Many women fear taking antidepressants during pregnancy. Why?

Because some drugs, such as Paxil, have been linked with birth defects (usually in the heart of the fetus). But are these concerns still plausible? A new study shows that taking antidepressants during pregnancy is actually safe, at least in terms of heart risks to the baby.

Reuters reports on taking antidepressants during pregnancy. 

The study looks at a million women those who took antidepressants while pregnant and those who did not. Apparently, taking common antidepressants did not pose a greater risk of being born with a heart defect for their babies.

Time magazine endorsed the study as well and reported,

“The research team specifically focused on adjusting for potential confounding factors that could explain the heart malformations, such as age, how many children the women had had, diabetes, hypertension and use of psychotropic medications. Even after accounting for these effects, they found no strong association between antidepressant use and heart defects.”

Why is the study a breakthrough? Is this a common problem today? The findings are important because so many women in the United States take antidepressants now and have great difficulty deciding whether to discontinue their use during pregnancy. Fox also commented on the study reporting, “About 10 to 15 percent of pregnant women are diagnosed with depression, the researchers note, making the safety of the drugs an important issue.”

How was the study conducted? It looked at the effects of popular drugs such as Paxil and Zoloft on the fetuses of many women’s’ babies. The study’s authors looked at the records of almost a million women to get a broad and accurate analysis. “Over 64,000 of the women, or almost seven percent, had taken antidepressants during the first three months of pregnancy. The researchers also checked records for evidence of infant heart problems that appeared up to 90 days after birth. They found that 72 out of every 10,000 babies not exposed to the drugs were born with a heart defect, compared to 90 out of every 10,000 babies whose mothers had taken antidepressants. That works out to a 25 percent increased risk. However, that finding didn't take into account that ‘women with depression often have behaviors that tend to increase their risk’ of giving birth to a child with a heart defect, separate from their use of antidepressants,” according to Reuters.

Antidepressant usage is not the only factor that could be causing heart defects in babies of women taking these medications. What other types of behaviors do women with depression exhibit that makes their babies more prone to having a heart defect? These habits include but are not limited to: drinking, smoking, taking other psychotropic medications, illegal drug use and a general unhealthy lifestyle.

Later on, researchers decided to focus only on women who have actually been diagnosed with depression for the study (since it is the effect on these women’s fetuses that needs to be deciphered). The New England Journal of Medicine explains, “When the researchers looked only at the 217,342 women with depression, they found the increased risk linked to antidepressants dropped to 12 percent. And when they further analyzed the data to take into account other risk factors such as diabetes, high blood pressure and indirect measures of depression severity, the extra risk dropped even further, to six percent. That effect was small enough that it could have been due to chance.”

Can women freely take antidepressants during pregnancy then? Well, women are not completely out of the woods yet and it is still important to take some caution. There are a couple of drugs that they might want to watch out for while pregnant. “Evidence had suggested that paroxetine might be causing problems in babies with the flow of blood from the right side of the heart to the lungs and that sertraline might increase the risk of ventricular septal defects, where blood backflows through a hole in the heart. In neither case could they confirm the risk,” according to Reuters.

How prevalent is this? How many women take antidepressants during pregnancy?

Time magazine reported,

“This should reassure the 8% to 13% of women who take antidepressants while expecting. Concerns about the risks of the drugs, primarily selective serotonin reuptake inhibitors (SSRIs), on the developing fetus prompted the Food and Drug Administration in 2005 to add warnings about the risk of heart defects in babies born to moms taking antidepressants. While studies have shown up to a three-fold increase risk in some congenital heart abnormalities associated with antidepressants, doctors couldn’t be entirely sure the higher risk wasn’t due purely to chance. Now, the New England Journal of Medicine reports that may indeed be the case.”

The authors of the study were ecstatic with the general findings. This is because the results show that women can actually take antidepressants during pregnancy without worrying too much about whether it will cause a defect in their baby. The author of the study Dr. Huybrechts, of Brigham and Women’s Hospital, told Reuters, “We did not find any association for any of the antidepressant categories or the individual drugs we studied. It will be up to individual physicians and women to determine how much it will sway their opinion one way or the other.”

Dr. Stark (not involved in the study), director of obstetrics at the Cleveland Clinic, gave an objective opinion about the study saying, “I don't know if it will completely settle the debate over antidepressants during pregnancy, but I'm pleased to hear more support for the safety of these medicines in pregnancy. I think many practitioners and obstetricians will be happy to see this study come out.”

But should women be completely one hundred percent at ease? The study’s lead author told Time, “Based on our study, there is no evidence to support a substantial increased risk of cardiac malformations overall. The study provides quite solid evidence of the low risk in terms of cardiac malformations, but the treatment decision should consider the whole range of other potential adverse outcomes.”

There are always outliers so make sure your doctor does an in depth analysis first (based on your condition, other medications you are taking, your medical history etc.) before deciding whether you should be taking antidepressants while pregnant.

These findings are so helpful, because many women rely on antidepressants and if they have to discontinue use during pregnancy then it becomes a lose-lose situation for them. If they do not take antidepressants then they face serious emotional issues and have difficulty maintaining stability, which will also adversely affect their baby. But if they do take antidepressants, then their baby could face the risk of a heart defect. However, thanks to this new study it may give new hope to patients wishing to stay on their medication.

Many experts in the field endorsed the study such as Dr. Stark. Fox gives Dr. Stark's take on what effect the study will have on pregnant women suffering from depression,

“I do think women are aware of the concern and are reluctant to take medication for depression and anxiety, and I think that the pregnancy itself carries a lot of potentially additional burden on these women. And if they're further dissuaded from using the medication, it's really not in their best interest. So I think it will help us to empower women to take the best care of themselves during the pregnancy, which may involve taking medications to help with mood disorders.”

Authors of the study hope that their findings will relieve many of the tensions that women suffering from depression during pregnancy face about continuing with other common antidepressants while expecting.

Bottom line: You need to have a comprehensive discussion with your doctor about whether or not continuing antidepressants during pregnancy is right for you.

Gerry Oginski
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NY Medical Malpractice & Personal Injury Trial Lawyer