임신 중 우울증 약 (SSRI) - 의학 (Medicine)

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====== SSRI Pregnancy ======
 
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전반적으로 기형의 위험은 매우 낮다.
특히 임신 일분기에는 
가능한 단일약물, 최소용량으로 복용하는 것이 좋다.

A new study in the BMJ may help guide clinicians' and patients' choice of antidepressant in pregnancy.

Using data from a large U.S. study, researchers identified nearly 18,000 birth defect cases and 10,000 controls. The mothers of 660 cases and 300 controls had used selective serotonin reuptake inhibitors (SSRIs) in the month before or first 3 months of pregnancy. [[https://www.jwatch.org/na38531/2015/07/15/which-ssris-are-safest-pregnancy|출처]]

Sertraline (Zoloft) wasn't associated with any of five defects to which it had previously been linked (e.g., septal defects).

Neither citalopram (Celexa) nor escitalopram (Lexapro) was associated with defects, except for a “marginal” link between citalopram and neural tube defects.

Fluoxetine (Prozac) was associated with ventricular septal defects, right ventricular outflow tract obstruction cardiac defects, and craniosynostosis.

Paroxetine (Paxil) was associated with anencephaly, atrial septal defects, right ventricular outflow tract obstruction cardiac defects, gastroschisis, and omphalocele.

The authors note that if the associations observed are causal, the absolute risks are small. For example, for babies exposed to paroxetine, the absolute risk for anencephaly would increase from 2 to 7 per 10,000.

Allison Bryant, associate editor with NEJM Journal Watch Women's Health, said: “Any risk... cannot yet be entirely separated from risks attributed to the underlying condition. Women and their providers should keep this in mind when considering the risk-benefit balance for treating maternal depression.”

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As always, these risks must be balanced against the risks of discontinuing or changing antidepressants, especially in women whose illnesses have been treatment refractory and have only responded to fluoxetine or paroxetine. 
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>However, the current findings suggest that in general **sertraline** should be the first-line agent in pregnant women needing an SSRI.

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