Pharmacological aspects of neonatal antidepressant withdrawal

Peter G J Ter Horst, Frank G A Jansman, Richard A van Lingen, Jan-Pieter Smit, Lolkje T W de Jong-van den Berg, Jacobus R B J Brouwers

    Onderzoeksoutput: Review articlepeer review

    32 Citaten (Scopus)
    494 Downloads (Pure)


    Depression is common in reproductive age women, and continued pharmacologic treatment of depression during pregnancy may be necessary to prevent relapse, which could be harmful for both the fetus and the mother. Although data on drug safety are imperfect and incomplete, the benefits of antidepressant therapy during pregnancy generally outweigh the risks. Neonates who are exposed to antidepressant medications during gestation are at increased risk to have neonatal withdrawal syndrome, although the exact incidence of this complication is unknown because the definition of the syndrome is not clear and withdrawal reactions are probably underreported. Tricyclic antidepressant withdrawal syndrome is most likely related to muscarinergic activity and individual drug half-lives, and selective serotonin reuptake inhibitor withdrawal may be due to a decrease in available synaptic serotonin in the face of down-regulated serotonin receptors, the secondary effects of other neurotransmitters, and biological or cognitive sensitivity. Other factors that influence neonatal toxicity or withdrawal include the normal physiologic changes of pregnancy, the altered activity of CYP450 enzymes during pregnancy, drug-drug transporter (PgP and OCT3) interaction, and the presence of genetic polymorphisms in genes influencing drug metabolism. Further research is necessary.

    Originele taal-2English
    Pagina's (van-tot)267-279
    Aantal pagina's13
    TijdschriftObstetrical & Gynecological Survey
    Nummer van het tijdschrift4
    StatusPublished - apr.-2008

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