Antidepressants during pregnancy can be tricky
October 31st, 2012
11:53 AM ET

Antidepressants during pregnancy can be tricky

For years, pregnant women who suffer from depression have been told it's safer for them and their unborn child to continue taking antidepressants during pregnancy.

Now a new study is challenging that advice, suggesting the opposite is true and advocating against most women taking these drugs. If the depression is severe, however, the benefits might outweigh the risks, so it's best to check with your psychiatrist or physician.

Experts say about 13% of women take an antidepressant at some point during their pregnancy. Many drugs are called SSRIs, or selective serotonin reuptake inhibitors.

Taking these medicines while pregnant, however, may raise safety concerns, according to a review of existing research published Wednesday in the journal Human Reproduction.

Study findings
"There is clear consistent evidence of risk with the use of these drugs by pregnant women and we know there is a range of pregnancy complications that are associated with the use of these drugs in pregnancy," says study author Dr. Adam Urato, chairman of the Department of Obstetrics and Gynecology at Metrowest Medical Center in Framingham, Massachusetts.

"Those include miscarriage, preterm birth (delivering the baby early), newborn behavioral syndrome (poor newborn adaptation) - and there is a big issue about the possible long-term effects of these drugs," he says.

But others are concerned this review does not address the risks of not treating women with severe depression, which can be equally important.

"Yes, there are issues with using antidepressants during pregnancy, but they (the study authors) are not putting this in any sort of context," says Dr. Jennifer Payne, director of the Women's Mood Disorders Center at Johns Hopkins School of Medicine in Baltimore. "They didn't even give a nod to (the fact that) there may be cases when you need to use antidepressants during pregnancy, and I find that irresponsible."

"Many women who are depressed don't sleep and don't eat properly," Payne says. "Women who are depressed during pregnancy are less likely to see their doctors for routine prenatal care."

Treatment during pregnancy also helps protect mothers from developing postpartum depression after the baby is born. Waiting to begin treatment until after delivery, "you're going to run the risk of letting mom slide into postpartum depression when perhaps you could have prevented this if you'd started treatment earlier," explains Dr. Marla Wald, a psychiatrist at Duke University Medical Center who specializes in perinatal and women's mental health.

The study authors also reviewed several studies that suggest use of SSRIs does not increase infertile women's chances of conceiving. More research is needed on the topic, they say.

The American Psychiatric Association and the American College of Obstetricians and Gynecologists issued a joint report in 2009 to address the concerns about the risks of antidepressants on the health of pregnant women and their babies.

According to the report, studies show pregnant women who take antidepressants have a slightly increased risk of miscarriage and may deliver their babies early, before 37 weeks of gestation. The report also says when pregnant women take antidepressants, 15% to 30% have babies with neurobehavioral problems such as irritability or risk for seizures. These symptoms usually go away in about two weeks, according to the APA and ACOG.

Another concern, according to the report, is persistent pulmonary hypertension, a type of high blood pressure that affects the arteries in the lungs and the right side of the heart, although the risks are very small. The jury is still out about the possibility of long-term effects of SSRIs on children, according to the APA/ACOG report, but lack of treatment for very depressed moms increases the risk of early developmental issues.

Depression levels differ
But the authors of the new study point out that the majority of women on SSRIs are not severely depressed, instead suffering only mild to moderate symptoms.

And in this group, "There is really no conclusive evidence that SSRIs are better than placebo," says study author Dr. Alice Domar, executive director of the Domar Center for Mind/Body Health at Boston IVF. "I don't want women to stay on this medication thinking it's as safe as a sugar pill because it's not."

The takeaway
Domar says that other treatments such as cognitive behavioral therapy are as good or better than SSRIs for those with mild to moderate depression. She says other options also being investigated include exercise, mindfulness based therapy, yoga, acupuncture and light box therapy.

But Wald wants to reassure women with severe depression who find that only SSRIs work as opposed to alternative therapies that they aren't doing anything wrong.

"I don't want women to be scared by this paper because fundamentally there is not enough being done for this population," she says. "I would be concerned if this information was viewed as saying there was too much treatment going on for these women, particularly too much medication treatment."

And she adds that each woman is different and needs to be evaluated by a psychiatrist or trained professional to determine if antidepressants are the best treatment option.

"They should make the best individual decision they can and not succumb to cultural pressures - make the best individual decision they can for themselves and their whole family, for all of their children," says Wald.

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soundoff (71 Responses)
  1. BillRubin

    Do you know what else is bad for a pregnancy? Suicide. While the data is clearly there, I am reminded of the black box warning on the use of SSRI's in adolescents and children. Then, in the mid-2000's, there were warnings of a slightly increased risk of suicidal thought (but not actual completed suicides) while on the drug. When SSRI use declined after the warnings , people were expecting the suicide rate to decline. Instead, however, the actual suicide rate in children and adolescents rate increased by 18%. While, it's just a correlation, it also an important lesson.

    Any pregnant patient with severe depression or at high risk for suicide should be closely followed by their physician if they decide to stop their SSRI's. We don't want to make the same mistakes in the past.

    October 31, 2012 at 18:42 | Report abuse | Reply
  2. Just

    Just dealing with pregnant women is tricky.

