title: [Antidepressant use in pregnancy: a critical review of the risk and benefits].
abstract: OBJECTIVE
  Pregnancy is considered a high-risk period for the development of a depressive disorder in women, particularly in those with a pre-existing affective disorder. The use of antidepressants in pregnancy may be responsible for congenital malformations and neonatal toxicity. The aim of the study is to review the literature examining the various antidepressants used in pregnancy and their relationship with the development of congenital malformation and neonatal diseases; in particular, we have focused on the evaluation of the risk/benefit in the administration of specific drugs, the possible teratogenicity and placental transfer.
  
  
  METHODS
  We performed a computerized search of PubMed through the papers published from 1996 to 2014, identifying the studies that have showed a relationship between treatment with antidepressants in pregnancy and teratogenic effects and toxicity in the short and long term.
  
  
  RESULTS
  The revision of the pharmacovigilance studies indicate that most of the selective serotonin reuptake inhibitors have a teratogenic risk substantially similar to that of unexposed controls. For other antidepressants (tricyclics, mirtazapine, venlafaxine, escitalopram, duloxetine) the evidences on the level of risk are still numerically inconsistent and need to be clarified by further research.
  
  
  CONCLUSIONS
  Despite the lack of guidelines for the treatment of depressive disorders during pregnancy, clinically relevant data are continuing to accumulate in the literature. For many medications, compared to the past, we are now able to make a more rational and less approximate estimate of the risk/benefit ratio.
authors.affiliation: Dipartimento di Medicina Molecolare e Dipartimento Interaziendale di Salute Mentale, AOU Senese, Università di Siena, USL 7, Siena.
authors.forename: Arianna
authors.initials: A
authors.lastname: Goracci
authors.affiliation: Dipartimento di Medicina Molecolare e Dipartimento Interaziendale di Salute Mentale, AOU Senese, Università di Siena, USL 7, Siena.
authors.forename: Marta
authors.initials: M
authors.lastname: Valdagno
authors.affiliation: Dipartimento di Medicina Molecolare e Dipartimento Interaziendale di Salute Mentale, AOU Senese, Università di Siena, USL 7, Siena.
authors.forename: Elisa
authors.initials: E
authors.lastname: Maltinti
authors.affiliation: Libera professionista.
authors.forename: Silvia
authors.initials: S
authors.lastname: Sillari
authors.affiliation: Dipartimento di Medicina Molecolare e Dipartimento Interaziendale di Salute Mentale, AOU Senese, Università di Siena, USL 7, Siena.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fagiolini
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D003866:Depressive Disorder / Q000188:drug therapy; D005260:Female; D005333:Fetus / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000139:chemically induced; D008431:Maternal-Fetal Exchange; D010920:Placenta / Q000378:metabolism; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011297:Prenatal Exposure Delayed Effects; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors