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Neonates exposed to fluoxetine and other SSRIs or serotonin and norepinephrine reuptake inhibitorsSNRIslate in the third trimester have developed complications requiring prolonged hospitalizationrespiratory supportand tube feedingSuch complications can arise immediately upon deliveryReported clinical findings have included respiratory distresscyanosisapneaseizurestemperature instabilityfeeding difficultyvomitinghypoglycemiahypotoniahypertoniahyperreflexiatremorjitterinessirritabilityand constant cryingThese features are consistent with either a direct toxic effect of SSRIs and SNRIs orpossiblya drug discontinuation syndromeIt should be noted thatin some casesthe clinical picture is consistent with serotonin syndromesee WARNINGS AND PRECAUTIONS

Table 3Anxiety and Insomnia Treatment Emergent Adverse ReactionsIncidence in PMDD Placebo-Controlled Clinical Trials.

CUse with caution if benefits outweigh risksAnimal studies show risk and human studies not available or neither animal nor human studies done.

Tell the doctor right away if you notice worsening depression/other psychiatric conditionsunusual behavior changesincluding possible suicidal thoughts/attemptsor other mental/mood changesincluding new/worsening anxietypanic attackstrouble sleepingirritabilityhostile/angry feelingsimpulsive actionssevere restlessnessvery rapid speechBe especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

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