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Should I Continue Using My Antidepressant If I’m Pregnant or Planning to Get Pregnant?

It used to be believed that continuing antidepressant medication throughout a pregnancy was fine thing to do. Latest research shows this is no longer the case. Read which ones to avoid and why.

Popular selective serotonin reuptake inhibitor (SSRI) antidepressants such as Prozac, Paxil or Celexa, Lexapro, Luvox, and Zoloft are commonly prescribed to women between the ages of 18 and 44 - i.e. those who are of childbearing age. And in terms of usage during pregnancy, the consensus has been that for those with mild to moderate depression no harm could be reaped from continuous use throughout those nine months.

This idea has been built upon the concept that the risks to the unborn child are greater if the mother’s symptoms of depression go untreated. That unborn babies are better off being exposed to antidepressants than the high levels of stress hormones related to mother’s (untreated) depression.

However, this way of thinking is now being challenged. A new meta analysis of 100 studies regarding the safety and efficacy of SSRIs in women shows that there’s little evidence that women (including those with infertility) would benefit from taking an SSRI.

While each woman is different and the risks and benefits should be weighed up accordingly, the evidence against usage is compelling.

SSRI use prior to and during pregnancy can pose significant risks to the pregnancy and to the short- and long-term health of the baby. These risks can include miscarriage, birth defects, preterm birth, pre-eclampsia, newborn behavioral syndrome, neonatal prolonged QT syndrome, persistent pulmonary hypertension of the newborn and long-term neurobehavioral changes.

From the meta analysis study, in terms of miscarriage, antidepressant use raises the risk of miscarriage from about 8 percent in the general population to 12 percent- 16 percent in those who use the drugs during pregnancy. Something to take note, if you are trying to conceive.

But these recommendations are only for women who have mild to moderate depression, not severe depression. As coauthor of the study, Alice Domar stated “We’re not talking about those with severe depression, who may need to stay on the drugs to prevent suicidal tendencies or a relapse that could leave them unable to get out of bed”.

But what should you do if you are taking an SSRI and want to get pregnant or are worried about your pregnancy?

The American College of Obstetricians and Gynecologists and American Psychiatric Association in a joint statement issued three years ago advised women taking antidepressants who’ve had mild depression for at least six months to consider tapering off the medications before they become pregnant. But cautioned that “medication discontinuation may not be appropriate in women with a history of severe, recurrent depression.”

So, firstly consult your doctor as suddenly stopping any prescribed medication without the guidance of a physician can be dangerous.  And if you’re currently pregnant and taking an antidepressant, talk to your doctor about the alternatives.

Many effective treatments do exist without the risky side effects such as cognitive-behavioral therapy (CBT).  One study published in 2008 showed impressive results for CBT in depressed women undergoing fertility treatments; 79 percent of women who received CBT reported a significant decrease in symptoms, compared with 50 percent of women in the medication group.

 Eastern medicine approaches can also alleviate symptoms of depression. Treatment options include yoga, meditation, acupuncture and nutritional supplements.

A final note from the senior author Adam Urato states “ We're not saying women should not take SSRIs. The goal is to give them information so they can make the right decision for them."

So be informed.

