Paxil and Preemie withdrawl(withdrawal)

My daughter was born premature at 33 weeks (pre-eclampsia, induction)  She was healthy, but suffered severe withdrawl (withdrawal) effects from my use of Paxil during my pregnaancy.  My doctor told me it was safe to continue taking (OB/Gyn and Psych.) during pregnancy, but in my 5th month the FDA changed the warnings.  My OB insisted it was still safe to take.  My daughters Neonatologist said that he hadn't seen many cases of withdrawl (withdrawal) from this drug, and I was just wondering if you had, and what testing is done currently to rule out heart/lung/brain problems caused by using the drug during pregnancy?

[Yao Sun, MD, PhD]

Paxil (paroxetine) is a member of the anti-depressant group known as the Selective Serotonin Reuptake Inhibitors (SSRIs).  These drugs have been studied over the last 10+ years with conflicting results from the research studies.  Even the risk of congenital malformations is still somewhat controversial

The most common neonatal effect may be a phenomenon some people call "abnormal neonatal adaptation", which means it takes a baby longer to achieve all the normal newborn behavior after birth.  Babies with this problem can have some breathing difficulties and feeding problems initially, but the symptoms are self-resolving and go away without any specific treatment required.

A premature infant can also have these types of symptoms, so it may be difficult to separate the effects of prematurity from any effects of the Paxil.  In my own experience, I have not seen true "withdrawal" effects from SSRI use during pregnancy, although I have occasionally seen some respiratory or feeding difficulties that then resolve.  The long-term effects of SSRI exposure during pregancy are still not known.

In terms of an evaluation, the clinical exam is the first and best overall evaluation to perform.  Based on your daughter's clinical status and exam, the neonatologist may then decide to obtain other diagnostic tests if it seems like there is a suspicion for underlying disease.

As always, the decision as to what anti-depressant to use during pregnancy is an individualized one for each person.  Your doctors weighed the risk/benefits of continuing with Paxil before advising you to continue.