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.