Toxicity of serotonin-norepinephrine reuptake inhibitors (SNRIs) during pregnancy and lactation

Major depressive disorder (depression) is a severe mood disorder. Lifestyle changes during the COVID-19 pandemic contributed to the high incidence of depression in the population. The primary care treatment is provided by both psychotherapy and antidepressants. In the last 35years,selective serotoninreuptakeinhibitors (SSRIs)were used because of lower adverse effects when compared to tricyclic antidepressants and monoamine oxidase (MAO) inhibitors. However, selective serotonin–norepinephrine reuptake inhibitors (SNRIs), which are second-generation antidepressants, are preferred over first-generation antidepressants by some physicians as they have broad uses nowadays. Anxiety disorders, depression, social phobia, attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), fibromyalgia syndrome, chronic neuropathic pain, and menopausal symptoms are among the conditions that can be treated with SNRIs. Although the effects of genetic factors and family history on these diseases, especially recurrence, are undeniable, these drugs provide a great deal of improvement. However, the use of SNRIs during pregnancy and lactation is still a debate. There is no definite judgment on whether a pregnant woman should use these drugs during pregnancy or not. As the rate of depression among pregnant women increases, this issue becomes more serious. A definitive answer has not been reached yet because studies on pregnant women cannot be carried out within the framework of ethical rules. In this review, the effects, toxicity, and safety of SNRIs during pregnancy and lactation are discussed.