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It’s not just the blues. Roughly 9% of all pregnant women suffer from clinical depression that prevents them from eating and sleeping properly to the point of losing weight and endangering their babies.
A new study finds that there is clear evidence in the literature that many antidepressants are safe during pregnancy.
Researchers compiled and analyzed data from four drug-specific studies published in the literature from 1993 to the present. They organized study findings into five categories and found some encouraging news for pregnant women with depression and their physicians — there is strong evidence that antidepressants are safe throughout pregnancy for both women and their children.
Researchers evaluated studies for the following categories:
• intrauterine fetal death;
• physical malformations;
• growth impairment;
• behavioral abnormalities;
• neonatal toxicity.
"We found no evidence that tricylcic antidepressants, specifically fluoxetine, and newer SSRIs (selective serotonin reuptake inhibitors) increase risk for intrauterine death or major birth defects," says Katherine L. Wisner, MD, psychiatrist and associate professor with University Hospitals of Cleveland and Case Western Reserve University, both of Cleveland.
Weighing the risks
Researchers also found that exposure to tricyclic antidepressants and SSRIs did not increase risk for growth impairment. "There were some reports of lower birth weights. However, we know that major depression commonly causes women to lose weight anyway. It is possible that an undertreated mood disorder, and not the drug itself, could affect the weight of both mom and baby. We recommend that doctors monitor the weight gain carefully in pregnant women being treated with antidepressants."
The study also found that there was no evidence that children prenatally exposed to tricyclic antidepressants had any problems with cognitive function, temperament, or general behavior compared to children who were not exposed to those drugs. No data were available for prenatal exposure to SSRIs, Wisner notes.
The one area of concern researchers found was the incidence of withdrawal symptoms in some newborns whose mothers were treated with antidepressants near the end of their pregnancies. Those symptoms included jerky movements and seizures, rapid heartbeat, irritability, feeding difficulties, and profuse sweating. Researchers suggest that those symptoms could be avoided by tapering to a lower dosage or even discontinuing antidepressants 10 to 14 days prior to a woman’s due date, Wisner says.
"When women and their physicians are weighing the benefits vs. the risks of drug therapy during pregnancy, they must look at just how severe the depressive symptoms are," says Wisner. "Being suicidal, not eating properly or enough, can do more harm to a pregnancy or fetus than an antidepressant. We share the hope that our paper will be a catalyst for improvements in the care of pregnant women with depression."
[See: Wisner KL, Gelenberg AJ, Leonard H, et al. "Pharmacologic treatment of depression during pregnancy." JAMA 1999; 282(13):1,264-1,269.]