Should Paxil Be Used During Pregnancy?

Seattle, WADespite the wealth of research on Paxil and its link to birth defects, findings remain inconclusive. The most recent study on the subject, published in the Journal of Midwifery & Women's Health on 3/25/10, notes that depression occurs in approximately 12 to 15 percent of pregnant women and is one of the most common medical conditions to impact expectant mothers. However, contradictory research on the treatment of depression in pregnant women makes it difficult for doctors and pregnant women to come to a decision about whether or not to treat the depression.


"Depression is a condition for which many women's health care providers feel unprepared to detect or manage," says study author Barbara Hackley. "Recent reports of neonatal complications associated with the use of some commonly used antidepressants makes the management of depression even more complex."

She further notes that there is limited evidence to help make a decision between the various antidepressants available to pregnant women. These antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs) and norepinephrine/dopamine reuptake inhibitors (NDRIs).

There is mixed scientific evidence as to whether or not Paxil and other SSRIs increases the risk of heart defects in infants. Paxil is a pregnancy category D medication, meaning that human studies and/or adverse reaction data show evidence of fetal risk but the benefits may outweigh the risks. Some studies have suggested a higher risk of cardiac defects in infants exposed to paroxetine (Paxil) during the first trimester.

Other side effects linked to SSRIs include pulmonary hypertension and preterm birth. Here, too, the scientific studies are split as to whether or not exposure to SSRIs increases the risk of these side effects. Some studies suggest a link between SSRIs late in pregnancy and an increased risk of pulmonary hypertension; others came to the conclusion that there is no increased risk.

Exposure to SSRIs prior to birth has also been linked to short-term problems in infants after birth, such as jitteriness, irritability, respiratory distress and problems feeding.

There are also potential complications resulting from untreated depression in pregnant women, including miscarriage, early birth, suicide attempts and postpartum depression. Untreated depression in the mother can also result in poorer behavioral and mental health outcomes in the children.

Hackley suggests that, if possible, women should wait to use antidepressants until after the first trimester. She further recommends starting the antidepressant at a low dose and gradually moving it up until remission is achieved.