Pregnant mothers who have depression or are at the risk of depression are often concerned about the effects of antidepressants on their developing babies. A study published in late June (full abstract is included below) suggested that risks of 3 types of birth defects – craniosynostosis, omphalocele, or heart defects – were not significantly increased with SSRI use overall. However, there appeared to be a slight increase in risk in certain birth defects with certain types of antidepressants: paroxetine (brand name Paxil) and sertraline (brand name Zoloft) were two medications found to have associated increase in certain birth defects. The authors concluded that the absolute risk of birth defects due to antidepressant use during the first trimester of pregnancy is small.
“First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects” by Carol Louik, Sc.D., Angela E. Lin, M.D., Martha M. Werler, Sc.D., Sonia Hernández-Díaz, M.D., Sc.D., and Allen A. Mitchell, M.D. Published in New England Journal of Medicine (NEJM) Volume 356:2675-2683, June 28, 2007, Number 26.
ABSTRACT
Background The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial.
Methods We assessed associations between first-trimester maternal use of SSRIs and the risk of birth defects among 9849 infants with and 5860 infants without birth defects participating in the Slone Epidemiology Center Birth Defects Study.
Results In analyses of defects previously associated with SSRI use (involving 42 comparisons), overall use of SSRIs was not associated with significantly increased risks of craniosynostosis (115 subjects, 2 exposed to SSRIs; odds ratio, 0.8; 95% confidence interval [CI], 0.2 to 3.5), omphalocele (127 subjects, 3 exposed; odds ratio, 1.4; 95% CI, 0.4 to 4.5), or heart defects overall (3724 subjects, 100 exposed; odds ratio, 1.2; 95% CI, 0.9 to 1.6). Analyses of the associations between individual SSRIs and specific defects showed significant associations between the use of sertraline and omphalocele (odds ratio, 5.7; 95% CI, 1.6 to 20.7; 3 exposed subjects) and septal defects (odds ratio, 2.0; 95% CI, 1.2 to 4.0; 13 exposed subjects) and between the use of paroxetine and right ventricular outflow tract obstruction defects (odds ratio, 3.3; 95% CI, 1.3 to 8.8; 6 exposed subjects). The risks were not appreciably or significantly increased for other defects or other SSRIs or non-SSRI antidepressants. Exploratory analyses involving 66 comparisons showed possible associations of paroxetine and sertraline with other specific defects.
Conclusions Our findings do not show that there are significantly increased risks of craniosynostosis, omphalocele, or heart defects associated with SSRI use overall. They suggest that individual SSRIs may confer increased risks for some specific defects, but it should be recognized that the specific defects implicated are rare and the absolute risks are small.
You may also read an interpretation of this and other related studies at the Wall Street Journal Health Blog.
{ 8 comments… read them below or add one }
My girlfriend who had been on antidepressants for years prior to conceiving, went off her medications at the advice of her doctor after weighing the possible effects on her child. She would have been at about 10 weeks on Monday, and committed suicide last night. We are all in shock. It seems that the greatest harm to the development of the fetus is the loss of the mother. Low birth weight and a few weeks premature look acceptable to me in light of today’s events. Yours is the first information I read today that has even suggested it is perfectly fine for a mother-to-be to continue her treatment. Please make this side of the arguement be heard with a more powerful voice.
Hi Amy,
I’m so sorry to hear about your friend. I’ve been getting more emails relating to the risk/benefit ratio of antidepressants during pregnancy, and in the past I’ve also reviewed a book by a medical doctor who looks at depression before, during, and after pregnancy. Resources for pregnancy and depression remain scarce!
It’s very easy to make blanket judgments on ‘stopping all meds’ when a woman is pregnant, yet for some who suffer from clinical depression and become pregnant, the decision is not that simple. It is indeed true that the most harm to the baby occurs when the mother harms herself, and in tragic cases, ends her life due to a very treatable illness. I believe that our doctors – especially ob/gyns who see pregnant women – may need to be more vigilant about looking at individual patients’ risk factors and weigh the risks of depression in the big picture.
My condolences,
Jane
I just came upon this website as I was looking to see what was on Google regarding the use of antidepressants in pregnancy. I am so sorry to hear about your friend
I study the safety of antidepressants in pregnancy(I have published many studies,you can GOOGLE me) and there is no evidence to say that a woman should not be able to take these drugs in pregnancy if she requires treatment. Unfortunately, physicians are not doing their homework by looking in the literature and are giving women incorrect advice, sometimes with tragic consequences like what happened to your friend
Adrienne
Adrienne,
Can you help us understand why there is such a huge gap in information and awareness re: pregnancy, depression, and treatment options? Is there something we can do about it?
Jane
There is really a great deal more information than you think regarding depression in pregnancy and the safety of antidepressants. In the scientific literature there is information on thousands of pregnancy outcomes of infants whose mothers took antidepressants in pregnancy with no adverse effects on their babies. Unfortunately, only the few reports of babies who did have problems hits the lay literature and usually the baby does not have the problems because of the drug, although the mother is convinced that it is. No-one mentions that in every pregnancy there is a 1-3% chance of having a baby with a birth defect whether you take a drug or not, this is nature
In addition, reporting is very biased, studies that have shown risk far more frequently get reported than ones who don’t. For instance, I recently published a study in The American Journal of Psychiatry in June of this year, with 1100 women exposed to Paxil and a comparison group of 1100 women who were not exposed and the rates of heart defects was exactly the same in each group. Unfortunately this study was not picked up by the media, so no-one heard about it. If I had found something bad, you can be sure that it would all over the media. This is wrong because women and their health care providers have the right to know if something is safe, just as much as if it is not
You can call Motherisk at 416 813-6780 inToronto, Canada or other organizations like Motherisk in the US, where you can find the numbers to call on the website http://www.otispregnancy.org In addition there is also a group in Europe http://www.entis.org
You will be given all the up to date evidence-based information from proper studies
Adrienne
so I am a bit confused
so overall the risks are low with all anti-deppersants (expecpt the two mentioned above)
its such a contridiction to what has been said
Which two antidepressants mentioned above? I did not mention that any antidepressants cause birth defects, so now I am confused. I do not think you read carefully what I wrote.
Adrienne, I am interested to find out if there has been any research on the long term effects of maternal SSRI use during pregnancy on the children born. Does it effect the children’s naturally produced seratonin levels and therefore their own likelihood of being depressed?