Reported facts:
(1) The relative odds of a neonate having atrial or ventricular septal defects and/or persistent pulmonary hypertension of the newborn (PPHN) are increased if the mother is taking paroxetine, primarily in the first trimester.
(2) The absolute risk appears low.
(3) It is uncertain how much of the apparent risk may be due to bias in some of the retrospective studies performed.
(4) It is uncertain whether all pertinent risk factors were controlled for.
Because there may be a risk, it is prudent to take a number of steps in a woman of child-bearing age with depression:
(1) If the woman is likely to become pregnant, then use another antidepressant if possible.
(2) The use of contraception should be considered, especially if short term use is anticipated.
(3) If the woman is taking paroxetine, abrupt discontinuation may be associated with a withdrawal syndrome or worsening of depression, the risks from which may outweigh the hazards of continuing the paroxetine.
(4) If the woman is taking paroxetine the lowest possible dose should be used (increased risk was reported by Berard et al for doses greater than 25 mg per day).
(5) Avoid the use of two or more types of SSRI if possible (Pedersen et al).
The patient must be informed of the various risks and the alternatives discussed to allow for an individualized solution.
