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I know that isotretinoin's packaging is labelled with ideograms against pregnancy, as it can cause birth defects. I'm assuming that some teratogens aren't thus labelled, as paroxetine isn't,

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but according to The Hospital for Sick Children :

Selective serotonin reuptake inhibitors (SSRIs), which are used to treat depression, are capable of crossing the placenta and affecting the baby. Most of the effects in the baby are subtle, and include irritability, agitation, tremor, increased respiratory rate, nasal congestion, or diarrhea. However, the SSRI paroxetine is thought to cause birth defects in early pregnancy. [I bolded.] It is important to note that depression itself may be more harmful than the drugs used to treat depression. The benefits of SSRIs in the treatment of depression need to be weighed against the risks to the unborn baby.

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As a point to note with your 2 selections of medications, Isotretinoin (e.g. Roaccutane) is used to treat acne and Paroxetine is for treating depression, General Anxiety Disorder, panic disorder and Post Traumatic Stress Disorder. These are medical conditions with very different possible outcomes.

Acne can be lived with without affecting daily life, but others (depression etc.) can severely affect daily life, which can include risks of suicide.

With Paroxetine (a type of antidepressant called Selective Serotonin Reuptake Inhibitors (SSRIs)) manufacturers advise that you avoid taking them during pregnancy unless the potential benefit outweighs the risk (British National Formulary).

Now, you can stop taking Roaccutane with no adverse effects, but you cannot just stop taking SSRIs. Stopping needs to be under the direction, advice and control of your doctor. Stopping suddenly can lead to withdrawal symptoms such as:

  • stomach upsets
  • flu-like symptoms
  • anxiety
  • dizziness
  • sensations in the body that feel like electric shocks
  • seizures (fits)

If your GP or mental health specialist decides to stop your course of SSRIs, they'll reduce the dose gradually over a few weeks.

I don't know about other countries, but here in the UK, SSRIs come packaged with a patient information leaflet which discusses side effects, contraindications, etc.

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    Good answer. The other side of the coin, of course, is the level of risk and effect. Not all teratogens are the same. Isotretinoin carries a high risk (up to 60% if memory serves) for major congenital malformations. Paroxetine carries a small risk for minor to moderate congenital malformations. The FDA has phased out it's pregnancy category system recently (despite it being fairly useful, in my opinion), but isotretinoin was classified as pregnancy category X (never use), paroxetine as pregnancy category D (ok in certain circumstances).
    – De Novo
    Mar 8, 2019 at 21:35

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