Neonatal Discontinuation Syndrome in Serotonergic Antidepressant-Exposed Neonates

J Clin Psychiatry. 2017 May;78(5):605-611. doi: 10.4088/JCP.16m11044.

Abstract

Objective: To determine whether infants exposed in utero to serotonin reuptake inhibitor (SRI) antidepressants or a DSM-IV-TR-defined mood disorder have significantly more neonatal discontinuation signs compared to an unexposed group of infants at 2-4 weeks after birth.

Methods: This secondary analysis was derived from 2 observational studies with enrollment from July 2000 to December 2011 in Cleveland, Ohio, and Pittsburgh, Pennsylvania. Mothers (n = 214) belonged to one of 3 groups based on exposure status during pregnancy: (1) Comparison-women who did not take psychotropics during pregnancy and had no major mood disorder; (2) SRI-exposed-women with a mood disorder who were taking an SRI but no benzodiazepines; and (3) Mood Disorder-women with depression or bipolar disorder who did not take psychotropic medications. The infants were examined for signs according to the Finnegan Scale by evaluators blind to maternal exposure status.

Results: The rates of sign presence (defined as a score ≥ 2 on the Finnegan Scale) in the SRI, Mood Disorder, and Comparison groups were similar at 34.1%, 35.1%, and 30.4%, respectively. Women in the SRI group had a significantly higher preterm birth rate (24.4%) compared to the other 2 groups (7.4% and 8.9% in the Mood Disorder and Comparison groups, respectively; P = .012). Preterm newborns had a significantly higher sign rate compared to full-term newborns (54% vs 31%, P = .020). We observed a significant relationship between Finnegan signs and preterm birth.

Conclusions: The presence of neonatal signs at 2-4 weeks was more closely associated with prematurity than with in utero SRI or mood disorder exposure.

Trial registration: ClinicalTrials.gov identifiers: NCT00279370 and NCT00585702.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Antidepressive Agents / adverse effects*
  • Antidepressive Agents / therapeutic use
  • Antimanic Agents / adverse effects*
  • Antimanic Agents / therapeutic use
  • Bipolar Disorder / drug therapy*
  • Depressive Disorder, Major / drug therapy*
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature, Diseases / chemically induced
  • Infant, Premature, Diseases / diagnosis
  • Neonatal Abstinence Syndrome / diagnosis
  • Neonatal Abstinence Syndrome / etiology*
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Prenatal Exposure Delayed Effects / diagnosis*
  • Prenatal Exposure Delayed Effects / etiology*
  • Selective Serotonin Reuptake Inhibitors / adverse effects*
  • Selective Serotonin Reuptake Inhibitors / therapeutic use

Substances

  • Antidepressive Agents
  • Antimanic Agents
  • Serotonin Uptake Inhibitors

Associated data

  • ClinicalTrials.gov/NCT00279370
  • ClinicalTrials.gov/NCT00585702