WEDNESDAY, Oct. 31 (HealthDay News) -- Women who take a popular
class of antidepressants during pregnancy may be risking the health
of their developing fetus, and the risk may outweigh any benefit to
the mother, a new review of data suggests.
According to new research, use of selective serotonin reuptake
inhibitors (SSRIs) -- which include Celexa, Paxil, Prozac and
Zoloft -- while pregnant can increase the risk of miscarriage,
preterm birth, pregnancy complications such as preeclampsia and
neurobehavioral problems such as autism later in life.
"There is clear and concerning evidence of risk when pregnant women use these medications," said Dr. Adam Urato, senior author of a study appearing in the Oct. 31 online edition of Human Reproduction.
On the other hand, he said, there is no clear evidence that SSRI
antidepressants actually benefit the mother in terms of alleviating
Not everyone agreed with the researchers' conclusions, however.
Dr. Beatriz Currier is associate professor of psychiatry and
behavioral sciences at the University of Miami Miller School of
She said there is no blanket recommendation as to how best to
treat depression during pregnancy and "every woman who presents to
a clinician has to undergo a case-by-case analysis of the benefits
and risks of antidepressant therapy."
Currier also said that there is "no conclusive data about an
increased risk of miscarriage being associated with
antidepressants." Nor is there any reason to conclude the rate of
preeclampsia or birth defects is higher, she said, although there
is some evidence that antidepressant use may be associated with low
birth weight babies.
According to background information in the study,
antidepressants are the most widely prescribed medications among
adults aged 18 to 44. Up to 13 percent of pregnant women take an
antidepressant. Many of these may be women undergoing treatment for
infertility, a condition which is often accompanied by
In 2010, up to almost 7,000 babies conceived by in vitro
fertilization (IVF) may have been exposed to an antidepressant, the
study authors said.
In their research, Urato and his team looked at the existing
literature on women who had fertility problems and were also taking
SSRIs. They say they found a number of concerns.
First of all, some studies suggest that SSRIs may actually
undermine women's efforts to get pregnant, the researchers said.
And for those who do get pregnant, the drugs may increase the risk
for miscarriage as well as congenital problems in their children.
The most striking association was for use of Paxil (paroxetine)
during pregnancy and the risk for congenital heart defects, they
The study authors noted that, in 2005, the U.S. Food and Drug
Administration requested that Paxil's maker, GlaxoSmithKline,
change Paxil's pregnancy category from a "C" to a "D" rating,
indicating that it poses a risk to the fetus.
The authors also pointed to a 2011 study from Kaiser Permanente
Medical Care Program of Northern California that found a "twofold
increased risk of autism spectrum disorders associated with
maternal treatment with SSRI antidepressants during the pregnancy,
with the strongest effect associated with treatment during the
On the other hand, isn't untreated depression in a mother-to-be
a hazard for both mother and fetus? According to Currier, sometimes
SSRIs remain the best option for women facing this situation.
"Generally speaking, for women with very mild depression, the first course of treatment is that of cognitive behavioral therapy or other non-pharmacological [forms] of treatment," she said. "But in many cases, patients with moderate and severe depression will, in fact, require antidepressant therapy in order to treat their comorbid psychiatric illness, which cannot be ignored or dismissed," Currier added.
However, Urato said that an increasing number of studies are
finding that SSRIs have little clinical benefit for
mild-to-moderate depression when compared with a placebo (inactive)
Other alternatives may exist for women who are battling
depression, added study lead author Alice Domar, executive director
of the Domar Center for Mind/Body Health at Boston IVF. The center
is described on its Web page as focused on "enhancing the mind/body
connection" through interventions such as "acupuncture, psychology,
nutrition and restorative yoga."
According to Domar, cognitive behavioral therapy, in which
patients learn how to direct their thinking and behavior to more
constructive ends, probably has the most evidence behind it.
Exercise also has demonstrated efficacy, and yoga may have some
benefit, she added.
"What I don't want to do is scare the heck out of women who are pregnant and have severe depression," Domar said. "I'm not suggesting that someone who is suicidal stop taking antidepressants cold turkey. You have to look at the individual risk-benefit ratio. In that case [suicidality], the risk of harm to her and her baby is far higher than the risk posed by an SSRI. For those with mild or moderate depression, the ratio shifts the other direction," she noted.
And, Urato added, "We're not saying women should not take SSRIs.
The goal is to give them information so they can make the right
decision for them."
There's more about dealing with depression during a pregnancy at
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