I had shared the following article months ago...as I had taken Paxil for 18
weeks of my latest pregnancy and baby did have resp. concerns and
irritability and constipation.  Will cite the study once I get it off
PubMed.

Ann Marie Henninger RN BSN IBCLC RLC

May 6, 2002 -- Women taking the antidepressant Paxil should know this: If
they get pregnant, their baby could go through a withdrawal period right
after birth -- one that causes respiratory problems and hospitalization for
up to two weeks. However, researchers say, there don't seem to be any
long-term negative effects on the infant.
Paxil is one of the antidepressants known as SSRIs (selective serotonin
reuptake inhibitors) and is commonly prescribed for depression, anxiety, and
panic disorder.
"However, Paxil is a little bit different from the other SSRIs ... in
adults, it has higher rates of discontinuation syndrome -- problems when
people abruptly stop taking the drug -- like nervousness, sleep problems,
sweating," says Gideon Koren, MD, professor of pediatrics, pharmacology, and
medicine and medical genetics at the University of Toronto.
Koren's previous studies and others "have shown that SSRIs are safe in
pregnancy, that they do not cause malformations in the fetus," he tells
WebMD. His current study focuses on the effects of Paxil on the newborn
infant -- whether a baby exposed to Paxil throughout the mother's pregnancy
experiences any withdrawal symptoms.
He presented his paper today at the annual meeting of the Pediatric Academic
Societies in Baltimore.
The study involved 55 women who took Paxil throughout their pregnancies, 27
women who stopped taking Paxil after the second trimester, and 27 women who
took other drugs considered not to cause birth defects.
Twelve of the babies exposed to Paxil through the third trimester had
complications that lasted one to two weeks and required hospitalization. The
problems: respiratory distress in nine infants, low blood sugar in two
infants, and jaundice in one.
"But the good news is, [the complications] were short term," Koren tells
WebMD. "None of these babies had long-term adverse effects from the Paxil."
In the comparison group, two infants exposed to Paxil in the first and
second trimesters had respiratory distress and a complication in which the
infant breathes in its own feces while still in the womb. A third infant who
was not exposed to Paxil was born with jaundice.
In the third trimester-exposed group, 36 women breastfed and continued
taking Paxil after delivery. Eight women reported symptoms in their babies
including difficulties with alertness, constipation, sleepiness, and
irritability, but the majority of women reported no such symptoms. In the
comparison group, 44 babies were breastfed and none of the mothers reported
symptoms.
"Breast milk may have a protective effect," says Koren. "If mom took the
drug through pregnancy and she continues through breastfeeding, the baby is
supplemented with lower levels of the drug and may be protected from these
effects -- gradually weaned off the drug."
While there was a high rate of premature babies among the
third-trimester-exposed women, data showed that Paxil was not the cause,
Koren tells WebMD. "Why we see more prematurity among mothers with deep
depression may be due to their depression. It does not explain this picture
[of withdrawal symptoms]."
His advice to pregnant women: "I don't think there should be real concern
[about taking Paxil throughout pregnancy]. It but does mean that the baby of
a mother on an SSRI should be monitored carefully -- the family should be
informed that the first few days may be stormy. And of course they should
have very good medical care. Clearly these are not your garden-variety cases
that can go home with no follow-up. They need to be in a good hospital with
a good neonatal center."
The consequences of not taking the medication can be worse, he says. "We
have examples of very sad outcomes, in which moms stopped cold turkey the
SSRIs or other psychiatric drugs they needed. There were a lot of
hospitalizations, suicidal thoughts, suicide attempts, replacing drugs with
alcohol. It would be counterproductive for women to stop the drug."
The antidepressant Prozac has shown far fewer withdrawal symptoms in
infants, Koren says.
Jennifer Niebyl, MD, head of obstetrics and gynecology at the University of
Iowa College of Medicine, has written medical textbooks on drugs during
pregnancy. She adds a cautionary note:
"We don't think there is any risk in terms of birth defects in the first
trimester, but we don't know about what exposure [to a psychiatric drug]
during the second and third trimester might do to the developing brain,"
Niebyl tells WebMD. "We can't guarantee that it wouldn't have an effect."
Pregnant women should reassess how badly they need a psychiatric drug, she
says. While those with serious psychiatric disorders and suicidal tendencies
should stay on their medication, that may not be true for all people. "Some
individuals may be able to go off [their medication] if they have more
intensive psychotherapy during their pregnancy ... see the psychologist or
psychiatrist more often, deal with the problem in other ways. We usually
encourage that."
Koren says he doubts that SSRIs have negative effects on developing brains.
"We don't know about Paxil, but we have published in The New England Journal
of Medicine that Prozac and tryciclic antidepressants [such as Elavil and
Pamelor] show no apparent effects. If Paxil works through the same
receptors, it's not very likely. We do know kids on Paxil and other, newer
SSRIs and other [antidepressants] do not appear to be different from other
children. Language and [thinking] do not seem to be affected."

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