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PPHN and antidepressant information: Risk of Persistent Pulmonary Hypertension

 

Risk of Persistent Pulmonary Hypertension

Neuropsychiatry Reviews
March, 2006
By Karen L. Spittler

In the February 9 New England Journal of Medicine, Christina D. Chambers, PhD, MPH, and colleagues found that use of SSRIs during late pregnancy was associated with persistent pulmonary hypertension in newborns. Neither the use of SSRIs during early pregnancy nor the use of non-SSRI antidepressant drugs was associated with an increased risk of persistent pulmonary hypertension.

A total of 377 infants with persistent pulmonary hypertension and 836 control infants were included in the study. Maternal interviews were conducted regarding medication use in pregnancy and potential confounders, including demographic variables and health history. Among mothers taking antidepressants, the following SSRI medications were used: citalopram, fluoxetine, ... and sertraline. In addition, mothers reported using the following non-SSRIs: tricyclic antidepressant medications (ie, amitriptyline, imipramine, and nortriptyline), bupropion, venlafaxine, and trazodone.

Dr. Chambers’ team found that 14 infants with persistent pulmonary hypertension had been exposed to an SSRI after the 20th week of gestation, compared with six control infants. "The frequency of infant death up to the time of maternal interview was 3% in the persistent pulmonary hypertension group and 0% in the control group," noted the researchers.

They also reported that the risk of persistent pulmonary hypertension was not associated with exposure to any antidepressant medication at any time during pregnancy, nor was risk associated with exposure to SSRIs alone at any time during pregnancy. However, further analysis revealed that exposure to SSRIs after the 20th week of gestation was associated with an increased risk of persistent pulmonary hypertension. "There was no increased risk of persistent pulmonary hypertension when SSRI use was restricted to the first half of the pregnancy," stated the researchers.

"Further research should assess the relationship of different types and dosages of SSRIs with persistent pulmonary hypertension and with milder respiratory complications in newborns," suggested Dr. Chambers and her colleagues. "Studies should also be undertaken to investigate whether there is any association between SSRIs and persistent pulmonary hypertension in the offspring of women who discontinue SSRI use late in pregnancy. Furthermore, to better identify patients who may be at risk, investigations should explore interactions between environmental and genetic factors."

The researchers concluded that "clinicians and their patients must consider both the benefits of SSRIs in the treatment of depression and the potential risk of persistent pulmonary hypertension relative to the risks and benefits of alternative treatments or nontreatment."

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