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There are many studies which support the use of certain antidepressants during pregnancy. Most of the research over the last decade has focused on the selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and the older tricyclic antidepressants but there is some new data supporting the use of bupropion (Wellbutrin) during pregnancy.
Earlier reports had revealed an unexpectedly high number of malformations of the heart and great vessels in bupropion-exposed infants. To more carefully quantify the risk for cardiovascular malformation in bupropion-exposed infants, another study was conducted relying upon two large insurance claims databases (Cole et al, 2006). This retrospective cohort study including over 1200 infants exposed to bupropion during the first trimester did not reveal an increased risk of malformations in the bupropion-exposed group of infants nor did it demonstrate an increased risk for cardiovascular malformations.
The most recent information comes from the Bupropion Pregnancy Registry maintained by the manufacturer GlaxoSmithKline. It includes data from 517 pregnancies involving first trimester exposure to bupropion. In this sample, there were 20 infants with major malformations. This represents a 3.9% risk of congenital malformation that is consistent with what is observed in women with no known teratogen exposure. (Health care providers may receive an updated report from GlaxoSmithKline by calling (800) 336-2176.) Given these data, bupropion may be an attractive option for women who have not responded well to fluoxetine or tricyclic antidepressants. Further studies are required to assess the risk of neonatal symptoms in bupropion-exposed infants and to better evaluate the long-term neurobehavioral effects of bupropion exposure.
