Posts Tagged ‘ SSRIs ’

Antidepressants And Pregnancy: What Are The Take-Home Messages?

Monday, November 5th, 2012

A recent review paper published in Human Reproduction has shined a light on an emerging debate concerning the use of antidepressants in women who are seeking treatment for infertility. The issues extend, of course, to all pregnant women (whether or not they sought treatment for infertility), and they are serious and complex. Here I’ll summarize my take on the most important take-home messages. 

First, if you have seen the headlines about this study, you may think twice about getting treated for depression if you are trying to get pregnant or are currently pregnant. This is not the point of the debate. Any level of depression should be treated. The issue being discussed is how it should be treated.

The authors of the review paper make the argument that use of serotonin selective reuptake inhibitors (SSRIs) during pregnancy – which include the commonly prescribed drugs Celexa, Prozac, and Zoloft – is associated with a number of potentially serious problems. These include pregnancy complications, preterm birth, and neurobehavioral compromise in infants. There are studies which back up these claims (click here and here for recent papers on the topic). As the authors note, these studies do not provide definitive evidence – clearly more studies need to be done to get better estimates of the level of risk. But the current findings should, at a minimum, be on the minds of women who are dealing with depression when trying to get pregnant or currently pregnant. They need to be factored into considerations of the benefits, and risks, of taking antidepressants.

Expanding on that, perhaps the most important guideline to keep in mind is that SSRIs are most effective as a treatment for severe levels of depression. A recent review published in the Journal of the American Medical Association (JAMA) provided compelling data that SSRIs had no greater effect than a pill placebo when treating mild to moderate levels of depression. In contract, SSRIs were significantly more effective in managing severe depression.

Putting it all together, an argument can be made that women who are dealing with mild to moderate depression may want to consider using only non-drug treatments if they are trying to get pregnant or are pregnant. Many forms of psychotherapy are also effective but of course do not carry to potential biological risks of SSRIs. The more complex assessment of risk and benefits of SSRIs would apply to women who are suffering from severe depression. Severe depression can be a debilitating disorder and can compromise health and well-being. As there is no simple solution in this case – especially if a woman has a history of severe depression along with a history of positive response to an SSRI – the potential risks and benefits of SSRI use during pregnancy should be an active discussion point with both an obstetrician and psychiatrist. It may be worthwhile to consider, and try, only non-drug treatments. In this case the good counsel of the attending physicians and open discussion of the issues will be essential to promote the health of both mom and baby.

Pregnant woman via Shutterstock.com

 

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Antidepressants And Autism: Too Early For A Take-Home Message?

Tuesday, July 5th, 2011

As reported by my fellow blogger Holly Lebowitz Rossi, a recent study published in the Archives of General Psychiatry suggested a link between use of antidepressants while pregnant and autism spectrum disorder (ASD). As Holly noted, there are important limitations to the study, and hence the clinical implications are not entirely clear.

After reading the research report, my feeling is that this preliminary study flags an important area for researchers to delve into — but the science conducted to date is not at the point of delivering a solid take-home message. Two considerations are especially important.archgenpsychiatry

First, all the analyses were based on information taken from medical records. It would be critical to replicate and extend these findings by directly studying the mothers and their children. Key issues will be getting more precise validation of the timing of antidepressant use, and also conducting diagnostic interviews of the children. As the study authors note, any imprecision in the medical records could skew the findings — and using medical records, while informative, is not the gold standard of this type of research.

Second, the associations, while statistically significant, were small. Consider that 278 of the 298 children whose mothers took antidepressants did not develop ASD. In addition, 50 of the 1507 children whose mothers did not take antidepressants did develop ASD. The study authors suggest that, based on their analyses, about 2% of the cases of ASD in their sample were attributable to use of antidepressants. And the paper also notes a number of other potential confounding issues that further research will have to consider.

Taken together, we would need to see more research that builds on this important initial observation by utilizing more informative measures. Keep in mind that the issue is not just to replicate the finding — it’s possible that a well-designed study could reveal even larger associations between use of antidepressants and ASD. Preliminary studies such as this are very influential in research because they open the door to new ideas and provide a platform for new studies that could provide much better resolution on this issue.

So where does this leave women who are pregnant and suffering from depression? At this point, they will need to rely on the counsel of their physicians, and their own judgement, to try to balance the importance of treating depression with the possibility that using antidepressants could, in some cases, contribute to risk for ASD. The reality is that, as of now, the current research does not provide a definitive answer.

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