Paroxetine (Paxil®)

Does taking paroxetine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Some studies suggest that taking paroxetine may slightly increase the chance of miscarriage. However, research also shows that depression itself may increase the chance of miscarriage. This makes it hard to know if an increased chance of miscarriage is due to medication, the underlying condition, or other factors. 

Does taking paroxetine increase the chance of birth defects? 

Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Some studies suggest that exposure to paroxetine in the first trimester might be associated with a small increased chance for heart defects. Other studies did not find a possible increased risk. The background rate of heart defects for any pregnancy is about 1 in 100 (1%). If there is an increased chance of birth defects with paroxetine use in the first trimester, it is expected to be small. Paroxetine exposure in pregnancy has not been shown to increase the chance of other birth defects. 

Does taking paroxetine in pregnancy increase the chance of other pregnancy-related problems?

Some studies suggest a higher chance for preterm delivery (birth before week 37) with the use of an SSRI such as paroxetine, while others do not. Conditions such as depression may increase the chance of pregnancy-related problems, such as preterm delivery. This makes it hard to know if it is the medication, the condition being treating, or other factors that are increasing the chance of pregnancy-related problems. 

Some, but not all, studies have suggested that when individuals who are pregnant take SSRIs during the second half of the pregnancy, their babies might have a higher chance for a serious lung condition called persistent pulmonary hypertension. Persistent pulmonary hypertension happens in 1 or 2 out of 1,000 births. Among the studies looking at this, the overall chance for pulmonary hypertension when an SSRI was used in pregnancy was less than 1/100 (less than 1%). 

I need to take paroxetine throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth? 

The use of paroxetine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms may include jitteriness, increased muscle tone, irritability, changes in sleep patterns, tremors, trouble eating, and trouble breathing. These symptoms are usually mild and go away on their own. Some babies may need to stay in a special care nursery for several days. Not all babies exposed to paroxetine will have these symptoms. It is important that your healthcare providers know you are taking paroxetine so that if symptoms occur your baby can get the care that’s best for them. 

Does taking paroxetine in pregnancy affect future behavior or learning for the child?

It is not known if paroxetine can increase the chance for behavior or learning issues. One study looking at prescriptions for SSRIs including paroxetine suggested an increased chance of autism spectrum disorder. Studies based on filled prescriptions/prescription records cannot tell if a person took the medication, so it is hard to know if the outcomes are related to the medication or other factors. Also, this study did not look at factors such as other exposures, paternal mental illness, or other family history of autism. Another prescription study did not report an increased chance for autism spectrum disorder. 

One study looking at pregnancies exposed at least during the third trimester to SSRIs including paroxetine reported no differences in developmental outcomes between the exposed 46 infants or the unexposed 23 infants at 2 and 8 months of age. A follow-up study on some of these children found no difference in behaviors such as emotional reactivity, withdrawal, irritability, depression, or anxiety in the exposed group (22 children) when compared to the group that was not exposed to paroxetine (14 children). 

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