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.