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Antidepressant Use During Pregnancy

Katlyn Joy | 5, July 2012


Choosing whether or not to treat depression during pregnancy with medications is a delicate balancing act in deciding what the specific risks and potential benefits of such treatment may be for both mother and child.

Antidepressants are prescribed in an estimated 8 percent of pregnancies in the US each year. According to the Mayo Clinic, taking antidepressants during pregnancy poses risks although at a relatively low rate. However, no medication for anxiety has been proven safe and some studies have raised significant concerns over health issues connected to maternal antidepressant use.

Prematurity. According to certain research in the last few years, both antidepressants and depression are linked to prematurity. However, in the case of medication, it appears that withdrawing use in the last trimester is sufficient to prevent most instances of premature birth.

Hypertension in mothers. According to an April 2012 study published in the British Journal of Clinical Pharmacology, using antidepressants while pregnant increases the risk of high blood pressure in expectant mothers 53 percent over women who do not take the medication. The study looked at 13,000 women. More alarming were the results for women taking a specific antidepressant, Paxil; those women saw an 81 percent increase.

However, the increases are still at a generally low rate. For instance, taking antidepressants raises the rate of hypertension from 2 percent to 3.2, and with Paxil the rate goes from 2 percent to 3.6.

The study also noted that 1 in 5 women are diagnosed with depression during pregnancy and of those 14 percent use antidepressants for the treatment of the condition.

Pulmonary hypertension in newborns. According to a January 2012 study out of Stockholm, Sweden, children born to mothers who took an antidepressant during pregnancy were at higher risk of developing pulmonary hypertension. This condition, while rare, causes shortness of breath, fainting, dizziness, breathing difficulties and is associated with heart failure. The rate of pulmonary hypertension associated with maternal antidepressant usage is low, about 3 percent, and doubles if taken during the last trimester of pregnancy.

The study looked at 1.6 million births between 1996 and 2009 and infants were examined at 33 weeks. Drugs prescribed included citalopram, escitalopram, fluvoxamine, fluoxetine, paroxetine and sertraline.

Heart defects. Two major studies have linked the use of Paxil in the first trimester to heart defects in newborns. The rate increases from 1 to 2 percent with the early pregnancy use of Paxil and has lead to the manufacturer detailing the risks in its literature.

Due to these studies, the American Congress of Obstetricians and Gynecologists has now issued an advisory to all pregnant women to avoid taking Paxil during their pregnancies. ACOG however warns women to discuss the medication with their doctor as rapidly discontinuing the drug without medical supervision can be dangerous as well. Additionally the risks from a serious depression may outweigh the potential side effect risks from medication.

Autism. In a 2011 study, a link between autism and maternal antidepressant use was found. Further studies however are needed to provide substantial evidence of the link. Yet the mere risk may be enough to warrant avoiding antidepressant use in many cases.

Birth defects. Earlier studies indicated a risk of limb malformations due to antidepressants being taken in early pregnancy by mothers. Later studies were not as clear on whether the medications play a significant role in such birth defects.

Which drugs to avoid:

Paxil is now considered off limits to pregnant women at any stage of pregnancy due to the risks of heart problems and pulmonary hypertension in children.

Also, monoamine oxidase inhibitors (MAOIs) — including phenelzine and tranylcypromine or Parnate are no-no's for expectant moms. These medications can inhibit fetal growth and elevate maternal blood pressure particularly in women who already tend to be hypertensive.

What to Consider

Every woman's case is different and requires careful consideration and advice from a medical professional. If a woman is already taking antidepressants when she becomes pregnant she should not suddenly discontinue the medicine.

Sudden stopping of the medication can cause SSRI Discontinuation Syndrome. This condition can cause chills, nausea and perhaps vomiting, irritability, anxiety and fatigue.

Doctors and mothers must weigh the potential risks of depression to the risks of the treatment. Some women taper off their meds and try alternative stress reducing treatments such as relaxation exercises, breathing exercises, prenatal yoga, massage, or therapy.

Some women who have experienced severe depression or postpartum depression or psychosis may opt to continue treatment with medication to prevent more severe symptoms from returning.

Women who have serious depression that worsens during pregnancy, perhaps due to hormones or increased stress, may self-medicate with drugs or alcohol and risk more damage to baby and themselves.

Making the right choice is a very personal one that should be well informed and deeply considered.

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