Antidepressants and Pregnancy
An Important Warning For Antidepressant Users
There is some controversy regarding antidepressants and pregnancy and whether taking antidepressants during pregnancy poses health risks for babies.
Health Risks To Newborns
According to a study found in the Canadian Medical Association Journal, there was a 68 percent increase in the risk of miscarriage in women who used antidepressants during pregnancy.
In particular, the drugs Paxil and Effexor were associated with increased risk of miscarriage. In addition, they found that a combination of different antidepressants doubled the risk of miscarriages.
Also, babies born to women who take antidepressants during pregnancy may experience small delays in reaching certain developmental milestones, but the causal links are not certain.
For example, compared to children born to women who did not take antidepressants, children born to women who took antidepressants in pregnancy sat up for the first time an average of 16 days later and walked almost a month later.
However, babies exposed to antidepressants still reached these milestones within the range of what is considered normal development. In general, however, the findings suggest the combination of antidepressants and pregnancy has some impact on the fetal brain.
Similarly, animal studies have linked early exposure to antidepressants to lasting behavioral changes, but previous studies in humans have failed to confirm this finding.
In one study of 82,000 babies born in Denmark between 1996 and 2002, babies born to mothers who took antidepressants in their second and third trimesters were twice as likely to be unable to sit up without support as babies born to women who did not take antidepressants.
The delay was significant only for exposed boys, who were three times as likely to need assistance sitting up at age 6 months compared to unexposed babies.
However, no difference in motor development was seen at age 19 months, but the antidepressant-exposed toddlers did exhibit shorter attention spans than the unexposed toddlers.
In addition, there was little difference between the antidepressant-exposed and unexposed babies in other milestones such as language, hearing, and social development.
Study Limitations
Assessing the risks of antidepressants and pregnancy is difficult because those suffering from depression are more likely to engage in risky behaviors such as smoking, drinking, and using recreational drugs, which may harm fetal health. This makes causal implications difficult as it is difficult to ascertain whether the antidepressants or risk behaviors had a negative effect on the pregnancy. In addition, antidepressant use has been linked to early delivery, but so has untreated depression.
Celexa
Celexa has been linked with a rare but serious newborn lung problem PPHN (persistent pulmonary hypertension of the newborn) when ingested during the last half of pregnancy. It has also been associated with septal heart defects, and has been linked to the following: Anencephaly (a birth defect that affects the brain and skull), Craniosynostosis (a birth defect that affects sutures on the head), Omphalocele (a birth defect that affects the abdominal organs).
Prozac
Prozac has also been linked with PPHN when taken during the last half of pregnancy.
Paxil
Paxil has been associated with fetal heart defects when taken during the first trimester. It has also been linked to PPHN when taken during the last half of pregnancy, and has also been linked to Anencephaly, Craniosynostosis and Omphalocele.
Zoloft
Zoloft has been linked with PPHN when taken during the last half of pregnancy, and is associated with septal heart defects, Omphalocele, PPHN (persisent pulmonary hypertension of the newborn), Anencephaly, and Craniosynostosis.
Amitriptyline (Elavil)
Early studies of Amitriptyline (Elavil) suggested a risk of limb malformation, but this has not been replicated or confirmed by newer studies.
Nortriptyline
Early studies of Nortriptyline suggested a risk of limb malformation, but this has not been replicated or confirmed by newer studies
Nardil
Nardil (Phenelzine) may cause a severe increase in blood pressure that triggers a stroke. As a result, it is generally avoided during pregnancy.
Parnate
Parnate (Tranylcypromine) may cause a severe increase in blood pressure that triggers a stroke. As a result, it is generally avoided during pregnancy.
Wellbutrin
To date, Wellbutrin (Bupropion) has not been linked to any established fetal health risks during pregnancy.
The Treatment Dilemma
The issue of antidepressants and pregnancy is a double edged sword because patients run the risk of depressive relapse if they stop taking medication. Also, abruptly discontinuing an SSRI (Selective Serotonin Reuptake Inhibitor) type antidepressant may cause side effects such as nausea, vomiting, chills, fatigue, insomnia, anxiety and irritability.
Some Helpful Guidelines
In reference to antidepressants and pregnancy, the American Psychiatric Association (APA) and the American College of Obstetrics and Gynecology (ACOG) recommend:
* Women with severe depression, psychotic episodes, bipolar disorder, or those with a history of suicide attempts or current suicidality should not stop taking antidepressants in pregnancy.
* Women with mild depression and those who have experienced few symptoms during the last six months or longer can consider gradually reducing or stopping medication under the close supervision of their treating doctor.
* Psychotherapy and other non-drug treatments may be emphasized as an alternative to antidepressants during pregnancy for some patients. Again, this is done only under the supervision of a treating psychiatrist.
The Bottom Line About Antidepressants And Pregnancy
If you are pregnant or thinking about becoming pregnant consult with your healthcare provider. Depending on the individual case, mild depression can often be managed with psychotherapy or other methods. However, if the depression is severe or you have a recent history of depression, the risk of relapse may be greater than the risks associated with antidepressants.
In the end, the risks and benefits must be weighed carefully on a case-by-case basis. Therefore, it is essential to work in conjunction with your treating psychiatrist in order to make an informed choice regarding antidepressants and pregnancy.
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