Americans take more antidepressants than they do any other type of prescription drug, and pregnant women are no exception. One out of every eight pregnant women in the U.S. takes selective serotonin reuptake inhibitors (SSRIs) to treat depression or other mood disorders. A handful of recent studies suggest that these drugs could have adverse effects on infant health: they may increase the risk for rare heart defects, premature delivery, low birth weight and withdrawal symptoms. Nevertheless, some doctors argue that the benefits these drugs provide still outweigh the potential risks.
Worries over the use of SSRIs during pregnancy first surfaced in journal articles published in the 1980s, but it was not until 2005 that the U.S. Food and Drug Administration conceded that babies born of mothers who take paroxetine (sold as Paxil and Seroxa) during their first trimester are up to twice as likely to exhibit fetal heart defects. A 2005 study published in the Lancet also found that some newborns born of mothers taking paroxetine suffer from withdrawal symptoms such as convulsions and abnormal crying for several days.
More recently, pregnancy risks associated with other SSRIs have also come to light. A study published in the September 26 issue of the British Medical Journal monitored nearly 500,000 Danish children from nationwide registries and found that women who take sertraline (Zoloft), citalopram (Celexa) and fluoxetine (Prozac) are more likely to give birth to babies with heart defects, although the overall risk is still quite low. A study in press in the Journal of Clinical Psychopharmacology notes that women treated with SSRIs during late pregnancy are more likely to give birth to small and premature babies. A study published in the October 2009 Archives of Pediatric and Adolescent Medicine suggests that women taking SSRIs are twice as likely to have preterm births as compared with the general population and that their babies are more likely to spend time in the neonatal intensive care unit.
So should women stop taking SSRIs when they are pregnant? Not necessarily, says Emilio Sanz, a clinical pharmacologist at the University of La Laguna in Tenerife, Canary Islands, and co-author of the 2005 Lancet study. He notes that untreated depression increases the risk of prematurity, low birth weight and neonatal complications, too. Sengwee Darren Toh, an epidemiologist at the Harvard School of Public Health, points out that these similar outcomes make it “quite difficult to tease out effects of the drugs from those of underlying depression.”
Sanz and Toh point out, however, that many women who take SSRIs have not been diagnosed with clinical depression—some take the drugs for obsessive-compulsive disorder, pain management or even severe premenstrual symptoms. For these kinds of conditions, there may be other, potentially safer options. For instance, in September 2009 a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists argued that psychotherapy is a suitable treatment for some pregnant women suffering from mild forms of depression or other mood disorders. Doctors have to “distinguish between real depression and just blues, sadness, feeling down,” Sanz says.
This article was originally published with the title Are Antidepressants Safe for Pregnant Women?.
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8 Comments
Add CommentI think SSRI's are bad news. Doctors prescribe these to people way too often. People with serious forms of depression could likely benefit but they are likely a small percent of those that are prescribed. They also do nothing to address the cause of depression to begin with.
Reply | Report Abuse | Link to thisIf you are depressed, you need to do something about the cause. If you can't do something about the cause, you need to find a successful strategy for coping with it. Drugs are not likely to be the solution except in some few cases.
I can speak from experience. I went through a very painful divorce and started having health problems because of it. The doctor practically threw Paxil at me. I took it for awhile but the only real solution was to move on in my life.
abyssalmystery, you do speak from experience - your own. That is an experiment with no methodology, no controls, no measured outcome, etc. I'm glad things went well for you, but please do not suggest that your one incident should be accepted as instructive on its own. "The cause?" We have little clue why some who go through tough times get depressed and others do not - and certainly no reliable info on how to prevent it. And we have no idea why some get terrible depression without any identifiable inciting incidents. After all, this is Scientific American
Reply | Report Abuse | Link to thisDoctors should take the time to be reasonably sure of the diagnosis, and should describe the risks/benefits and the alternatives before prescribing a drug for depression - but when was the last time any physician did this before prescribing you ANYTHING. That's not a problem of antidepressants - it's a problem of the medical system that focuses more on throughput than on outcome.
Anyway, I am sorry you had to go through a painful divorce, and I'm glad you were able to move on.
Gewisn, there's only few reason why people get depressed, it because they don't want to or cant move on. It is true i am against taking meds, and thats why i agree doctors are prescribing medications like giving out candies.
Reply | Report Abuse | Link to thisIt is absolutely essential that physicians, as well as the general public, understand the difference between grief and major depressive disorder.
Reply | Report Abuse | Link to thisWe will all experience an episode of grief in our lives, varying in degrees, but there are others who suffer DAILY from unexplainable, recurring bouts of very extreme grief which is out of their control.
For many who truly suffer from major depressive disorder and other various mood disorders, psychotherapy can help manage the stresses in our lives which may worsen our mood, but the reality is that these chronic episodes do not go away merely by "moving on" or finding the "problem."
The fact of the matter is, there IS no concrete, observable problem. These episodes were not caused by a divorce, the loss of a loved one, debt, or any of the stresses a person might encounter in their lives. These deep, debilitating states of sadness and alienation often creep up upon them, lasting for weeks at a time and destroying all ability to go on with the daily routine.
Depression is overdiagnosed and antidepressants are overprescribed, this is very true. But for those who truly suffer from major depressive disorder, they will tell you firsthand that they've suffered for much of their lives, episodes which they cannot explain. Some days they can't move, they can't sleep, and they can't eat.
There are other sufferers of major depressive disorder who CANNOT tell you firsthand of their struggles, because after years of unexplained episodes and failed treatments, they made the choice to end their life.
People need to reach a better understanding of what this disorder truly is. It is not "the blues" or the sadness over a dog dying. This is not one episode of sadness, brought on by a loss. This is a disorder, recurring episodes of extreme grief that make it impossible for a person to function and live a fulfilling life, a disorder that is out of a person's control.
There is a difference between "getting depressed" and suffering from major depressive disorder. It is a disorder that can destroy a person's life. It is a CONFUSING disorder for those who truly have it, who cannot explain why they've woken up with the weight of the world on their shoulders.
Those who suffer fro the disorder WANT their lives back. If medication allows them to go back to work or school without breaking down, if it gives them the strength to take a shower today, if it allows them to FEEL the embrace of a loved one and truly feel comforted by it, than they not only need this medication, but they DESERVE it.
Apparently, the bad side-effects of antidepressants are aplenty, surely they cannot be good or safe for pregnant women.
Reply | Report Abuse | Link to thisChances are many have been given placebo most of the time. Just ask those big Pharmas, who know all the details.
karmabites, That's what I was trying to say, anti-depressants are being prescribed way too much and the doctors fails to tell those 2 apart(normal, depression which everyone goes through in some part of their life,u can say its part of evolving-mentally and the other which is real, serious depression, which needs to be treated by not these medicines because mostly people feel even more worse after taking these medicines. There need to be something more better method which doesn't harm(more) then it cures)
Reply | Report Abuse | Link to thisThe title of this article is biased and misses the point. It should be called, "Do the benefits of antidepressants outweigh the risks for pregnant women and their babies?" The answer is sometimes yes, sometimes no, and we desperately need more data.
Reply | Report Abuse | Link to thisthe reason these things are being prescribed like candies is because of the influence of the bigger drug companies have on doctors. The drug companies encourage doctors to prescribe it to everyone, you might have noticed that doctors were asking the government to allow them to prescribe cholesterol lowering drugs to children's. The doctors are given extra commission to prescribe these things. Do not believe me, do some search on internet and you will be amazed.
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