preagnant

Women who are taking antidepressants are faced with a very difficult choice when they become pregnant, and for many of them the risks vs. benefits of continuing the treatment are not very clear, according to the findings in the joint report from the American College of Obstetricians and Gynecologists and American Psychiatric Association.

This report confirms that there are far more questions than there are answers about the danger antidepressants pose to infants that are born to women who take them. The report also presents guidelines to help patients and physicians identify who should and should not consider stopping the medication treatment. The report concluded that women who are pregnant that have bipolar disorder, experience psychotic episodes, or are suicidal or have a history of attempts to commit suicide should not be taken off antidepressants.

Charles Lockwood, an OB-GYN at the Yale University School of Medicine, said, “We know that untreated depression poses real risks to babies. That is not conjecture. We know much less about the risks associated with antidepressant use. It is clear that more study is needed.”

According to a previous study, the rate of antidepressant use by women who were pregnant more than doubled between the years 1999 and 2003. The study found that in 2003, approximately one in eight women took antidepressants as some point while they were pregnant. Greater use of the selective serotonin reuptake inhibitor or SSRI antidepressants such as Zoloft, Prozac and Paxil were largely responsible for this increase. These medications were generally considered to be safe for pregnant women at that time, but safety concerns soon emerged, especially regarding the antidepressant Paxil.

Separate studies that were conducted in the U.S. and Sweden suggest that there was an increased risk for congenital heart defects in infants born to women who took Paxil while they were pregnant. These reports lead the FDA to issue an advisory in December of 2005 warning about the potential risk that was based on early results of these two studies. However, the joint panel found that the evidence that linked Paxil use during pregnancy to the heart problems in infants to be inconclusive. Lockwood stated that if this risk is real, it is probably no just limited to Paxil. He says, “It is very likely to be a class effect and not just this one drug.”

The use of SSRI’s during pregnancy has also been linked in some other studies to an increased risk for a low birth weight, preterm delivery and even miscarriage. However, once again, this report found no definitive link between the use of antidepressants and these outcomes with pregnancy.

The joint panel states, “Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or behaviors that can adversely affect pregnancy.” This report was published in both the American College of Obstetricians and Gynecology journal Obstetrics and Gynecology and the American Psychiatric Association journal General Hospital Psychiatry.

The joint panel concluded that a gradual reduction of the antidepressant dosages and stopping the antidepressants altogether may be appropriate for women who are thinking of getting pregnant if they have had mild or no symptoms for the past six months or longer.

The joint panel also recommends that:

* Women who are already expecting should not attempt antidepressant withdrawal if they suffer from sever depression.
* Women who are psychiatrically stable who wish to stay on their antidepressants during their pregnancy should consult their psychiatrist and ob-gyn about the potential benefits and risks.
* Women that suffer from recurrent depression or those who still have symptoms despite the medication treatment may benefit from psychotherapy when it is available.

Ariela Frieder, M.D., who is a psychiatrist that specializes in treating women who are pregnant that suffer from depression at the Montefiore Medical Center in New York City, says that her patients tend to be very concerned about how the antidepressants will affect their infants and much less aware of the dangers that are posed by untreated depression. Frieder was a practicing ob-gyn in her native Argentina before she moved to New York where she completed her residency in psychiatry. She said, “Many women want to stop treatment abruptly and even stop on their own, but this can be very risky.”

Jennifer Wu, MD, who is an OB-GYN who practices at New York’s Lenox Hill Hospital, agrees with Frieder. “The old conventional wisdom was that pregnancy was a honeymoon period for depression and that patients would be able to come off their medications and be OK. But we have learned that this is not true. It has become more and more apparent that pregnancy is a vulnerable time for patients with a history of depression.”