Skip to main content
PMC home page
Journal of Psychiatry & Neuroscience : JPN logoLink to Journal of Psychiatry & Neuroscience : JPN
. 2001 Jan;26(1):44–48.

Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling.

A Einarson 1, P Selby 1, G Koren 1
PMCID: PMC1408034  PMID: 11212593

Abstract

OBJECTIVE: To assess the consequences to mother and baby of abruptly discontinuing antidepressant or benzodiazepine medication during pregnancy and to assess the impact of our counselling. PARTICIPANTS: All women who consulted the Motherisk Program between November 1996 and December 1997 and who stopped taking antidepressant or benzodiazepine medication when pregnancy was confirmed agreed to participate in the study. DESIGN AND INTERVENTIONS: Subjects were interviewed, received counselling, and completed a questionnaire 1 month after their initial call and after the birth of their baby. RESULTS: Of 36 women who completed the study, 34 discontinued their medication abruptly for fear of harming the fetus, 28 on the advice of their physician; 26 (70.3%) women reported physical and psychological adverse effects, 11 reported psychological effects only, and 11 reported suicidal ideation (4 were admitted to hospital). After counselling, 22 of 36 (61.1%) women resumed taking their medication, and 4 found that they no longer required it. One woman had a therapeutic abortion and 2 experienced spontaneous abortions; there were therefore 35 healthy babies (including 2 sets of twins) born to 33 women; 14 of 21 mothers breast-fed their babies while taking their psychotropic medication, with no adverse effects reported. CONCLUSIONS: When assessing the risks and benefits of taking psychotropic medication during pregnancy, women and their physicians should be aware that the abrupt discontinuation of psychotropic drugs can lead to serious adverse effects. Counselling is effective in reassuring women to adhere to therapy.

Full text

PDF
44

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altshuler L. L., Cohen L., Szuba M. P., Burt V. K., Gitlin M., Mintz J. Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry. 1996 May;153(5):592–606. doi: 10.1176/ajp.153.5.592. [DOI] [PubMed] [Google Scholar]
  2. Czeizel A. Lack of evidence of teratogenicity of benzodiazepine drugs in Hungary. Reprod Toxicol. 1987 1988;1(3):183–188. doi: 10.1016/s0890-6238(87)80031-x. [DOI] [PubMed] [Google Scholar]
  3. Dominguez R. A., Goodnick P. J. Adverse events after the abrupt discontinuation of paroxetine. Pharmacotherapy. 1995 Nov-Dec;15(6):778–780. [PubMed] [Google Scholar]
  4. Einarson A., Bailey B., Jung G., Spizzirri D., Baillie M., Koren G. Prospective controlled study of hydroxyzine and cetirizine in pregnancy. Ann Allergy Asthma Immunol. 1997 Feb;78(2):183–186. doi: 10.1016/S1081-1206(10)63385-6. [DOI] [PubMed] [Google Scholar]
  5. Haque W., Watson D. J., Bryant S. G. Death following suspected alprazolam withdrawal seizures: a case report. Tex Med. 1990 Jan;86(1):44–47. [PubMed] [Google Scholar]
  6. Koren G., Bologa M., Long D., Feldman Y., Shear N. H. Perception of teratogenic risk by pregnant women exposed to drugs and chemicals during the first trimester. Am J Obstet Gynecol. 1989 May;160(5 Pt 1):1190–1194. doi: 10.1016/0002-9378(89)90186-5. [DOI] [PubMed] [Google Scholar]
  7. Koren G., Klein N. Bias against negative studies in newspaper reports of medical research. JAMA. 1991 Oct 2;266(13):1824–1826. [PubMed] [Google Scholar]
  8. Koren G., Pastuszak A., Ito S. Drugs in pregnancy. N Engl J Med. 1998 Apr 16;338(16):1128–1137. doi: 10.1056/NEJM199804163381607. [DOI] [PubMed] [Google Scholar]
  9. Kulin N. A., Pastuszak A., Sage S. R., Schick-Boschetto B., Spivey G., Feldkamp M., Ormond K., Matsui D., Stein-Schechman A. K., Cook L. Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA. 1998 Feb 25;279(8):609–610. doi: 10.1001/jama.279.8.609. [DOI] [PubMed] [Google Scholar]
  10. Mattson S. N., Riley E. P., Gramling L., Delis D. C., Jones K. L. Heavy prenatal alcohol exposure with or without physical features of fetal alcohol syndrome leads to IQ deficits. J Pediatr. 1997 Nov;131(5):718–721. doi: 10.1016/s0022-3476(97)70099-4. [DOI] [PubMed] [Google Scholar]
  11. McElhatton P. R. The effects of benzodiazepine use during pregnancy and lactation. Reprod Toxicol. 1994 Nov-Dec;8(6):461–475. doi: 10.1016/0890-6238(94)90029-9. [DOI] [PubMed] [Google Scholar]
  12. Nulman I., Rovet J., Stewart D. E., Wolpin J., Gardner H. A., Theis J. G., Kulin N., Koren G. Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med. 1997 Jan 23;336(4):258–262. doi: 10.1056/NEJM199701233360404. [DOI] [PubMed] [Google Scholar]
  13. Oo C. Y., Kuhn R. J., Desai N., Wright C. E., McNamara P. J. Pharmacokinetics in lactating women: prediction of alprazolam transfer into milk. Br J Clin Pharmacol. 1995 Sep;40(3):231–236. doi: 10.1111/j.1365-2125.1995.tb05778.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pastuszak A., Schick-Boschetto B., Zuber C., Feldkamp M., Pinelli M., Sihn S., Donnenfeld A., McCormack M., Leen-Mitchell M., Woodland C. Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac) JAMA. 1993 May 5;269(17):2246–2248. [PubMed] [Google Scholar]
  15. Rickels K., Case W. G., Schweizer E., Garcia-Espana F., Fridman R. Benzodiazepine dependence: management of discontinuation. Psychopharmacol Bull. 1990;26(1):63–68. [PubMed] [Google Scholar]
  16. Rickels K., Schweizer E., Case W. G., Greenblatt D. J. Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation. Arch Gen Psychiatry. 1990 Oct;47(10):899–907. doi: 10.1001/archpsyc.1990.01810220015002. [DOI] [PubMed] [Google Scholar]
  17. St Clair S. M., Schirmer R. G. First-trimester exposure to alprazolam. Obstet Gynecol. 1992 Nov;80(5):843–846. [PubMed] [Google Scholar]
  18. Terao T., Tani Y. [Two cases of psychotic state following normal-dose benzodiazepine withdrawal]. J UOEH. 1988 Sep 1;10(3):337–340. doi: 10.7888/juoeh.10.337. [DOI] [PubMed] [Google Scholar]
  19. Turkington D., Gill P. Mania induced by lorazepam withdrawal: a report of two cases. J Affect Disord. 1989 Jul-Aug;17(1):93–95. doi: 10.1016/0165-0327(89)90028-1. [DOI] [PubMed] [Google Scholar]
  20. Wisner K. L., Perel J. M., Findling R. L. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996 Sep;153(9):1132–1137. doi: 10.1176/ajp.153.9.1132. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Psychiatry and Neuroscience are provided here courtesy of Canadian Medical Association

RESOURCES