Serotonin reuptake inhibitors (SSRIs) are frequently combined with benzodiazepines for the management of anxiety disorders or major depression with comorbid anxiety.  While we have data regarding the reproductive safety of both the SSRIs and benzodiazepines, we have much less information on outcomes in women taking SSRIs and benzodiazepines together.  A previous study (Oberlander 2008) found that neither the use of an SSRI alone nor the use of a benzodiazepine alone increased the risk for congenital malformation; however, in this study, the combined use of the two drugs increased the risk of cardiovascular defect. A recent study reassesses the risk of major malformation in women taking SSRIs combined with benzodiazepines.

This study utilized data from the Swedish Medical Birth Register and included 10,511 infants born to women who had used SSRIs (but no other central nervous system (CNS)-active drugs), 1000 infants born to women who had used benzodiazepines (but no other CNS-active drugs), and 406 infants born to women who had used both an SSRI and benzodiazepines.

The three groups did not differ significantly from one another in terms of risk for any major malformation or for any cardiac defect.  The risk of major malformations in these three groups was similar to that observed in the general population.  Thus it appears that the combined use of SSRIs and benzodiazepines during pregnancy does not increase the risk for congenital malformation.

Ruta Nonacs, MD PhD

Oberlander TF, Warburton W, Misri S, et al. Major congenital malformations following prenatal exposure to serotonin reuptake inhibitors and benzodiazepines using population-based health data. Birth Defects Res B DevReprodToxicol 2008;83:68–76.

Reis M, Kallen B.Combined use of selective serotonin reuptake inhibitors and sedatives/hypnotics during pregnancy: risk of relatively severe congenital malformations or cardiac defects.A register study.BMJ Open 2013.