cont. from

Newborns Can Develop Symptoms...

Maternal use of antidepressants during pregnancy can result in a neonatal discontinuation syndrome characterized by symptoms such as irritability, respiratory difficulty and poor feeding. Tapering or discontinuing antidepressants prior to delivery may therefore be beneficial for the neonate, but also introduces the risk of depressive relapse in the mother. Neonates born to mothers on antidepressant therapy should be monitored for discontinuation symptoms over the first week of life.^[1]

...Or Even as a Result of Breast Feeding

All antidepressants studied have been shown to be present in breast milk and therefore have the potential to cause toxic effects in breast fed infants. Furthermore, a possible case of neonatal discontinuation reaction following abrupt discontinuation of sertraline by a nursing mother has been reported.^[11] Whether the possibility of antidepressant neonatal toxicity and/or discontinuation symptoms outweighs the benefits of breast feeding for mother and infant is a decision which can be made only on a case by case basis.

Tables

Table 1. Antidepressants reported to have caused discontinuation symptoms^[1]

TCA = tricyclic antidepressant; MAOI = monoamine oxidase inhibitor; SSRI = selective serotonin reuptake inhibitor.

Table 2. Key symptom groups and common symptoms in SSRI and TCA discontinuation syndromes^[2]

Symptom group	Common symptoms	Common feature of SSRI discontinuation syndromes	Common feature of TCA discontinuation syndromes
Dysequilibrium	Light headedness/dizziness, vertigo, ataxia
Sensory symptoms	Paraesthesia, numbness, electric shock-like sensations
General somatic symptoms	Lethargy, headache, tremor, sweating, anorexia
Sleep disturbance	Insomnia, nightmares, excessive dreaming
Gastrointestinal symptoms	Nausea, vomiting, diarrhea
Affective symptoms	Irritability, anxiety/agitation, low mood

SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant.

next: How to Safely Stop Taking Your Antidepressant

References

1. Haddad PM. Antidepressant discontinuation syndromes: clinical relevance, prevention and management. Drug Saf 2001; 24 (3): 183-97
2. Haddad P. The SSRI discontinuation syndrome. J Psychopharmacol 1998; 12 (3): 305-13
3. Michelson D, Fava M, Amsterdam J, et al. Interruption of selective serotonin reuptake inhibitor treatment: double-blind, placebo controlled trial. Br J Psychiatry 2000; 176: 363-8
4. Oehrberg S, Christiansen PE, Behnke K, et al. Paroxetine in the treatment of panic disorder: a randomised, double-blind, placebo-controlled study. Br J Psychiatry 1991; 167: 374-9
5. Fava M, Mulroy R, Alpert J, et al. Emergence of adverse effects following discontinuation of treatment with extended-release venlafaxine. Am J Psychiatry 1997; 154 (12): 1760-2
6. Rosenbaum JF, Fava M, Hoog SL, et al. Selective serotonin reuptake inhibitor discontinuation syndrome: a randomised clinical trial. Biol Psychiatry 1998; 44: 77-87
7. Olver JS, Burrows GD, Norman TR. Discontinuation syndromes with selective serotonin reuptake inhibitors: are there clinically relevant differences? CNS Drugs 1999 Sep; 12 (3): 171-7
8. Price JS, Waller PC, Wood SM, et al. A comparison of the postmarketing safety of four selective serotonin re-uptake inhibitors, including the investigation of symptoms occurring, on withdrawal. Br J Clin Pharmacol 1996; 42: 757-63
9. British National Formulary. No. 41. London: The Pharmaceutical Press, 2001 Mar: 187
10. Rosenbaum JF, Zajecka J. Clinical management of antidepressant discontinuation. J Clin Psychiatry 1997; 58 Suppl. 7: 37-40
11. Kent LSW, Laidlaw JDD. Suspected congenital sertraline dependence [letter]. Br J Psychiatry 1995; 167: 412-3

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Reviewed: 12/2001