Which antidepressant is SAFEST for use in the third trimester of pregnancy based on evidence for minimal neonatal adaptation syndrome?

• A Paroxetine
• B Fluoxetine
• C Venlafaxine
• D Sertraline ✓

Explanation

Sertraline has the most favorable safety data in pregnancy: minimal placental transfer, lowest breast milk levels among SSRIs, and lowest risk of neonatal adaptation syndrome (jitteriness, poor feeding, respiratory distress from abrupt serotonin level drop at delivery). Paroxetine is associated with cardiac defects (first trimester) and strongest neonatal withdrawal. Fluoxetine's long half-life leads to drug accumulation in the neonate. Venlafaxine has higher rates of neonatal withdrawal.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.