By Jon Hood
ConsumerAffairs.com
September 8, 2009
For decades, pregnant women have been warned to avoid certain activities, and for good reason. Drinking alcohol or using drugs while expecting can lead to serious birth deformities and, in some cases, to a miscarriage. Smoking cigarettes while pregnant greatly increases the chances that a newborn will have an abnormally low birthweight.
A more vexing question involves the use of prescription drugs, specifically antidepressants, during pregnancy. A 2007 study by the Centers for Disease Control and Prevention found that the use of selective serotonin-reuptake inhibitors (SSRIs) -- the most common form of antidepressants -- does not significantly increase the risk of most birth defects, but left many open questions.
A new joint study released by the American Psychiatric Association and the American College of Obstetricians and Gynecologists does little to answer those questions. The study offered general recommendations for women with varying levels of depression, but was unable to definitively quantify the effect antidepressants have on a developing fetus.
The issue is of increasing importance, as reports show the use of antidepressants among Americans on the rise. A recent study found that the number of Americans taking antidepressants doubled between 1996 and 2005, shooting from 5.84 percent to 10.12 percent. Pregnant women are no exception, and in fact are more likely to be on antidepressants. A 2003 study found that fully 13 percent of pregnant women had taken such drugs while expecting, over twice as many who reported doing so just four years earlier. The jump was due mainly to increased use of SSRI's.
At least one SSRI -- Paxil -- has been linked to a possible birth defect. A number of studies indicated that women taking Paxil were more likely to have babies with congenital heart defects. In response to the studies, the Food and Drug Administration (FDA) took the step of issuing an advisory, which noted that use during the first trimester posed the highest risk.
Women have a 10 to 25 percent risk of being clinically depressed at some time in their life. Depression is most prevalent in women of childbearing age -- those between 18 and 44 years old.
The study reaffirmed how difficult it is to find a definitive cause for birth defects. Available research has not yet adequately controlled for other factors that may influence birth outcomes, the study noted, including maternal illness or behaviors that can adversely affect pregnancy. Indeed, every pregnancy carries a 3 percent risk of some birth defect, regardless of the mother's diet or behavior.
The report did offer concrete advice for pregnant women suffering from depression. Women with bipolar disorder or a history of psychotic episodes or suicide attempts should continue taking antidepressants, given the risks of stopping or even reducing their regimen. Women who experience severe depression during their pregnancy should likewise remain on medication. Women who have had no or mild symptoms for at least six months, however, should wean themselves off the medication before attempting to become pregnant.
No one -- pregnant women included -- should ever stop taking an antidepressant without consulting their doctor first. Abrupt discontinuation of an antidepression regimen can lead to debilitating side effects. This is especially true of Paxil, which has a very short half life compared to other SSRI's.
