Switch from Lexapro to Zoloft?

[ams2]

We are considering trying to conceive another baby. I currently take 5 mg of Lexapro, which works well for me. My OB has recommended that I switch to Zoloft for pregnancy, but my psychiatrist says it is fine to stay on Lexapro. Is there reason to switch from Lexapro to Zoloft during pregnancy?

[Sandra]

ams2,

The data on each is very similar. If the Lexapro works for you I do not think it would be necessary to switch. Here is our data on each:

Lexapro is rated a P3-unknown risk to fetus cannot be ruled out. The use of escitalopram (Lexapro) in the third trimester of pregnancy did not have any adverse effects on the infant. Escitalopram (Lexapro) is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRI?s). In a case report published in 2006, the use of escitalopram in the third trimester of pregnancy did not have any adverse effects on the infant. Other studies have linked the use of SSRI?s with infant respiratory distress and low birth weight. More recently, an association between congenital heart defects and the use of SSRI's was described. This, however, has not been confirmed and more studies need to be done that address this.

1.##Alwan S, Reefhuis J, Rasmussen SA, Olney RS, Friedman JM. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med. Jun 28 2007;356(26):2684-2692.
2.##Oberlander TF, Warburton W, Misri S, Aghajanian J, Hertzman C. Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry. Aug 2006;63(8):898-906.
3.##Sivojelezova A, Shuhaiber S, Sarkissian L, Einarson A, Koren G. Citalopram use in pregnancy: prospective comparative evaluation of pregnancy and fetal outcome. Am J Obstet Gynecol. Dec 2005;193(6):2004-2009.


Zoloft (sertraline) is rated a P3-unknown risk to fetus cannot be ruled out. Studies show that the use of this drug in pregnancy does not increase the risk of congenital malformations.[1, 2] Sertraline is an antidepressant drug belonging to the group of selective serotonin reuptake inhibitors (SSRIs). Studies show that the use of this drug in pregnancy does not increase the risk of congenital malformations.[1, 2] Further, this drug has been linked to the development of neonatal abstinence syndrome. It is recommended that infants born to mothers who were on any SSRI during their pregnancy be followed closely for at least 48 hours.[3] This is to ensure that the infant does not develop neurologic symptoms of withdrawal. In a study published in 2009 by the British Medical Journal, it was found that infants of mothers who took an SSRI during pregnancy were at a higher risk of developing septal heart defects.[4] This data has subsequently been refuted and we do not believe that sertraline increases the risk of septal heart defects. A study has shown that if infants are exposed to SSRI prenatally alone or prenatally and postnatally via breast milk have blunted response to pain as compared to control infants.[5] A small prospective study has shown that mothers taking SSRI had a delayed onset of milk secretory activation by an average of 16.7 hours and the breastfeeding rate at 2 weeks postpartum was 27% to 33% lower than mother who didnt take antidepressants. More studies need to be done on this topic.

1.##Kulin NA, Pastuszak A, Sage SR, et al. Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA. Feb 25 1998;279(8):609-610.
2.##Einarson TR, Einarson A. Newer antidepressants in pregnancy and rates of major malformations: a meta-analysis of prospective comparative studies. Pharmacoepidemiol Drug Saf. Dec 2005;14(12):823-827.
3.##Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med. Feb 2006;160(2):173-176.
4.##Pedersen LH, Henriksen TB, Vestergaard M, Olsen J, Bech BH. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study. BMJ. 2009;339:b3569.
5.##Oberlander TF, Grunau RE, Fitzgerald C et al. Pain reactivity in 2-month-old infants after prenatal and postnatal serotonin reuptake inhibitor medication exposure. Pediatrics. 2005;115:411-25. PMID:15687451.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519