I love research, but often don’t like the results. Such was the case when I read a recent review published in the journal Human Reproduction of more than 100 studies that looked at the effects of antidepressants taken by infertile women during pregnancy. The researchers concluded that “there is little evidence that infertile women benefit from taking a selective serotonin reuptake inhibitor (SSRI) antidepressant, therefore they should be counseled appropriately about the risks and be advised to consider alternate safer treatments to treat depressive symptoms.” (In the past, monoamine oxidase inhibitors (MAOIs) antidepressants, such Parnate, have also been avoided during pregnancy because they can limit fetal growth and aggravate maternal high blood pressure.)
SSRIs are a popular type of antidepressants that block the re-uptake of the brain chemical serotonin. They have been a godsend to people suffering depression, and include popular antidepressants such as Prozac, Zoloft, Paxil, Celexa, and Lexapro. Due to the improvement in medication (and in my cynical view, the failure of insurance to cover more expensive forms of treatment including therapy), use of antidepressants has soared in the US (up 400%) in the last 20years, and they are now the most commonly prescribed medication in the U.S. for people between 18 and 44 years of age. (That statistic alone is worthy of a “Wow”!)
It will come as no surprise to you that depression is particularly common in infertile woman. Duh! We all know that infertility is depressing. In another recent study, researcher Dr. Ali Domar (and others), reported at the American Society of Reproductive Medicine conference I attended a couple of weeks ago that over 11% of the 1,945 women studied at one fertility clinic took antidepressants.
One of the researchers in the Human Reproduction study, Dr. Adam Urato, chairman of obstetrics and gynecology at MetroWest Medical Center and a maternal-fetal medicine specialist at Tufts Medical Center, summarized their findings:
“First, there is clear and concerning evidence of risk with the use of the SSRI antidepressants by pregnant women, evidence that these drugs lead to worsened pregnancy outcomes. Second, there is no evidence of benefit, no evidence that these drugs lead to better outcomes for moms and babies. And third, we feel strongly that patients, obstetrical providers, and the public need to be fully aware of this information.”
In the past, doctors often counseled pregnant woman to continue taking their antidepressants during pregnancy because they thought that exposure to the antidepressants was less harmful to unborn babies than exposure to the elevated stress hormones and other physiological effects of a mother’s untreated depression. Three years ago, however, in a joint statement, the American College of Obstetricians and Gynecologists and American Psychiatric Association advised women taking antidepressants “who have had mild or no symptoms of depression for at least six months to consider tapering off the medications before they become pregnant”, but added that “for women with a history of severe, recurrent depression, discontinuing medication may not be advisable.” This latest research supports this statement, but seems to add more urgency.
Antidepressant risks to the fetus may include:
- Increase risk of miscarriage from about 8 percent in the general population to 12 to 16 percent for those pregnancies where the mother took antidepressants .
- Increased risk of preterm birth.
- Nearly a third of newborns born to mothers who took antidepressants develop a condition called “newborn behavioral syndrome” that causes jitteriness, feeding problems, and inconsolable crying during the first few days or weeks after birth. In some cases, babies develop severe breathing difficulties and require a breathing tube.
- Concerns over longer term behavioral problems. Animal studies have found that antidepressants lead to changes in brain development, and a human study suggested a possible increased autism risk.
What’s a woman to do if she wants to get pregnant, but is taking an antidepressant? First, of course, is talk with your doctor—both your infertility doctor and the doctor prescribing the antidepressants. Keep in mind that all the researchers seem to agree that discontinuing antidepressant use is probably too risky if the woman is severely depressed.
You might want to also consider alternative or complimentary treatments for your depression. Research has found that other options, such as psychotherapy, cognitive-behavioral therapy, and physical exercise, can significantly reduce depression in the general population; and research in infertility has found that some forms of counseling and relaxation techniques, such as yoga, are effective in treating depressive symptoms in infertile women.
We will have the lead researchers on a couple of the studies mentioned above, including Dr. Ali Domar and Dr. Adam Urato, on an upcoming Creating a Family radio show/podcast this year. Not sure of the exact date yet, but we are working on November. Sign up for our weekly e-newsletter (top left of this page) to get advanced notice of when this show will air, and you can send in your questions for me to ask the researchers.
Image credit: Gypsy and the Fool
My docs wanted me to go on antidepressants. I was deeply depressed during my pregnancy due to a severly abusive husband. I chose though not to take them. The decision was a very difficult one for me. I knew that stress vomiting and the panic attacks could not be good for my son but I had this deep feeling that I should not take them.
The DAY that I gave birth to my son EVERY OTHER commercial on the tv was “Attention did you take antidepressant during your pregnancy? Does you child have X, Y or X? Then call 1-800-555-5555 Right now!!” I was shocked and relieved over my decision
I’m interested in how they define pregnancy outcome – my own, after moving off my meds, was a 38 week drug-free vaginal birth with nary a tear, of an adorable healthy 8lb daughter. But it also involved antenatal depression, hospitalisation with postnatal psychosis at five days postpartum, hospitalisation for severe postnatal depression at six weeks postpartum, and (the worst) postnatal OCD in the form of violent intrusive thoughts until my daughter weaned at three years old. I suspect a lot of this could have been avoided by me staying on my meds while pregnant. One anecdote such as mine hardly makes for good scientific data, but I would encourage women with a psychiatric history to be VERY careful about the decision to come off their meds. If you are generally psychiatrically healthy, perhaps taking an SSRI because if infertility related depression, that’s one thing, but if you have a long history of complicated psyc conditions, I’d counsel to stay on your antidepressants. A meta-analysis, or any study large enough to have the power to find a result for that matter, can never take into account the individual variations in circumstance people experience. (Note: While I say this as a layperson, I do have a phd in the genetics of psychopharmacology, so make of that hat you will!)
Kate, I’d love for you to send in a question for the researchers when they are on the show, but I suspect they will agree with you whole-heartedly!!