What is the role of antidepressant medications in the pathogenesis of neonatal abstinence syndrome (NAS)?

Updated: Dec 20, 2017
  • Author: Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP; Chief Editor: Santina A Zanelli, MD  more...
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Answer

Neonates exposed to antidepressant medications during gestation are at increased risk of NAS. Selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine, paroxetine, sertraline, citalopram, escitalopram, and fluvoxamine) are now the most frequently used drugs to treat depression both in the general population and in pregnant women, and they are also used to treat a wide spectrum of other mood and behavioral disorders. Infants exposed to SSRIs during the last trimester of pregnancy may exhibit neonatal adaptation syndrome. This is primarily manifested as CNS signs (eg, irritability, seizure), motor signs (eg, agitation, tremors, hypertonia), respiratory (eg, increased respiratory rate, nasal congestion), and GI signs (eg, emesis, diarrhea, feeding difficulty), fever, and hypoglycemia. [20] The onset of these signs ranges from several hours to several days after birth, and they are self-limiting, usually disappear by age 2 weeks. Symptoms are more commonly reported with fluoxetine and paroxetine exposure.

A prospective study showed no statistically significant differences between tricyclic antidepressants and SSRIs. It also revealed that women using antidepressants often use other medications as well during pregnancy, making the interpretation of antidepressant withdrawal symptoms difficult. A decrease in maternal SSRI and tricyclic antidepressant use during the third trimester may lower the neonatal risk of developing withdrawal syndrome; however, this needs to be balanced against the harmful effects of depression during pregnancy.

A case has been reported in which maternal tianeptine (atypical antidepressant) dependence during pregnancy appeared to induce a type of NAS that mimics opiate NAS. [21]


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