Taking antidepressants during late pregnancy. How should we advise women?

QUESTION In light of recent negative media attention to antidepressant use during late pregnancy, several of my patients have either discontinued or are considering discontinuing their antidepressant medications. How can I best counsel these patients on taking antidepressants during late pregnancy? ANSWER Antidepressant use during the third trimester has been associated occasionally with a transient neonatal withdrawal-like syndrome characterized by jitteriness, self-limiting respiratory difficulties, and problems with feeding. When counseling patients, the risk of these adverse effects must be weighed against the risks associated with untreated depression during late pregnancy. Abrupt discontinuation of psychotropic medications has been associated with both physical (eg, withdrawal) and psychological (eg, suicidal thoughts) symptoms.