It is a decision that too many women face, and that has no easy answer: to remain on antidepressants during pregnancy despite risks of abnormal development or birth problems, or to stop taking the medication, placing yourself and your child at risk of the dire effects of major depression. SSRI attorneys at Pintas & Mullins take a fresh look at this issue and the complexities involved.
An article published by the New York Times last week has sparked controversy in the medical field over whether antidepressants - specifically, a class known as SSRIs - are safe to take during pregnancy. Some applauded the article, believing that too many women are unaware of the risks of certain medications; others pushed back against it, arguing it would spread unnecessary fear based on conflicting research. Mental health organizations were largely on the nay-saying side, stating that the author trivialized depression instead of treating the women facing this issue with compassion.
Some medications, such as the acne drug Accutane, are irrefutably linked with birth defects when used in pregnant women and relatively easy for women to stop taking. Depression is not like acne; it is a serious, life-changing mental disorder with complex and largely unknown causes. The Times author states that pregnant women "rarely" stop taking SSRI antidepressants even though they have been linked in numerous studies to a host of birth disorders. The FDA has issued clear statements on the risks of Paxil in particular, so why are so many pregnant women still taking them?
Doctors generally believe that depression is more dangerous for mother and child than an SSRI medication. Statistically, women with depression who stop taking medication are three times more likely to relapse than those who continue taking an antidepressant. On the other hand, the medications cross the placental barrier during pregnancy, and blood samples taken at birth indicate that the drugs do indeed enter the fetus' bloodstream and amniotic fluid.
There have been numerous studies on this topic with conflicting results. Some studies found a link between SSRIs and infant cardiac deaths, others with miscarriage, lung conditions, autism, ADHD, and clubfoot. Still others have found no correlation or even suggested SSRIs cause lower cardiac defects. For example, since 2011 five studies have been published on the link between SSRI use and autism, three of which found some type of association.
Conversely, animal studies show that pregnant women who show stress, depression or anxiety are more likely to have children with inadequate neurological development or suffer miscarriages or preterm birth. Other studies found that children whose mothers were depressed during pregnancy were more likely to suffer from future mental illness, such as schizophrenia or depression.
In other words, for many women, it is a no-win situation. For pregnant women suffering from depression, all factors need to be taken into account. Do you think your depression could be managed without medication, supplemented by talk therapy or behavioral counseling, consistent and regular exercise, and other interventions? Or, would tapering off the medication cause too much stress and anxiety, ultimately causing more harm than good? For some, the depression may be so severe that medication is undoubtedly the best bed; for others, major changes in lifestyle are within reach and preferable to the risks of SSRI use. We urge anyone facing this type of situation to consult psychiatrists, family and doctors to come to the final decision.
Despite the dearth of factual knowledge there are efforts being made to fund studies and research. It is an important and serious issue that affects more women than we could ever know. There is a wide array of information on this topic available online (some more reputable than others). The New York Times recently published a series on mental illness in new and expectant mothers, available here.