Zoloft Side Effects And Warnings

Learn Facts About Zoloft, its Side Effects, and Associated Risks

Zoloft and Pregnancy

Zoloft During Pregnancy

Zoloft is an antidepressant used to treat different depression related disorders. It contains a substance called sertraline which is a selective serotonin reuptake inhibitor (SSRI) which helps the brain absorb serotonin a lot faster than normal.

Using Zoloft in the first trimester of pregnancy may lead to increased risk of congenital malformations. Also, babies could suffer right after birth from seizures, respiratory distress, low blood sugar, irritability and constant crying[1]. These clinical symptoms are thought to be the result of a toxic effect of SSRI but they could also be the result of withdrawal. If the mother takes this antidepressant during pregnancy it could lead to symptoms associated with withdrawal reactions in the newborn[2]. Sertraline is a substance which affects the level of serotonin in the brain, so there are concerns regarding the risk of abnormal development of the baby's brain. It is theorized that the newborn may behavioral problems such as autism or ADHD, but there is no scientific proof to support this theory.

These symptoms were found in 30% of newborn babies who had been exposed to Zoloft due to antidepressant therapy during pregnancy. Studies showed that such newborn babies must be closely monitored for at least 48 hours after birth in order to avoid cardiac arrest or pulmonary complications. Comparing 267 women exposed to Zoloft, study results showed an unwanted association of SSRIs with increased risk of malformations or miscarriage.

This medicine is a C category drug, which means it is suspected of causing harm on the fetus or newborn baby[3]. There are 5 categories of pharmaceutical substances named as following: A, B, C, D and X, where A is completely harmless for infants to X which indicates demonstrated fetal abnormalities and adverse reactions in pregnant women. Fetuses should be monitored especially in the third semester or pregnancy.

When it comes to breastfeeding, Zoloft use is not recommended, although it is one of the most preferred antidepressants during breastfeeding. Mothers taking this drug during pregnancy or postpartum may experience breastfeeding difficulties even though Zoloft levels in breast milk are quite low during treatment[4]. According to a study in which 30 breastfed infants were analyzed, sertraline levels were below 1mcg/l. Their mothers were under Zoloft treatment, taking an average dose of 109 mg daily. This result showed that no adverse effects affected the infants even though they ingested an average of 2% of the sertraline levels of the mother[5].

If your clinician decides you must take Zoloft during pregnancy, start with the treatment in the lowest dose possible. Alternatively, you could try Paxil which is also an antidepressant but it is less dangerous for the fetus. Ask your doctor to monitor the blood level of the drug in your baby. It is the best to measure it 2-6 hours after you have taken the antidepressant. A low blood level will reassure you that you could safely continue taking this drug after giving birth and also during breastfeeding.

References:

  1. Pediatrics105, Use of psychoactive medication during pregnancy and possible effects on the fetus and newborn, 2000
  2. Levinson Castiel R., Marlob P., Linder N., Sirota L., Klinger G., Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants, 2006
  3. Roerig Division, New York, Product information. Zoloft (sertraline)
  4. Whitby D., Smith K., The use of tricyclic antidepressants and selective serotonin reuptake inhibitors in women who are breastfeeding, 2005
  5. Mammen O., Perel J., Rudolph G., Foglia J., Wheeler S., Maternal sertraline treatment and serotonin transport in breastfeeding mother-infant pairs, 2001