Antidepressants During Pregnancy Have Risks and Benefits

Pregnant Woman in Dress

Women like this who are pregnant must decide which medication to keep taking and which to stop.

Pregnancy usually prompts lifestyle changes, such as limiting coffee consumption and reducing the use of many medications. For women taking antidepressants, pregnancy can mean a tough choice between managing their condition and potentially harming the child. Now a new study has set out to highlight the risks as well as the benefits of taking antidepressants during pregnancy.

In a paper published in the American Journal of Psychiatry, Alan Brown, M.D. and colleagues at the Columbia University Mailman School of Public Health, Columbia University Medical Center, and the New York State Psychiatric Institute studied data from the Finnish Medical Birth Center from between 1996 and 2010. For the study, the researchers divided the more than eight hundred thousand women into three groups: those that did not have a depression or anxiety diagnosis and did not use antidepressants, those who had a diagnosis of depression or anxiety but still did not purchase antidepressants, and those that were using antidepressants during pregnancy. The researchers then analyzed data on the mother’s medical history, their psychiatric history, and prescription drug purchases.

In Finland and the U.S., about four to ten percent of pregnant women receive a prescription for SSRI antidepressants during pregnancy, although an estimated thirteen percent of pregnant women and new mothers suffer from depression. Of the women in the study, just under thirteen thousand purchased antidepressants in the first trimester of their pregnancy while a little over nine thousand purchased two or more SSRI prescriptions during their pregnancy.

The data did reveal some benefits of using antidepressants during pregnancy. For those with a diagnosis, taking antidepressants seemed to result in a sixteen percent lower risk of preterm birth. This is significant because preterm birth is the greatest single cause of infant death and can cause neurological disability when the infants survive.

The study also suggested that not taking antidepressants when needed can increase the risk of needing a Caesarean section. About seventeen percent of those taking antidepressants or who had no diagnosis received a C-section while more than twenty-six percent of those not taking antidepressants for their psychiatric condition had a C-section. There was also a slightly higher risk of bleeding during or after delivery for the diagnosed but not medicated group. There was no significant difference in birth weight versus gestational age for the three groups.

However, the news for those using antidepressants during pregnancy was not all good. The group taking SSRI medication showed an increased risk of breathing problems and other health problems at birth. This increase in poor health lead to longer hospital stays with more intensive care for the infants.

A previous study published in the British Medical Journal also revealed negative health outcomes from SSRI antidepressant use. Those researchers found that women who used SSRI drugs during pregnancy were more likely to give birth to babies with birth defects, such as heart problems and an abnormally formed brain and skull.

SSRI drugs are the most common type of antidepressants that doctors prescribe. The medication prevents the brain from reabsorbing serotonin, a neurotransmitter. This appears to improve communication between brain cells which then leads to mood improvement.

Looking over all the results from the study, the researchers concluded there is no clear answer to whether women should continue to take their SSRI antidepressants during pregnancy or forego their medication for the next nine months. Because taking or discontinuing antidepressants can have varying results, the researchers suggest the decision should be made case-by-case. The best advice for women who are taking SSRI drugs that become pregnant, or plan to become pregnant, is to discuss their case with their doctor and find the solution that is best for them and their baby.

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