Five Questions With: Amy Salisbury

Amy Salisbury is associate professor of pediatrics as well as associate professor of psychiatry and human behavior at Brown University. She recently authored a study about the neurological effects on newborns when their mothers have been prescribed antidepressants while carrying them.
Amy Salisbury is associate professor of pediatrics as well as associate professor of psychiatry and human behavior at Brown University. She recently authored a study about the neurological effects on newborns when their mothers have been prescribed antidepressants while carrying them.

Amy Salisbury is associate professor of pediatrics as well as associate professor of psychiatry and human behavior at Brown University. She received her B.A. in neuroscience from Clark University and her doctorate in behavioral sciences and developmental psychobiology from the University of Connecticut. She recently authored a study about the neurological effects on newborns when their mothers have been prescribed antidepressants while carrying them.

PBN: How common is the prescribing of antidepressants generally, and the prescribing of more than one specifically, for women who are pregnant?
SALISBURY:
Published estimates are that about 4 percent of pregnant women are prescribed antidepressants during pregnancy, which represents about one-third of those who are depressed during pregnancy, with about 4 percent prescribed a benzodiazepine, which is an anti-anxiety medication. The frequency of prescribing both medications together is not clear, but can be inferred to be less than 4 percent of pregnant women.

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PBN: How pronounced were the neurological symptoms among newborns affected by the medications taken by their mothers – were they noticeable at first glance or are they subtler than that for the most part?
SALISBURY:
The behaviors seen for infants exposed to selective serotonin reuptake inhibitors, also known as SSRIs, with and without a benzodiazepine drug, were more frequent startles and tremors with low or inconsistent motor tone. For some infants, particularly those with both medications, this would be obvious when observing them. The exposed infants also had increased irritability compared to infants who were not exposed – this is also observable, but may not be singled out as a problem since many infants can be irritable in the first month. These signs might occasionally interfere with feeding and can be difficult for caretakers in the case of irritability.

PBN: It seems like the calculus of weighing maternal health versus infant health is complex in some cases – was that one of the reasons for doing the study?
SALISBURY:
Yes, the goal was to provide information about the effects of the medication over and above the effects of depression since both it and stress can contribute to adverse infant outcomes. These findings show that maternal depression also contributes to alterations in infant development that are different from those attributable to medication exposure, with differences more apparent at 30 days after birth.

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PBN: Do the neurological symptoms among babies affected by anti-depressants taken by their moms while pregnant generally resolve, and if so, how long does it typically take?
SALISBURY:
The startles and tremors and any feeding issues related to them do resolve. What we found is that these signs last longer than previously thought – with a peak at 14 days rather than seven to 10 days as previous studies suggested. It is not clear if the motor tone issues resolve completely, and we are conducting further studies to examine this issue. Infants with SSRI and benzodiazepine exposure continued to have lower motor quality at 30 days after birth.

PBN: What is the single most important takeaway of the study?
SALISBURY:
There are actually two key takeaways. First, infant irritability and motor issues may last longer than the first week or two. If women are expecting things to resolve quickly and they do not, this may lead to frustration or other adverse feelings that preparedness might prevent. Second, if a woman needs SSRI medication to treat her condition, the infant outcomes do not suggest against taking these medications. A higher level of caution may be indicated when using SSRIs with benzodiazepines, for potentially worse infant outcomes as well as the higher severity of maternal depression and anxiety associated with their use in this study.

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