Antidepressants Bad for Babies




Recently, two studies reported that selective serotonin reuptake inhibitors (SSRIs), a common class of antidepressant medication, increase the risk for congenital malformations and developmental disorders among children when taken by mothers during pregnancy.

The first study, published in Obstetrics and Gynecology, evaluated more than half of a million offspring over 11 years. Of these, just over 1% of the children were exposed to an SSRI during the first trimester of pregnancy. The study provided evidence for a two- to four-fold increased risk of cardiac and neural tube defects with specific SSRIs. Fetal alcohol spectrum disorders were also 10 times more likely in children exposed to an SSRI during pregnancy.

The risk of cardiac abnormalities in children exposed to SSRIs during pregnancy has been shown in many other studies over the last 15 years, with varying degrees of significance. Overall, the absolute risk of abnormalities associated with SSRIs is still very small. Other studies have reported neurobehavioral disorders, bleeding abnormalities, craniosynostosis, and abdominal malformations associated with prenatal SSRI exposure.

The second recent study reported a link between SSRI exposure during pregnancy and an increased risk of autism. This study, published in the Archives of General Psychiatry, found a two- to three-fold increase in autism spectrum disorders among children exposed to SSRIs during pregnancy. The risk was highest when SSRI exposure occurred during the first trimester of pregnancy. The study cannot prove cause and effect, and a link between a family history of depression and autism has already been established. SSRI exposure may have less to do with the development of autism than the genetic predisposition to depression and autism. This study was small, and its results should be interpreted cautiously. In both of the recent studies, the authors caution women not to change their mental health treatment plans without speaking to their physician.

In general, it is prudent to avoid unnecessary exposure to medication or other potentially harmful chemicals or products during pregnancy. And, the overall safety profile of SSRIs during pregnancy is questionable. But, SSRIs are also very effective antidepressants. This class of drugs should not be removed from a mother’s possible treatment options if she requires intervention for prenatal depressive disorders. In other words, don’t throw the proverbial baby out with the bath water.

Studies like the ones published recently might cause unwarranted alarm and prevent mothers from seeking mental health care during pregnancy. Clinicians should be vigilant to confirm a diagnosis of depression during pregnancy and communicate openly with mothers about the benefits, risks, and alternatives of treatment options. Ideally, every pregnancy ends with a healthy baby and a healthy mom. Mental health is a large piece of the puzzle for new moms and moms-to-be and the physical and psychological risks associated with depression during and after pregnancy might be worse than the risks of congenital malformations or developmental disorders to the fetus.

References

None (2006). SSRI antidepressants and birth defects. Prescrire international, 15 (86), 222-3 PMID: 17167929

Banti S, Mauri M, Oppo A, Borri C, Rambelli C, Ramacciotti D, Montagnani MS, Camilleri V, Cortopassi S, Rucci P, & Cassano GB (2011). From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the Perinatal Depression-Research & Screening Unit study. Comprehensive psychiatry, 52 (4), 343-51 PMID: 21683171

Croen LA, Grether JK, Yoshida CK, Odouli R, & Hendrick V (2011). Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders. Archives of general psychiatry PMID: 21727247

Malm H, Artama M, Gissler M, & Ritvanen A (2011). Selective serotonin reuptake inhibitors and risk for major congenital anomalies. Obstetrics and gynecology, 118 (1), 111-20 PMID: 21646927

Patel SR, & Wisner KL (2011). Decision making for depression treatment during pregnancy and the postpartum period. Depression and anxiety, 28 (7), 589-95 PMID: 21681871

Tuccori M, Montagnani S, Testi A, Ruggiero E, Mantarro S, Scollo C, Pergola A, Fornai M, Antonioli L, Colucci R, Corona T, & Blandizzi C (2010). Use of selective serotonin reuptake inhibitors during pregnancy and risk of major and cardiovascular malformations: an update. Postgraduate medicine, 122 (4), 49-65 PMID: 20675971

Tuccori M, Testi A, Antonioli L, Fornai M, Montagnani S, Ghisu N, Colucci R, Corona T, Blandizzi C, & Del Tacca M (2009). Safety concerns associated with the use of serotonin reuptake inhibitors and other serotonergic/noradrenergic antidepressants during pregnancy: a review. Clinical therapeutics, 31 Pt 1, 1426-53 PMID: 19698902

  • Theresa R

    Dear Dr. Gibson ….

    I am glad for you to use brain blogger as a forum for your discussion about both certain and possible side-effects of SSRI’s consumed prior to and/or during or soon after conception. It is wise for as many psychiatrists (AND psychologists and other counselors) to be aware of how a developing child will possibly be damaged. The dangers are significant for women who are not using contraceptive measures or planning a family to not be put on an SSRI at all.

    You talk about the dangers of the mother not being treated at all for her depression – and true, the exposure to depression pre and post birth can be harmful to the child…

    But – and I say this not with hostility, but with concern at what is being taught to the practicing psychiatrists treating these mothers, more and more being restricted because of reimbursements into the 15 minute appointment where there is room for little (as a patient as well as practitioner)than “how have you been doing? Any problems? Have you been taking all your meds or some? Changed any dosages? Now what do you need refilled?.. Yep, that is pretty much it.

    It is well known and study proven that for depression (not bipolar – find me a low-danger mood stabilizer), PSYCHOTHERAPY works fully as well. Well, the patient’s primary care may be prescribing this also, and it is paramount they are aware of the dangers, too, and of how effective therapy, even supportive therapy, as well as a firm reliable network of “family and friends”.

    Now the woman’s insurance may not provide for therapy on a weekly or biweekly sessions, but there are other options for low-cost, sliding scale and even free resources, ranging from pastoral care counselors to online support groups (which have come to both supplant and surpass family and friends in accessibility and safe to disclose to – no gossip around the family and social groups. On good groups, be they be prenatal concerns, or based on marital issues or even partner abuse.

    These women need validation, nurturance, support and love – and I personally aware of how there are groups that provide that.

    There is absolutely ZERO need for a woman to expose her fetus to any additional non-media aware possiblity of harm, be emotional stress and distress, anxiety, fear or panic. And we don’t want a mother to harm herself, but shoving a bottle of a lethal dose of ADs is not the answer either if she is that much in danger from her depression.

    It is an unethical thing to not direct a depressed pregnant mother to safe alternatives. I should hope that you consider editing this blog post to reflect that or to promptly follow this one up with another — giving you time, of course, to assure yourself of studies you may or may not be aware of..

    from a mom and grandmother

Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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