Antidepressant Therapy: Risky for Pregnant Women?

By Rachel Stockton (rachels@foodconsumer.org)

Twenty two years after the FDA gave the go ahead to the manufacturers of Prozac, psychiatrists and physicians are still unsure about whether or not pregnant women are at significant risk if they continue to take it or other SSRIs to term, according to the American Psychiatric Association and the American College of Obstetrics & Gynecology in a new report.

Antidepressant use during pregnancy doubled between 1999 and 2003; for a time, SSRIs were considered safe for pregnant women.   However, over the course of several years, speculation began to arise regarding the safety of Paxil.  Two studies, one out of Sweden and the other out of the United States suggested that pregnant women taking Paxil were more likely to have babies born with a congenital heart defect.  While the FDA issued a warning about the drug, later tests failed to verify those findings.

Other studies have linked SSRIs to an increased increase in miscarriage, low birth weight and preterm delivery.  However, most researchers agree that the studies that rendered those conclusions were not adequately controlled.

For now, both groups recommend that pregnant women speak to their doctors about the possible risks and benefits of maintaining drug therapy during gestation.  However, they are quick to point out that some women should continue to take their antidepressants to avoid withdrawal:  those who have bipolar disorder, those who have experienced psychotic episodes, and those who are suicidal.

The American Psychiatric Association is quick to point out the risk that untreated depression poses to babies.  In 2001, America was introduced to Andrea Yates, a woman who had suffered from post partum depression, yet who still failed to use birth control to prevent pregnancy.  After the birth of her last child, Yates depression turned into full blown psychosis.  In the summer of that year, Andrea drew a bath in her home and methodically drowned all five of her children, to help them escape the "fiery depths of hell" she believed was their fate if she continued to raise them.    The verdict in her trial was "not guilty by reason of insanity"; Yates now lives in a low security mental health institution in central Texas.

Before the Yates tragedy, traditional thinking was that pregnant women simply don't experience depression; if they had a history of it, many believed they would experience a symptomatic reprieve during pregnancy. Research has borne out, however, that pregnant women are particularly vulnerable to depression because of hormonal and physical changes that take place before a baby is born.