From the Guidelines
Neonatal abstinence symptoms can occur with SSRIs, and pregnant women taking these medications should be aware of the potential risks and discuss medication management with their healthcare providers. When a pregnant woman takes SSRIs such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), or escitalopram (Lexapro) during pregnancy, especially in the third trimester, the newborn may experience withdrawal symptoms after birth, as reported in a study published in Pediatrics in 2012 1. These symptoms typically appear within the first few days of life and may include:
- Irritability
- Excessive crying
- Tremors
- Feeding difficulties
- Sleep disturbances
- Respiratory distress
- Occasionally seizures
The condition is sometimes called Neonatal Adaptation Syndrome or Poor Neonatal Adaptation when associated with SSRIs. The mechanism involves the sudden discontinuation of serotonin exposure to the infant's brain after birth, following consistent exposure during pregnancy 1. Despite these potential effects, abruptly stopping antidepressant medication during pregnancy is not recommended, as the risks of untreated maternal depression may outweigh the risks of medication exposure. Pregnant women taking SSRIs should discuss medication management with both their psychiatrist and obstetrician to develop an appropriate treatment plan, and clinicians should be aware that infants are at risk for manifesting clinical signs of drug toxicity or withdrawal over the first week of life and arrange for early follow-up after the initial hospital discharge 1.
From the FDA Drug Label
Neonates exposed to PAXIL and other SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs), late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. 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. Nonteratogenic EffectsNeonates exposed to Prozac and other SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs), late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. 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.
Yes, neonatal abstinence symptoms can happen with SSRI use. The symptoms include:
- Respiratory distress
- Cyanosis
- Apnea
- Seizures
- Temperature instability
- Feeding difficulty
- Vomiting
- Hypoglycemia
- Hypotonia
- Hypertonia
- Hyperreflexia
- Tremor
- Jitteriness
- Irritability
- Constant crying 2 and 3
From the Research
Neonatal Abstinence Symptoms and SSRI
- Neonatal abstinence symptoms can occur in infants exposed to selective serotonin reuptake inhibitors (SSRIs) during pregnancy, as reported in a study published in 2001 4.
- The symptoms of neonatal withdrawal syndrome after in utero SSRI exposure can include irritability, constant crying, shivering, increased tonus, eating and sleeping difficulties, and convulsions 4.
- A study published in 2014 found that 13% of infants exposed to SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) in utero expressed signs of severe abstinence, while 22% had mild abstinence symptoms 5.
- Another study published in 2021 identified hypoglycemia, tremors, hypotonia, tachycardia, rapid breathing, respiratory distress, and hypertonia as potential withdrawal signs in infants exposed to SSRIs or SSRIs/venlafaxine in utero 6.
Comparison with Other Substances
- Neonatal abstinence syndrome (NAS) is typically associated with exposure to opiates or illicit drugs during pregnancy, as noted in a study published in 2013 7.
- However, the available evidence suggests that SSRIs can also cause neonatal abstinence symptoms, although the pathophysiology and clinical presentation may differ from NAS caused by other substances 4, 5, 6.
- The Finnegan scoring system is commonly used to assess the severity of NAS, but its application to SSRI-induced neonatal abstinence symptoms may require further study 8.
Clinical Implications
- Infants exposed to SSRIs in utero should be closely monitored for withdrawal symptoms after birth, as recommended in a study published in 2001 4.
- The use of SSRIs during pregnancy, particularly in the third trimester, should be carefully considered and weighed against the potential risks of neonatal abstinence symptoms 4, 6.
- Further research is needed to fully understand the risks and consequences of SSRI-induced neonatal abstinence symptoms and to develop effective strategies for prevention and treatment 6.