    November 2, 2012 at 10:08 | Report abuse | Reply
  3. Norml

    What about the long term effects on the child? Two of my friends whose children have autism took Zoloft while pregnant. There may or may not be a connection. But, I am concerned about taking any medications while pregnant because of the possible effects on my child. The only thing they told my friend about Zoloft while she was pregnant was that it may cause Jaundice in her son, which it did. He had a bad case of Jaundice. That means his liver was over-loaded. What else could be happening that doesn't have a physical manifestation?
    Not doubting that many women NEED the antidepressants. But, it would be sad to later find out that their use of them had long term repercussions.

    November 2, 2012 at 11:17 | Report abuse | Reply
    • A

      I too used Zoloft while pregnant (which was the result of my now ex raping me, hence the reason I needed the Zoloft). My daughter is now 3 and is not autistic. Not saying that there isn't a connection between the two... But new studies are finding that scientists have found a the gene combo that results in autism, meaning that those children probably would have had autism regardless of whether their mothers took Zoloft or not. In fact they are believing now that they can screen for autism during pregnancy, just like they screen for Down's Syndrome and other maladies. And if found during pregnancy they can start therapy for it earlier.

      I honestly think I would have become another suicide statistic had I not been on an anti-depressant while pregnant. I spent some time in an emergency psych ward even though I was taking an anti-depressant.

      August 26, 2013 at 13:16 | Report abuse |
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  6. Mark Romanillos

    Please help my daughter


    November 24, 2012 at 07:35 | Report abuse | Reply
  7. CNNNN

    I have PTSD and Anxiety and went off Zoloft before I got pregnant. I was not comfortable with any increased risk. I do my best to keep the PTSD and Anxiety under control with deep breathing if I feel panicky, controlling stress etc.

    November 25, 2012 at 11:53 | Report abuse | Reply
  8. Texas4

    If your taking medication to fight depression, suicide, PTSD, bipolar and so on, why are you having kids? You risk a childs health for the sake of wanting and what kind of parent will be when you spend a majority of your day just fighting your illness.

    December 11, 2012 at 16:33 | Report abuse | Reply
    • Mia

      What an ignorant thing to say. Are large part of the population suffers from mental illness but that disqualifies them from exercising their right to have children? Are we to punish those for something they cannot control? What about those with bipolar disorder? Bipolar disorder is genetic and so we are going to punish those who were born with a mental illness, something beyond their control? There are people out there who would make excellent parents because despite having a mental illness they do everything they can to treat their mental illness and are able to lead normal, healthy lives. If we are talking about potential risks to a child's health because of taking certain medications while pregnant then we may as well apply it to those with diabetes who have to constantly monitor their blood sugar levels and take insulant everyday. If we disqualify them too then another majority of the population would not be able to have children.

      March 12, 2013 at 13:57 | Report abuse |
    • A

      This is truly an ignorant thing to say. That's like saying ANYONE with ANYTHING wrong with them shouldn't have children. Women with diabetes have children. Hell, even people with mental retardations have had children, perfectly healthy children at that.

      I have struggled with depression since I was 13 or 14 (now 27). But most of it was due to the deaths of several close family members (my father died when I was 16) and friends. I took anti-depressants while pregnant as the result of my now ex raping me. Had I not taken anti-depressants while pregnant, I probably would have commited suicide.

      August 26, 2013 at 13:43 | Report abuse |
    • Michelle

      I TOTALLY agree Texas4

      November 1, 2013 at 12:14 | Report abuse |
    • Em

      Michelle and Texas4 are ignorant morons.

      July 11, 2014 at 21:19 | Report abuse |
  9. Mrs.Mason

    I actually became pregnant twice while on Prozac (as well as other meds for other issues), and had two miscarriages (the causes were not determined, I am NOT saying the Prozac caused it)... Now I am pregnant for a 3rd time. I am not taking any of the medication I was on (basic pain meds, anti-inflammitories, anti-depressant, and anti-anxiety) because I am scared it will mess with my body. I am actually happier now, pregnant, than I was on the medication, and I think it's partially the hormone changed that happen in pregnancy. My OB agreed with me, but did say at the first signs of depression for my hubby or me to call in and he will get me on a pregnancy "safe" anti-depressant. He also told me that many of the Class C pregnancy drugs (ie most anti-depressants) are not Class C because they haven't been studied... they have been studied, just not by the manufacturer, which determines the class. I believe him, he's one of the the best OBs in the country (he won a top award in 2011), but for my body, I don't want to risk it.

    December 11, 2012 at 21:29 | Report abuse | Reply
  10. Shopeastwest

    Pregnancy hormones were once thought to protect women from depression, but researchers now say this isn't true. In addition, pregnancy can trigger a range of emotions that make it more difficult to cope with depression.Depression treatment during pregnancy is essential. If you have untreated depression, you might not have the energy to take good care of yourself.

    April 10, 2013 at 05:31 | Report abuse | Reply
  11. chowhanjeet

    The question of how to treat the condition is critical because research does show there are some risks to a baby from taking medication. And many women do take antidepressants: One study found that approximately 13 percent of women took an antidepressant at some time during their pregnancy.

    October 30, 2013 at 05:35 | Report abuse | Reply
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