March 2006
Antidepressants and pregnancy: Tough choices
Some widely-used drugs increase risks for baby
Three recent research reports create a serious dilemma for pregnant women who take the most commonly prescribed antidepressants. If they stop, they risk a potentially dangerous relapse. But if they continue, the drugs may endanger their newborn's health or even life. The new findings mean that women must work with their doctors to judge which is the lesser of two evils: worsening depression or increased risk to their baby's health.
All three studies focused on selective serotonin-reuptake inhibitors (SSRIs), the popular class of antidepressants that includes citalopram (generic, Celexa), fluoxetine (generic, Prozac), paroxetine (generic, Paxil), sertraline (Zoloft), and the closely related drug venlafaxine (Effexor). Here's what they found:
Pregnant women who stopped using antidepressant drugs had a five times greater likelihood of relapse than those who stayed on the drugs, according to a study in the Feb. 1, 2006, Journal of the American Medical Association. Those findings are worrisome because depression during pregnancy often continues after delivery, hampering the mother's ability to bond emotionally with her baby and setting up the child for developmental delays and long-term psychological problems. In extreme cases, depressed mothers can become suicidal or physically harm their infants.
Newborns whose mothers used SSRIs during the second half of pregnancy had a sixfold increase in the incidence of persistent pulmonary hypertension of the newborn, a life-threatening condition in which blood carrying too little oxygen continues to circulate after birth. As reported in the Feb. 9, 2006, edition of The New England Journal of Medicine, the risk was still fairly low--about 6 to 12 cases per 1,000 births--but roughly 11 percent of babies with the condition die and many more suffer brain damage and other lasting health consequences. Thirty percent of newborns exposed to SSRIs during gestation had symptoms of drug withdrawal for as long as four days after birth, including jitteriness, diarrhea, sleeping problems, stiff muscles, and a high-pitched cry, researchers reported in the February 2006 issue of Archives of Pediatric and Adolescent Medicine. The babies recovered on their own, but no one knows the long-term effects.
What you can do
Medical experts we consulted suggested the following measures to minimize the risks to yourself and your baby:
Some widely-used drugs increase risks for baby
Three recent research reports create a serious dilemma for pregnant women who take the most commonly prescribed antidepressants. If they stop, they risk a potentially dangerous relapse. But if they continue, the drugs may endanger their newborn's health or even life. The new findings mean that women must work with their doctors to judge which is the lesser of two evils: worsening depression or increased risk to their baby's health.
All three studies focused on selective serotonin-reuptake inhibitors (SSRIs), the popular class of antidepressants that includes citalopram (generic, Celexa), fluoxetine (generic, Prozac), paroxetine (generic, Paxil), sertraline (Zoloft), and the closely related drug venlafaxine (Effexor). Here's what they found:
Pregnant women who stopped using antidepressant drugs had a five times greater likelihood of relapse than those who stayed on the drugs, according to a study in the Feb. 1, 2006, Journal of the American Medical Association. Those findings are worrisome because depression during pregnancy often continues after delivery, hampering the mother's ability to bond emotionally with her baby and setting up the child for developmental delays and long-term psychological problems. In extreme cases, depressed mothers can become suicidal or physically harm their infants.
Newborns whose mothers used SSRIs during the second half of pregnancy had a sixfold increase in the incidence of persistent pulmonary hypertension of the newborn, a life-threatening condition in which blood carrying too little oxygen continues to circulate after birth. As reported in the Feb. 9, 2006, edition of The New England Journal of Medicine, the risk was still fairly low--about 6 to 12 cases per 1,000 births--but roughly 11 percent of babies with the condition die and many more suffer brain damage and other lasting health consequences. Thirty percent of newborns exposed to SSRIs during gestation had symptoms of drug withdrawal for as long as four days after birth, including jitteriness, diarrhea, sleeping problems, stiff muscles, and a high-pitched cry, researchers reported in the February 2006 issue of Archives of Pediatric and Adolescent Medicine. The babies recovered on their own, but no one knows the long-term effects.
What you can do
Medical experts we consulted suggested the following measures to minimize the risks to yourself and your baby:
- If your depression is mild, talk to your doctors about substituting a nondrug treatment for the duration of your pregnancy,
such as talk or behavioral therapy.
- Don't categorically shun antidepressants. Experts say drug treatment is warranted if the mother's depression could lead to
suicide or other actions dangerous to herself and her baby, such as alcohol abuse, smoking, or not eating properly.
- If you need drug therapy, it may be possible to adjust your dosing schedule to reduce risks to your baby. For example, research
to date suggests that women can use most SSRIs in the first 20 weeks of pregnancy without increasing their baby's chance of
developing persistent pulmonary hypertension. So a reasonable strategy might be to taper off antidepressants and substitute
intensive nondrug therapy for the last 20 weeks of gestation.
- Stay away from paroxetine. Not only does it have the same risks as the other SSRIs, but research has also shown that women
who use it in the first trimester of pregnancy are more likely to give birth to babies with heart defects.
- Insist that the physicians taking care of your depression and your pregnancy confer with each other so you don't get contradictory
advice.
See our reports on mental health and alternative medicine, as well as our free reports on common drugs with hidden dangers (which includes information about drugs mentioned in this report) and the safest prescription drugs.