Fenella Das Gupta is a licensed Marriage and Family Therapist ( #47275) working in Northern California,specializing in fertility counseling. She works with individuals and couples as they make their way through the fertility maze.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Carolyn Andrews November 15, 2012 at 06:58 PM
I lived with a woman roommate who had taken antidepressants during her 2 pregnancies. I would say that the older child was shockingly emotional and would not just cry but would wail and scream in agony for hours on end. Though there may be some inherited tendency to depression, I would not expect it to manifest at age 2. I attribute this child's suffering to these medications.
Aprille November 15, 2012 at 08:12 PM
If folic acid is almost a requirement for pregnant women because it effect the brain development of a baby I think mental health medications would also have a significant effect that we may not know the full result of yet. It seems wiser to follow nature as it has been show that there is a correlation between diet/lifestyle and mental health. Elimination of toxins like tobacco, caffeine, alcohol in combination with getting some sunshine exposure, eating lots of vegetables, legumes and nuts(Omega 3), 30+ minutes of exercise, drinking plenty of water, listening to classical music(for brain frontal lobe stimulation) are just a few.
Tina McMillan November 15, 2012 at 10:05 PM
As an MFT that works with women who suffer from chronic depression and mood disorders I'd like to contribute a different point of view. The thought that a woman who wants to get pregnant would have to choose between her mental health and her baby's health seems like a "Sophie's Choice". I have worked with patients whose physicians successfully took them off antidepressants for the first trimester and then put them back on for the remaining pregnancy. The babies were born healthy and the mother’s did not have postpartum depression following the birth. The first most important point is leaving this decision to the physician and the patient. I do not believe I am qualified to make recommendations about this decision for my patients. While I personally believe that supplements, exercise, meditation and cognitive behavioral therapy work for some people, I have worked with patients for whom these interventions were not effective and who felt shamed and judged by therapists and physicians for not getting better. I think we all have our own philosophy about these things but it is critical that women who struggle with depression not be criticized by friends and family for their choices. Living with depression is an unbelievably painful process. Who are we to decide what treatment method is the best for someone else?
Fenella Das Gupta PhD Neuroscience, MFT November 15, 2012 at 11:30 PM
Tina You make some interesting points. We can all agree on the statement made by the authors in this paper that -“ We're not saying women should not take SSRIs. The goal is to give them information so they can make the right decision for them."- That in fact , this is not about shaming the patient in any way. It is something between the Dr and the patient to discuss and this article is for informational purposes only. Shame doesn't need to be involved. I do believe that clients and patients have the right to have this knowledge- Afterall that is why we do biological research at all. It is especially noteworthy in the light of infertility treatment which often comes with the diagnosis of Depression or Anxiety due to a medical condition.
Fenella Das Gupta PhD Neuroscience, MFT November 16, 2012 at 02:03 AM
contd... What I would hope is that patients understand the risks, benefits and alternatives to antidepressant use. That talking with their Dr as to the best option for them would be an important way to proceed given these recent results. Thank you for addressing these important points Tina as it allows me to further clarify
Wire November 25, 2012 at 03:56 AM
Obama care You may just want to have a pap smear or check your cholesterol. However, I am now mandated by the government to talk to you about your weight, exercise, family life, smoking, sexual abuse(!), and even to ask if you wear seat belts. And I am mandated to record your answers. Have a gun in the house.
Rico November 25, 2012 at 06:49 PM
That is part of the new electronic medical records database project funded by the taxpayers and ordered by Obama in 2009. The only way to stay out of this new program (unless one is on MediCare or MediCal), is to not enroll in a private corporate medical insurance corporation. If you have a primary care physician in a private practice, then you can save a ton of money by paying the doctor directly. The doctors office is very happy with single payers, they don't have to hire extra staff to fill out insurance forms and also don't have to spend time on entering your personal, intimate information into a EMR database. The reason for this database is to primarily benefit the private insurance corporations so they can raise ones rates if they find out about some pre-existing condition or personal habits. But another reason is to create a database that will contain more personal, intimate and detailed information on every citizen than any other agency in history. Can they actually, legally ask if one has a gun in the house ? They already know what pharmaceutical drugs that one is hooked on, so that should be all that they need to know.
Wire November 25, 2012 at 07:32 PM
You asked afraid to look on the internet: Gun Owner Rights and Obamacare - Yes It Is In The Law - Forbes www.forbes.com/.../gun-owner-rights-and-obamacare-yes-it-is-in-the... Jul 23, 2012 – In medical training, physicians are taught to screen for potential violence. ... will tell you if they are homicidal or suicidal – you just have to ask. Maybe Ms. Fenella Das Gupta PhD Neuroscience, MFT can come forward, get it forward.
Tina McMillan November 25, 2012 at 07:45 PM
Fenella When I look up the research from which your article originated I am struck by the conflicting data. Some of the headlines read: Antidepressants and pregnancy: New review finds a risk Karen Weintraub, Special for USA TODAYShare "Controversial new research suggests that women suffering depression should stay away from antidepressants while pregnant. A number of experts, however, disagree." When I go further it looks as if the population examined included women using antidepressants in conjunction with IVF which also has associated risks to the unborn child. Common Antidepressants Too Risky During Pregnancy, Researchers Say But another expert disagrees, saying all options must be open to women faced with this situation Wednesday, October 31, 2012 "According to background information in the study, antidepressants are the most widely prescribed medications among adults aged 18 to 44. Up to 13 percent of pregnant women take an antidepressant. Many of these may be women undergoing treatment for infertility, a condition which is often accompanied by depression. In 2010, up to almost 7,000 babies conceived by in vitro fertilization (IVF) may have been exposed to an antidepressant, the study authors said. In their research, Urato and his team looked at the existing literature on women who had fertility problems and were also taking SSRIs. They say they found a number of concerns."
Tina McMillan November 25, 2012 at 08:07 PM
Continued I found myself asking questions that were more appropriate to discuss with a physician. My main point is that as MFT's our role is to focus on the emotional impact of depression and infertility. Medical research is constantly evolving. I think about the thalidomide babies of the 1960's. Even then it appeared that people were being prescribed sleeping medications and tranquilizers at alarming rates. The key is physicians that prescribe medication judiciously and with the knowledge that we often don't learn the effects of drugs on the unborn or procedures like IVF until years later. There are studies linking Autism and ADHD to infertitility treatments. These same studies say that there are so many variables to consider that the fact that a patient is receiving treatment for infertility may also be the contributing factor to other conditions. In the antidepressant studies it looked as if the patients were also receiving fertility treatments. This combination of variables makes me wonder if both are links. Again, my belief is that the complexity of these issues means that the dialogue between a patient and her physician is where the conversation must begin. Doctors are the ones providing treatment for both depression and infertility. They have the training to be responsible for these recommendations while I do not. I agree that empowering patients is part of treatment. I just don't feel competent to sort through a medical issue of this complexity.
Rico November 26, 2012 at 01:23 AM
I don't doubt that they are worried about gun ownership and suicides, but many of the psychotropic drugs cause violence and suicides too, just look at all the TV ads about these drugs that are being pushed by doctors. And, in the news also about people who "go off" and cause violence while doped up on legal prescribed pharmaceutical drugs. Whenever the corporately controlled government tells you that they are taking your tax dollars to make you safe, lookout-you are about to lose your freedoms and your rights.

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