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Newborn Infant Behaviors Following In Utero Exposure to SSRIs and Maternal Depression
In Session With Amy L. Salisbury, PhD:
Newborn Infant Behaviors Following In Utero Exposure to SSRIs and Maternal Depression
Associate Professor, Departments of Pediatrics and Psychiatry & Human Behavior, Alpert Medical School, Brown University; Clinical Nurse Specialist, Child & Family Psychiatry, Brown Center for Children & Families, Women & Infants Hospital, Providence, RI
First published in Psychiatry Weekly, Volume 10, Issue
2, on December 28, 2015
An unabridged version of this interview is available at Primary Psychiatry
Q: What is generally understood about the risks or benefits posted to infants whose mothers received SSRI treatment during pregnancy?
A: Previous research has found that ~30% of infants whose mothers received antidepressant treatment during pregnancy may demonstrate an array of behavioral and physiological signs of distress (eg, irritability, poor feeding, and tremulousness). Several studies reported that the signs were no longer observed after the first 7–10 days following birth. It was suggested that these infants were experiencing withdrawal from the antidepressants medication. It was unclear, however, why some infants had these signs and others didn’t, nor was it clear whether any of these signs could be attributed to a mother’s underlying diagnosis of a depressive disorder.
We devised our own study, with a goal of measuring these infant behaviors with a standardized neurobehavioral exam over the first postnatal month. The exam was conducted on days 2, 4, 7, 14, and 30 following delivery. Four groups of infants were included in the study: exposure to SSRI-only, exposure to SSRI+benzodiazepine, exposure to maternal depression with no pharmacological treatment, and no exposure to maternal depression or psychotropics.
Q: How did postnatal behavioral outcomes vary in infants across the continuum of exposure in your study?
A: None of the full-term infants in the study appeared to have any serious adverse events that could be attributed to medication or depression exposure. Infants in the SSRI-exposed and SSRI+benzodiazepine groups had lower quality of movement and more CNS stress signs than infants in the non-exposed group and the non-treated depression group overall. Although the change over time was not statistically different between groups, the trajectories show that both quality of movement and CNS stress signs were highest at the 14-day assessment for SSRI-exposed infants, indicating that SSRI-exposed infants were more irritable than the other infants during the first several weeks following birth. Infants with SSRI+benzodiazepine exposure continued to have lower quality of movement and lower self-regulation than other infants at day 30.
There was a trend for all three clinical groups to have a widening gap from the control infants by day 30 for attention and habituation. In fact, the infants in the three clinical groups showed a flattening in scores toward day 30 for attention scores, and a decline in habituation scores. Maternal depression was a common factor for these three groups, which suggests that depression, rather than medication exposure alone, may have contributed to these findings, and that the effects attributable to maternal depression may be more apparent later in the first month than effects attributable to medication exposure.
Remission of maternal depressive symptoms during pregnancy should remain the focus of treatment for women with depression. This study was not designed to test safety of the medications, but it does address the course of the behaviors often seen in infants after SSRI exposure. This information can be used to prepare women for what to expect after delivery, particularly that the infant may exhibit irritability and distress, which may actually get worse after the first two weeks, especially with SSRI+benzodiazepine exposure, but that most infants will show improvement in these behaviors by the end of the first month.
An unabridged version of this interview is available at Primary Psychiatry
Disclosure: Dr. Salisbury reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.
References:
Salisbury AL, O’Grady KE, Battle CL, et al. The roles of maternal depression, serotonin reuptake inhibitor treatment, and concomitant benzodiazepine use on infant neurobehavioral functioning over the first postnatal month. Am J Psychiatry. 2015 Oct 30. [Epub ahead of print]