Should Women Worry About Antidepressants During Pregnancy?

When women are pregnant, they frequently worry that something they swallow will harm the developing baby. The debate about antidepressants during pregnancy has been going on a long time. Now, an FDA panel meeting has added to expectant mothers’ anxieties. The dilemma has been that untreated depression during pregnancy puts both mother and fetus at risk. Yet some previous studies suggested that taking SSRI antidepressants during pregnancy might put babies at risk for attention deficit hyperactivity disorder or even autism.

What the FDA Panel Said About Antidepressants During Pregnancy:

Dr. Marty Makary, FDA commissioner, convened a panel of 10 experts to consider the question of selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine or paroxetine in pregnancy. He introduced their deliberations by suggesting that such drugs are not adequately addressing the problems that lead to depression. Some panelists followed suit, questioning the effectiveness of antidepressants. At least one participant suggested that too often doctors medicalize normal emotional experiences when they prescribe antidepressants.

Dr. Makary also listed a number of side effects that women might not recognize.

SSRIs are “implicated in different studies to be involved in postpartum hemorrhage, pulmonary hypertension and cognitive downstream effects in the baby, as well as cardiac birth defects.”

Two skeptics with excellent credentials testified at the hearing. Dr. David Healy in North Wales is convinced that antidepressant use during pregnancy can pose a risk of autism in the infant. Dr. Joanna Moncrieff of University College, London, has challenged the biochemical paradigm of depression.

Such findings pose a terrible double bind for women. Untreated depression can put the mothers’ health at risk, and thus indirectly harm their babies as well. One panelist, Dr. Kay Roussos-Ross, emphasized the need for treatments that would help depressed women during pregnancy.

She noted:

“Not every single woman will need an antidepressant. But for those that do, this is life changing. And this is lifesaving.”

In a similar vein, Dr. Nancy Byatt of the University of Massachusetts commented on the panel:

“I am far more concerned about the risks of untreated illness than I am about the risk of medication.”

Where Does This Leave Pregnant Women?

The strong emphasis from the panel on potential harm may well leave many people confused and worried about using SSRI antidepressants during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) emphasized that SSRI antidepressants during pregnancy are safe. Presumably the doctors were relying on studies such as this one that we described several years ago on this site:

The Swedish Study of Antidepressants During Pregnancy:

A study published in the Journal of the American Medical Association (JAMA) found no evidence for psychiatric harm such as autism among the children of women using antidepressants during the first trimester of pregnancy.

The data included all live births in Sweden between 1996 and 2012, more than 1.5 million youngsters. The researchers compared the infants born to mothers who took antidepressants during pregnancy to siblings born after a pregnancy that did not include antidepressants.

The investigators found just one complication: a 30 percent increased risk of premature birth. At that time, premature birth was not very common in Sweden. Consequently, a 30 percent increase in relative risk did not affect a large number of deliveries.

The scientists concluded:

“Among offspring born in Sweden, after accounting for confounding factors, first-trimester exposure to antidepressants, compared with no exposure, was associated with a small increased risk of preterm birth but no increased risk of small for gestational age, autism spectrum disorder, or attention-deficit/hyperactivity disorder.”