Important Reads: Mirtazapine (Remeron) and Being pregnant

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This can be a type of shortcut which lets you discover probably the most related critiques and articles in reproductive psychiatry. Every Wednesday, we are going to add a brand new article to the gathering. On this part of our web site, we are going to spotlight probably the most up-to-date articles to assist information prognosis, scientific decision-making, and remedy choices. Yow will discover the hyperlink HERE or within the BLOG submenu.

Whereas we’ve sufficient knowledge to help using SSRI and SNRI antidepressants throughout being pregnant, there’s much less knowledge relating to different lessons of antidepressants. We sometimes don’t use mirtazapine (Remeron) throughout being pregnant as a result of the info relating to its reproductive security has been sparse. A latest evaluate paperwork the outcomes of infants uncovered to mirtazapine (Remeron), reviewing 31 papers with a complete of 390 circumstances of neonates uncovered to mirtazapine throughout being pregnant or lactation. This can be a very detailed evaluate, offering detailed outcomes of each research. Here’s a abstract of their findings:

Threat of Congenital Malformations: In a complete of 334 mirtazapine-exposed circumstances, the incidence of main malformations didn’t differ from the incidence noticed in youngsters uncovered to different antidepressants or non-teratogenic drugs. 9 youngsters (or 2.9%) of the mirtazapine-exposed youngsters had main malformations.

Threat of Neonatal Signs: One research confirmed a development towards elevated danger of respiratory issues and hypoglycaemia; nonetheless, no different vital opposed results on neonates had been reported.

Breastfeeding: 4 papers reported on 11 circumstances of publicity to mirtazapine by lactation. No opposed results had been detected.

Lengthy-Time period Neurodevelopment: Six papers reported on neurobehavioral improvement in a complete of 22 circumstances. The research different significantly by way of the assessments used and the age at which the assessments had been carried out (starting from 1.5 months to 12 months). No opposed results on behavioural improvement had been reported.

The Backside Line
Whereas these knowledge are reassuring and there’s no indication that mirtazapine carries extra danger than different antidepressants, the variety of mirtazapine exposures stays small. Ideally we wish to have knowledge from 600-700 exposures to get a greater estimate of danger; basing selections relating to security on small pattern sizes can result in miscalculations of danger in both path. Given the restricted data on reproductive security, we’d proceed to suggest utilizing, if potential, different antidepressants with higher characterised reproductive security profiles.

That mentioned, there could also be conditions the place mirtazapine has sure advantages distinct from SSRIs and SNRIs. There have been a number of experiences indicating that mirtazapine could also be useful for the remedy of hyperemesis gravidarum. Not like typical serotonin reuptake inhibitor antidepressants, mirtazapine acts as an antagonist on the serotonin 5-HT3 receptor. This makes mirtazapine much less prone to trigger nausea; there’s additionally suggestion that mirtazapine might need antiemetic results, and mirtazapine has been used to deal with nausea and vomiting in quite a lot of medical settings. Thus, this can be a scenario the place mirtazapine is most well-liked, even within the absence of sufficient knowledge on its reproductive security.

Ruta Nonacs, MD PhD

Smit M, Dolman KM, Honig A. Mirtazapine in being pregnant and lactation – A scientific evaluate. Eur Neuropsychopharmacol. 2016 Jan;26(1):126-35.

Subsequent Week’s Important Learn: Screening for Perinatal Anxiousness Problems

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