Recent Studies Shed Light On Risks Of Antidepressants During Pregnancy

Main Category: Pregnancy / Obstetrics
Also Included In: Depression
Article Date: 07 Oct 2009 - 3:00 PDT

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Although use of antidepressants during pregnancy seems to be "fairly safe" for the fetus, some studies have reported a slightly increased risk of certain fetal conditions with maternal use of the drugs, the New York Times reports. About 25% of all pregnant women have depression, and about one-eighth of them use an antidepressant at some point during pregnancy, according to 2003 data, the Times reports. Some studies have linked depression during pregnancy with premature births, growth changes, irritability and inattention in infants post-birth. However, the risks of medication must be weighed against those of untreated depression -- a balance that can be difficult to assess.

A recent report by experts from the American Psychiatric Association and the American College of Obstetricians and Gynecologists attempted to "put such findings in perspective" by reviewing existing research and issuing recommendations for managing depression during pregnancy, the Times reports. The experts said that talk therapy should be the first-line treatment for mild to moderate depression. They also said that the risks associated with antidepressants and shock therapy are relatively low for severe cases of depression. The report's tone is "generally reassuring but is filled with caveats," including that treatment decisions should be determined on a case-by-case basis, according to the Times. The report also "goes to great lengths" to emphasize the inconsistencies in the results of "some of the more alarming drug associations," the Times reports.

The report noted that research on drug effects in pregnancy is limited because pregnant women are not often recruited for clinical trials. There also are no data from randomized control trials, which are most trusted by researchers. Instead, large epidemiological studies that link patient databases are used to gain information, though this method does not allow researchers to control for characteristics other than drugs that might affect pregnancies, the Times reports.

Some critics of the report said it did not give enough attention to nondrug methods to treat depression, such as homeopathic remedies and nutritional supplements. Critics also charge that the paper's endorsement of psychotherapy was "politically correct" but not realistic, the Times reports. "By the time I get to hear about somebody's perinatal depression, it's usually worse than what can be treated with psychotherapy alone," Shari Lusskin, director of reproductive psychiatry at NYU Langone Medical Center, said, adding, "We should use a low threshold for treating women aggressively."

Studies Show Some Risks

Results of several recent studies have further complicated the issue of how to treat women with depression during pregnancy. A study published Tuesday in the Archives of Pediatrics & Adolescent Medicine reports that infants born to women who use antidepressants in the selective serotonin reuptake inhibitors class were more likely to be admitted to neonatal intensive care units and have low scores on the Apgar test, an overall measure of newborn health five minutes after birth.

Similarly, a Danish study in BMJ found a link between maternal use of several antidepressants in the SSRI class and an increased risk for septal health defects, commonly called holes in the heart. The study found that infants born to women who used the drugs citalopram -- sold as Celexa -- and sertraline -- sold as Zoloft -- had twice the risk of having the heart defect. However, the report noted that the absolute risk was less than 1% and the holes often close on their own. The study found the risk was higher if the woman took more than one kind of SSRI during her pregnancy.

According to the Times, other studies have indicated that SSRI use among pregnant women carries an increased risk for persistent pulmonary hypertension, which can lead to respiratory problems and serious complications in newborns. A recent study found a sixfold risk for the condition among infants born to women who took the drugs during the second half of pregnancy. However, the study noted that the condition affects no more than 1.2% of infants, even with the use of antidepressants. A larger number of infants are affected by symptoms of drug withdrawal post-birth, with 15% to 30% of infants born to women using SSRIs later in pregnancy experiencing effects like weak or no crying, irritability, abnormally fast breathing, hypoglycemia, seizure and unstable temperature. According to the Times, these symptoms typically resolve within two weeks (Rabin, New York Times, 10/6).

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