduction 2 weeks before delivery in view of the reduced capacity of the neonatal liver to metabolize and clear it. This, of course, poses the risk of relapse of depression in the mother.
I believe, on the basis of this study clinicians should not cease prescribing SSRIs during pregnancy nor cease or reduce dosage prior to delivery. Rather the message from this study is to favour SSRIs having shorter halflives for treatment of pregnant women. There is no evidence from this or other studies that such treatment endangers the infant, and the benefits in terms of effective treatment of depression will usually outweigh any risk.