Selective serotonin reuptake inhibitors and congenital malformations

doi:10.1136/bmj.b3525

Published 23 September 2009, doi:10.1136/bmj.b3525
Cite this as: BMJ 2009;339:b3525

Editorials

Selective serotonin reuptake inhibitors and congenital malformations

The small risk of harm must be balanced against risk of suboptimalor no treatment

The first 150 words of the full text of this article appear below.

Major depressive disorder in women is most common during theirchildbearing years, and about 13% of women in the United Stateshave taken an antidepressant drug during pregnancy.¹ ² In thepast 20 years, selective serotonin reuptake inhibitors (SSRIs)have become a mainstay of treatment in women with major depressivedisorder; however, concerns persist about safety for the developingfetus. This is counterbalanced by equally compelling concernsabout the consequences of undertreatment for mother and child.³

In the linked population based cohort study from Denmark (doi:10.1136/bmj.b3569),Pedersen and colleagues confirm a previously reported doublingof risk for septal heart defects after early exposure in pregnancyto SSRIs (odds ratio 1.99, 95% confidence interval 1.12 to 3.53).⁴However, in contrast to previous studies, redemptions of prescriptionsfor citalopram and sertraline, but not paroxetine or fluoxetine,were significantly associated with this group of heart defects.⁵⁶ ⁷ ⁸ Furthermore, unlike two previous large case-control . . . [Full text of this article]

Christina Chambers, associate professor

¹ Division of Dysmorphology and Teratology, Departments of Pediatrics and Family and Preventive Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0828, La Jolla, CA 92093-0828, USA

chchambers@ucsd.edu

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