Antidepressants and Pregnancy

Mother's Mental Health, Medication Safety Are Important Issues

Pregnant woman crying
Pregnancy and Antidepressants. Image Source / Getty Images

Mothers who become pregnant while taking an antidepressant are forced to make a difficult choice. Should they stop taking their medication in order to ensure the health of their baby, or should they continue to take their antidepressant to ensure that they don't become depressed? There are pros and cons to each.

Antidepressant Risks

While the SSRIs--a class of antidepressant including the drugs Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), Paxil (paroxetine), Celexa (citalopram) and Lexapro (escitalopram)--have been considered relatively safe during pregnancy, there is emerging evidence that they are not entirely without risk.

A study published in the February 9, 2006, issue of the New England Journal of Medicine looked at babies who developed persistent pulmonary hypertension, which, in rare cases, can be fatal. They found that compared to infants who did not develop this complication, their mothers were more likely to have taken these drugs during late pregnancy. The authors suggest that assuming this relationship is causal, infants exposed to SSRIs in late pregnancy would be six times more likely to develop PPHN than unexposed babies. Although the increased risk is significant, it still translates into approximately six to twelve infants in 1000 vs. one to two infants in 1000 if SSRIs are not used. The authors point out that 99 percent of women exposed to one of these medications late in pregnancy will deliver an infant unaffected by PPHN.

Another study, published in the February 2006 issue of Archives of Pediatrics and Adolescent Medicine, found that nearly one-third of newborns whose mothers took SSRIs during their pregnancy experienced neonatal abstinence syndrome.

Infants who experience this syndrome have symptoms such as high-pitched crying, tremors, disturbed sleep, gastrointestinal problems, and hypertonicity, which is an abnormal increase in muscle tone. While no medical intervention is necessary for this syndrome, it is uncomfortable for the child.

Research thus far does not seem to indicate any increased risk of major fetal abnormalities following exposure to the SSRIs or other newer antidepressants.

Although results have been inconsistent, some studies do indicate increased risk of low birth weight babies.

Depression Risks

Obviously, there are some risks associated with antidepressant use during pregnancy, but the mother's mental well-being must also be considered. While pregnancy was once thought to provide some protection against depression, this has since been shown to not be true. Women who discontinue their medications are significantly more likely to experience a relapse of their depression than women who remain on their medication.

Some researchers speculate that an increase in the mother's stress hormones may present risk to the developing fetus. Research presented at the American Academy of Child and Adolescent Psychiatry's 2006 meeting by Sheila M. Marcus and colleagues addressed this question in a group of 53 mother-infant pairs.

Among their findings, as reported in MedPage Today:

  • Children of mothers with major depression were born at an average of 35.6 weeks compared to 39.4 weeks for mothers who had no history of depression.
  • Cord blood of the babies born to depressed mothers had more of the stress hormone cortisol, although the difference between their levels and the levels of the babies born to low-risk mothers was not statistically significant. Given that the test group was relatively small, a larger sampling of babies is necessary to determine what, if any, meaning this may have.
  • Motor maturity tended to be lower, although again it did not reach a statistically significant level.

    With depression also comes an increased risk of the mother not taking proper care of herself or feeling suicidal. Susan (not her real name), a member of our forum community, was determined to do everything possible to ensure her baby's well-being. She ate right, exercised, didn't drink or smoke, never missed a doctor's appointment, and stopped taking her antidepressants "just in case they might hurt the baby".

    During the seventh month of her pregnancy, she began to think that maybe her husband and baby would be better off without her. At that time, she says, "My thoughts made perfect sense. I felt I was a burden to my husband because of my depression and that my baby would be better off being raised by someone without my problems." Her plan, she says, was to wait until the baby was born and then commit suicide. After the baby was born and she had resumed taking Prozac, she said, "I was amazed that I could have thought such things and actually believed that they made sense."

    Should You Stop Taking Your Antidepressant?

    At this point, there is no clear answer to this question. Antidepressants and untreated depression both present potential risks to the child's health. A decision must be made on a case-by-case basis whether the benefit to the mother and child's well-being outweighs any risks from the antidepressant. Mothers should consult with their own personal physician to obtain the latest medical information and advice prior to making their decision.

    Mothers who elect to discontinue their medication during pregnancy should take a lesson from Susan's experience and make certain they have a good support system in place in case they become depressed.

    Sources:

    Chambers, Christina D. et. al. “Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn.” New England Journal of Medicine 354.6 (2006): 579-587.

    Cohen LS, et. al. ”Relapse of Major Depression During Pregnancy in Women Who Maintain or Discontinue Antidepressant Treatment.” JAMA 295.5 (2006) : 499-507.

    Einarson, T.R.and A. Einarson ”Newer Antidepressants in Pregnancy and Rates of Major Malformations: A Meta-Analysis of Prospective Comparative Studies.” Pharmacoepidemiol Drug Saf 14.12 (2005) : 823-7.

    Levinson-Castiel, Rachel, et. al. ”Neonatal Adverse Reactions After In Utero Exposure to Selective Serotonin Reuptake Inhibitors: Still Controversial.” Arch Pediatr Adolesc Med 160.2 (2006) : 855-856.

    Marcus SM, et al. "Perinatal Depression: Neuroendocrine and Behavioral Impacts on the Neonate" American Academy of Child and Adolescent Psychiatry 33 (2006) A16.

    Oberlander TF, et. al. ”Neonatal Outcomes After Prenatal Exposure to Selective Serotonin Reuptake Inhibitor Antidepressants and Maternal Depression Using Population-Based Linked Health Data.” Arch Gen Psychiatry 63.8 (2006) : 898-906.

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