"SAFEST" OR Prefferrd SSRI in pregnancy

[Mel1108]

Hello I have recently tried zoloft with no success. My dr wants me to try trintellix but it is a newer SSRI. I would like to know what is considered the safest or preffered SSRI's in pregnancy or are they all.considered the same as far as safety? Specifically prozac, lexapro, and trintellix. Thankyou

[Sandra]

Mel1108,

The Trintellix is a newer medication than the Lexapro and the Prozac, but all are rated a P3's in pregnancy as was the Zoloft. Here is the data we have on each of these medication:

Trintellix is rated a P3-unknown-risk to fetus cannot be ruled out. "The incidence of anomalies in human pregnancies has not been established for vortioxetine at this time. However, there were no teratogenic effects in rats or rabbits at doses up to 77 and 58 times, the MRHD of vortioxetine when administered during organogenesis. Vortioxetine was found to cause developmental delays (decreased fetal body weight and delayed ossification) when administered during pregnancy to rats and rabbits at doses 15 and 10 times the maximum recommended human dose (MRHD).[1] Some neonates exposed to SSRIs or SNRIs late in the third trimester have developed serious complications requiring prolonged hospitalization. Such complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. These features are consistent with either a direct toxic effect of these classes of drugs or possibly, a drug discontinuation syndrome. Other antidepressant classes (e.g. SSRIs) that work similarly to vortioxetine have also been associated with persistent pulmonary hypertension of the newborn, although more recent studies dispute this association.[1] This medication should only be used if benefits to the pregnant woman outweigh risks to the fetus." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

1.##Pharmaceutical manufacturer prescribing information, 2013.

Lexapro is rated a P3-unknown-risk to fetus cannot be ruled out. "The use of escitalopram 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." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

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.

Prozac is rated a P3-unknown-risk to fetus cannot be ruled out. " Fluoxetine crosses the human placenta. Although some studies refute it, others suggest that there is an association between the use of fluoxetine in the first trimester and cardiovascular malformations.[2] In the third trimester, fluoxetine use does not seem to cause any complications to the fetus and neonate. Meta-analysis reviews have not proven any relationship between fluoxetine usage in the first trimester and congenital malformations in humans.[5] Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Compared with other drugs used in the treatment of depression, SSRIs have less side effects. [1] Fluoxetine crosses the human placenta. Although some studies refute it, others suggest that there is an association between the use of fluoxetine in the first trimester and cardiovascular malformations.[2] In the third trimester, fluoxetine use does not seem to cause any complications to the fetus and neonate.[3] It is important for mothers to continue using their antidepressant medication postpartum since there seems to be an association between depression in pregnancy and postpartum depression.[4] Meta-analysis reviews have not proven any relationship between fluoxetine usage in the first trimester and congenital malformations in humans.[5]" (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

1.##Morrison JL, Riggs KW, Rurak DW. Fluoxetine during pregnancy: impact on fetal development. Reprod Fertil Dev. 2005;17(6):641-650.
2.##Diav-Citrin O, Shechtman S, Weinbaum D, et al. Paroxetine and fluoxetine in pregnancy: a prospective, multicentre, controlled, observational study. Br J Clin Pharmacol. Nov 2008;66(5):695-705.
3.##Goldstein DJ. Effects of third trimester fluoxetine exposure on the newborn. J Clin Psychopharmacol. Dec 1995;15(6):417-420.
4.##Cohen LS, Heller VL, Bailey JW, Grush L, Ablon JS, Bouffard SM. Birth outcomes following prenatal exposure to fluoxetine. Biol Psychiatry. Nov 15 2000;48(10):996-1000.
5.##Addis A, Koren G. Safety of fluoxetine during the first trimester of pregnancy: a meta-analytical review of epidemiological studies. Psychol Med. Jan 2000;30(1):89-94.

Sandra Lovato R.N.
InfantRisk Center