title: Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence.
abstract: BACKGROUND
  Psychiatric disorders are among the leading causes of disability in Western societies. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressant drugs during pregnancy and the postpartum period. Over the last decade, conflicting findings regarding the safety of SSRI drugs during pregnancy and lactation have questioned whether such treatments should be used during this period.
  
  
  METHODS
  We discuss the main criteria that should be considered in the risk/benefit assessment of SSRI treatment in pregnant and/or breastfeeding patients (i.e., risks associated with SSRI use and with untreated depression as well as therapeutic benefits of SSRI and some alternative treatment strategies). For each criterion, available evidence has been synthesized and stratified by methodological quality as well as discussed for clinical impact.
  
  
  CONCLUSIONS
  Currently, it is impossible for most of the evaluated outcomes to distinguish between the effects related to the mother's underlying disease and those inherent to SSRI treatment. In women suffering from major depression and responding to a pharmacological treatment, introduction or continuation of an SSRI should be encouraged in order to prevent maternal complications and to preserve maternal-infant bonding. The choice of the right drug depends above all on individual patient characteristics such as prior treatment response, diagnoses and comorbid conditions.
authors.affiliation: School of Pharmaceutical Sciences, University of Geneva and University of Lausanne , Geneva , Switzerland.
authors.forename: Etienne
authors.initials: E
authors.lastname: Weisskopf
authors.forename: Céline J
authors.initials: CJ
authors.lastname: Fischer
authors.forename: Myriam
authors.initials: M
authors.lastname: Bickle Graz
authors.forename: Mathilde
authors.initials: M
authors.lastname: Morisod Harari
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Tolsa
authors.forename: Olivier
authors.initials: O
authors.lastname: Claris
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vial
authors.forename: Chin B
authors.initials: CB
authors.lastname: Eap
authors.forename: Chantal
authors.initials: C
authors.lastname: Csajka
authors.forename: Alice
authors.initials: A
authors.lastname: Panchaud
mesh_terms: D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007774:Lactation; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: antidepressant; benefit; lactation; pregnancy; risk; selective serotonin reuptake inhibitors