According to the National Institutes of Mental Health, one out of four women will experience depression in their lifetime. Furthermore, the American Psychiatric Association estimates that 14 to 23 percent of women will experience depressive symptoms during pregnancy. However, there are concerns that treating depression with medication during pregnancy can result in birth defects. Thus, women who seek treatment for their depression by using antidepressants (or selective serotonin-reuptake inhibitors – SSRIs) and who wish to start a family face the difficult choice between remaining on their medication and risking birth defects, or stop taking their medications and risk a relapse.
Risk of Birth Defects
A study in 2007 published in the New England Journal of Medicine evaluated the risk of exposure to SSRIs on babies during the early stages of pregnancy. Although the study did not find an increased risk of most birth defects associated with SSRI exposure, it did find that SSRIs were associated with a few, specific birth defects. The study found that Paxil (paroxetine) taken during the first trimester of pregnancy was associated with an increase in omphalocele, a birth defect that causes an infant’s abdominal organs to stick out of the belly button. In fact, the Mayo Clinic recommends that women avoid taking Paxil during pregnancy. This study also found that SSRIs were associated with an increased risk of craniosynostosis, a skull deformity, and anencephaly, a defect resulting in the absence of a large part of the brain.
However, these findings are not conclusive. Another study, also published in the New England Journal of Medicine in 2007, found no overall association between SSRI use and several birth defects. The study could not replicate the findings in the first 2007 study, but it found an increased risk in specific heart defects with the use of Zoloft (sertraline). Specifically, the study found that infants with mothers who used sertraline during pregnancy were twice as likely to have septal defects.
Slight and Inconclusive Risk of Autism
On July 4, 2011, the Archives of General Psychiatry published a study that found that mothers with children with autism were twice as likely to have taken an antidepressant during their pregnancy. The study also found that the risk of having a child with autism was even higher if the mother took antidepressants during her first trimester of pregnancy. However, the risk of autism found in the study is small and the study could not confirm any causality between taking antidepressants and autism. According to CNN, the lead author of the study did not that recommend pregnant women stop taking antidepressants as a result of her study without first conferring with their doctors.
Risk of not Treating Depression During Pregnancy
Not treating depression during pregnancy can also result in negative consequences to the infant. Women who already suffer from depression and who stop taking SSRIs during pregnancy are at a greater risk of relapse. Relapsing into depression may result in the mother’s inability to take care of herself and the fetus, such as not eating right, smoking, and drinking alcohol. Studies have also found that mothers with untreated depression during pregnancy were more likely to have preterm births. Babies born to depressed mothers also have an increased risk of irritability and have fewer facial expressions.
What Pregnant Women with Depression Should Do
The conflicting studies regarding the negative effects of SSRIs and the risks of not treating depression during pregnancy can be confusing and stressful. Therefore, women who suffer from depression and want to start a family, or women experiencing depressive symptoms during pregnancy, should consult with their doctors to assess the risks of treating their depression with SSRIs or leaving their depression untreated. Women who intend to discontinue the use of SSRIs should discuss alternative treatments for depression, such as psychotherapy, with their doctors.
References
Anne Harding, “Depression During Pregnancy Doubles Risk of Preterm Birth,” CNN.com (Oct. 3, 2008). Sura Alwan, et al., “Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects,” The New England Journal of Medicine (June 28, 2007). Carol Louik, et al., “First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects,” The New England Journal of Medicine (June 28, 2007). Anne Harding, “Antidepressant Use in Pregnancy May Raise Autism Risk,” CNN.com (July 6, 2011). Mayo Clinic, “Antidepressants: Safe During Pregnancy?” American Psychiatric Association & American College of Obstetricians and Gynecologists, “Depression During Pregnancy: Treatment Recommendations,” (Aug. 21, 2009).