Psychiatrist Prescribes Venlafaxine Leading to Development Delay

This case involves a twenty-eight-year-old female at the time of pregnancy who was prescribed venlafaxine, which resulted in numerous cognitive defects in her child. The woman was prescribed venlafaxine after she experienced depressive symptoms after the death of her father. She never contemplated suicide during this time and claimed that she was beginning to feel better once she became pregnant. Her psychiatrist recommended she stay on the anti-depressant because withdrawal could produce severe rebound depression. Shortly after the child was delivered, he began to have difficulties feeding. The baby was diagnosed with failure to thrive, requiring three months of hospitalization. Throughout the child’s life, several developmental milestones were delayed. The boy was unable to hold toys in his hand, crawl, and hold his head up independently. The child was also unable to walk and feed himself at the age of five. The boy also had very poor muscle tone and severe muscle weakness. The child’s preschool teacher also communicated that the boy had been exhibiting behavioral problems, including tantrums, excessive crying, and violence towards the other children. He was recommended to be enrolled at a specialized preschool for children with conduct disorders.

Question(s) For Expert Witness

1. What is the standard of care and risks associated with prescribing antidepressants to pregnant women?

Expert Witness Response E-005901

In 2004, the United States Food and Drug Administration (FDA) issued a safety alert that neonates exposed to venlafaxine (serotonin norepinephrine reuptake inhibitor or SNRI) late in the third trimester are at risk for a condition known as neonatal behavioral syndrome. Some symptoms associated with this syndrome include jitteriness, tremors, diarrhea, emesis, irritability, agitation, hypoglycemia, hypothermia, hyperreflexia, hypotonia, hypertonia, respiratory distress, excessive crying, difficulty in feeding, sleep disturbances, and seizures. The decision to prescribe anti-depressants during pregnancy is based upon risk-benefit analysis. One potential risk would be the effects seen in the development of the child. It would only be beneficial to continue antidepressant use in a pregnant female if she is suffering from severe depression. This would include thoughts of suicide, plans to danger oneself or others, and complete physical deterioration. This woman was not exhibiting any of these warning signs therefore plans to discontinue her antidepressant should have been discussed.