November 2, 2012
Popular drugs for depression may lead to more risks than benefits for pregnant women, a review of research finds. The review focused on women who had problems getting pregnant. But the studies reviewed also included other pregnant women. The most popular drugs for depression are called selective serotonin reuptake inhibitors. Prior research has linked the use of some of these drugs during pregnancy with higher risks of miscarriage, birth defects and preterm (early) birth. The strongest evidence of risk has been seen for paroxetine (Paxil). Some studies also suggest effects on the babies' behavior and health. The new review of research found no evidence that treating depression with drugs can lead to a healthier pregnancy or birth. The study did conclude that talk therapy can reduce depression symptoms. This type of treatment does not require drugs. Experts interviewed by USA Today disagreed with the conclusion that drug treatment does not benefit the mother and baby. They said each woman should decide about treatment with her doctor. The journal Human Reproduction published the study online. USA Today wrote about it October 31.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Untreated depression during pregnancy might lead to a less healthy baby. Antidepressant medicines during pregnancy may also harm the baby. Which is the bigger risk for the newborn?
A newly published review highlights what we know about the risks of antidepressants in pregnancy. The authors' conclusion: We are sure there are risks from these drugs in pregnancy, and we are not sure there is very much benefit.
About 13% of pregnant women take a drug for depression during all or part of their pregnancy. What are the risks?
The newly published review says antidepressants also increase the risk of:
There is a weak connection between antidepressants in pregnancy and autism. No one has shown whether the drugs can cause autism, however.
Several years ago the Food and Drug Administration changed the pregnancy safety rating of Paxil. The new rating is D for the entire pregnancy. This means there is evidence showing the drug is unsafe. Other drugs in the same class as Paxil include:
These other drugs have pregnancy safety rating C for the first and second trimesters. This means we don't have enough evidence to know much. They are generally unsafe in the third trimester. Most other antidepressants have a safety rating of C for the whole pregnancy.
What Changes Can I Make Now?
If you have new or continuing depression when you are pregnant, think carefully about your need for drug treatment. Get guidance from a doctor or therapist. Together, weigh the risks of taking the medicine versus delaying or stopping it.
Here are some things to think about as you make your decision:
Most women should avoid antidepressant drugs during pregnancy. In severe cases, it is important to treat depression with all resources that we have -- drugs, social support and psychotherapy.
What Can I Expect Looking to the Future?
We still have only a short experience with antidepressant drugs and pregnancy, so long-term effects on babies are unknown. One small study did not find anything abnormal in the brain function or development of exposed babies once they were 8 months old. This is reassuring, though more research is needed.