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Canadian Family Physician logoLink to Canadian Family Physician
. 2001 Mar;47:489–490.

Discontinuing antidepressants and benzodiazepines upon becoming pregnant. Beware of the risks of abrupt discontinuation.

A Einarson 1, P Selby 1, G Koren 1
PMCID: PMC2018402  PMID: 11281079

Abstract

QUESTION: Two of my patients are planning to become pregnant. One is taking paroxetine and the other lorazepam. We have discussed what to do when they become pregnant and have decided they should stop taking these drugs as soon as pregnancy is confirmed. Is this the right decision? ANSWER: The decision to discontinue these drugs during pregnancy should be based on scientific evidence rather than "hearsay" that women should not take psychotropic medications during pregnancy. Recent epidemiologic studies have documented the relative safety of these drugs, so women should not feel compelled to stop taking them when they become pregnant. If, after receiving appropriate evidence-based information, a woman decides to stop taking the drugs, they should be gradually tapered off to avoid abrupt discontinuation syndrome.

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Selected References

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  1. 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]
  2. 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]
  3. Einarson A., Selby P., Koren G. Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci. 2001 Jan;26(1):44–48. [PMC free article] [PubMed] [Google Scholar]
  4. Gallo M., Sarkar M., Au W., Pietrzak K., Comas B., Smith M., Jaeger T. V., Einarson A., Koren G. Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study. Arch Intern Med. 2000 Nov 13;160(20):3141–3143. doi: 10.1001/archinte.160.20.3141. [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. Kaplan E. M. Antidepressant noncompliance as a factor in the discontinuation syndrome. J Clin Psychiatry. 1997;58 (Suppl 7):31–36. [PubMed] [Google Scholar]
  7. 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]
  8. Lejoyeux M. Dépendance aux antidépresseurs: authentique addiction? Encephale. 1995 Feb;21(SPEC):63–65. [PubMed] [Google Scholar]
  9. 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]
  10. 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]
  11. 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]
  12. 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]
  13. Rosenbaum J. F., Fava M., Hoog S. L., Ascroft R. C., Krebs W. B. Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial. Biol Psychiatry. 1998 Jul 15;44(2):77–87. doi: 10.1016/s0006-3223(98)00126-7. [DOI] [PubMed] [Google Scholar]
  14. 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]
  15. 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]

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