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Central nervous system effects of prenatal selective serotonin reuptake inhibitors: sensing the signal through the noise

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Abstract

Rationale

Women are increasingly prescribed selective serotonin reuptake inhibitors (SSRIs) during pregnancy, with potential implications for neurodevelopment. Whether prenatal SSRI exposure has an effect on neurodevelopment and behavior in the offspring is an important area of investigation.

Objectives

The aim of this paper was to review the existing preclinical and clinical literature of prenatal SSRI exposure on serotonin-related behaviors and markers in the offspring. The goal is to determine if there is a signal in the literature that could guide clinical care and/or inform research.

Results

Preclinical studies (n = 4) showed SSRI exposure during development enhanced depression-like behavior. Half of rodent studies examining anxiety-like behavior (n = 13) noted adverse effects with SSRI exposure. A majority of studies of social behavior (n = 4) noted a decrease in sociability in SSRI exposed offspring. Human studies (n = 4) examining anxiety in the offspring showed no adverse effects of prenatal SSRI exposure. The outcome of one study suggested that children with autism were more likely to have a mother who was prescribed an SSRI during pregnancy.

Conclusions

Preclinical findings in rodents exposed to SSRIs during development point to an increase in depression- and anxiety-like behavior and alteration in social behaviors in the offspring, though both the methods used and the findings were not uniform. These data are not robust enough to discourage use of SSRIs during human pregnancy, particularly given the known adverse effects of maternal mental illness on pregnancy outcomes and infant neurodevelopment. Future research should focus on consistent animal models and prospective human studies with larger samples.

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Acknowledgments

Supported by R25 MH060490, Clinical Research Scholars Program in Psychiatry (TLG) and K24DA030301 (CNE), P50MH099910 (CNE, DRK), and K23 MH092399 (DK). Potential conflicts of interest (CEN): Pfizer-Consultant; Shire-Research Grant.

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Authors and Affiliations

  1. Penn Center for Women’s Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania Philadelphia, 3535 Market St, 3rd Floor, Philadelphia, PA, 19104, USA

    Tamar L. Gur, Deborah R. Kim & C. Neill Epperson

  2. Penn Center for the Study of Sex and Gender in Behavioral Health, Philadelphia, PA, USA

    Deborah R. Kim & C. Neill Epperson

  3. Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    C. Neill Epperson

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  1. Tamar L. Gur
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  2. Deborah R. Kim
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  3. C. Neill Epperson
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Correspondence to C. Neill Epperson.

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Gur, T.L., Kim, D.R. & Epperson, C.N. Central nervous system effects of prenatal selective serotonin reuptake inhibitors: sensing the signal through the noise. Psychopharmacology 227, 567–582 (2013). https://doi.org/10.1007/s00213-013-3115-8

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