The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond

STUDY QUESTION: What is the current literature on the safety and efficacy of selective serotonin reuptake inhibitor (SSRI) use in infertile women? SUMMARY ANSWER: There is little evidence that infertile women benefit from taking an SSRI, therefore they should be counseled appropriately about the risks and be advised to consider alternate safer treatments to treat depressive symptoms. WHAT IS KNOWN ALREADY: SSRI use is associated with possible reduced infertility treatment efficacy as well as higher rates of pregnancy loss, preterm birth, pregnancy complications, neonatal issues and long-term neurobehavioral abnormalities in offspring. STUDY DESIGN, SIZE, DURATION: Review of existing literature. PARTICIPANTS/MATERIALS, SETTING, METHODS: We conducted a review of all published studies that evaluate females with depressive symptoms who are taking antidepressant medications and who are experiencing infertility. MAIN RESULTS AND THE ROLE OF CHANCE: Antidepressant use during pregnancy is associated with increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn and possible longer term neurobehavioral effects. There is no evidence of improved pregnancy outcomes with antidepressant use. There is some evidence that psychotherapy, including cognitive-behavioral therapy as well as physical exercise, is associated with significant decreases in depressive symptoms in the general population; research indicates that some forms of counseling are effective in treating depressive symptoms in infertile women. LIMITATIONS, REASONS FOR CAUTION: Our findings are limited by the availability of published studies in the field, which are often retrospective and of small size. WIDER IMPLICATIONS OF THE FINDINGS: Practitioners who care for infertility patients should have a thorough understanding of the published literature so that they can adequately counsel their patients.