Haddad P M, Pal B R, Clarke P, Wieck A, Sridhiran S
Bolton, Salford and Trafford Mental Health NHS Trust, Prestwich, Manchester, M25 3BL, UK.
J Psychopharmacol. 2005 Sep;19(5):554-7. doi: 10.1177/0269881105056554.
We report a case of neonatal symptoms of irritability, increased tonus and convulsions after in-utero exposure to paroxetine 30 mg/day. The infant's symptoms commenced on the first day after birth and persisted for 10 days. Paroxetine levels were undetectable on day 6. Extensive investigations excluded infective and metabolic causes. Serotonin toxicity due to paroxetine seems the most likely mechanism, though an important differential diagnosis is a paroxetine discontinuation (withdrawal) syndrome. Differentiating between these two syndromes in the neonate presents a dilemma for clinicians. Irrespective of the mechanism, we recommend that all neonates exposed to antidepressants, particularly serotonin reuptake inhibitors (SSRIs), during the last trimester should be followed-up closely for adverse symptoms commencing in the first 10 days after birth. The possibility of such symptoms needs to be discussed with women who are considering starting or continuing antidepressant treatment in pregnancy. All neonatal adverse drug events should be reported to a pharmacovigilance centre. Further research is warranted.
我们报告了一例新生儿病例，该婴儿在子宫内暴露于每日30毫克帕罗西汀后出现烦躁、肌张力增高和惊厥等症状。婴儿的症状在出生后第一天开始，并持续了10天。第6天时检测不到帕罗西汀水平。广泛的检查排除了感染和代谢原因。帕罗西汀导致的5-羟色胺毒性似乎是最可能的机制，不过一个重要的鉴别诊断是帕罗西汀停药（戒断）综合征。在新生儿中区分这两种综合征给临床医生带来了难题。无论机制如何，我们建议所有在妊娠晚期暴露于抗抑郁药，尤其是5-羟色胺再摄取抑制剂（SSRI）的新生儿，应在出生后的头10天密切随访有无不良症状。需要与考虑在孕期开始或继续抗抑郁治疗的女性讨论出现此类症状的可能性。所有新生儿药物不良事件均应报告给药物警戒中心。有必要进行进一步研究。
