[New antidepressive agents during pregnancy and lactation. Drug concentration should be monitored and the lowest possible dose administered]

This article presents a literature review on the treatment with new antidepressants during pregnancy and lactation, focusing on possible unwanted effects to the fetus and infant. Most data is available for the selective serotonin reuptake inhibitors, and particularly for fluoxetine. Some information exists for venlafaxine, whereas no published data was found for other new antidepressants such as reboxetine and mirtazapine. In general, treatment with new antidepressants during the first trimester in pregnancy has not been associated with an increased risk for congenital malformations. In contrast, symptoms such as irritability, respiratory distress and muscular hypotonia have been reported in newborns after third trimester exposure. The excretion of new antidepressants in breast milk seems in most cases to be negligible. However, suspected adverse effects have been reported in a few infants. In conclusion, existing data seems to indicate that the positive effects of maternal drug treatment and of lactation to the infant generally outweigh the risks of possible pharmacological effects. Nevertheless, before a new antidepressant is prescribed to a pregnant or lactating woman, an individual risk/benefit-assessment should always be carried out.