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A Mother's Dilemma: Using Antidepressants During Pregnancy

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By far, Prozac has been the object of the greatest amount of research for its effects in pregnancy. And the evidence seems to suggest that use of the drug in the first trimester is not related to adverse birth outcomes.

"The data support the absence of major malformations following first trimester exposure to Prozac," Cohen says.

Similarly, first trimester use of older antidepressants, known as tricyclics, also appears to be relatively safe. "There are good data supporting that when we use the tricyclics in the first trimester, you don't see higher rates of major malformations in children who were exposed to those medications," Cohen says.

But Cohen and others caution that much less information is known about selective serotonin reuptake inhibitors, or SSRIs, other than Prozac, like Paxil and Zoloft. "We cannot make assumptions about reproductive safety with incomplete data, even for medications that are in the same family," Cohen says.

Moreover, all of the research on antidepressant use in pregnancy pertains to short-term outcomes. Little or nothing is known about the long-term effects on offspring, researchers say.

Several studies presented at the APA meeting appear to support the relative short-term safety of using antidepressants during pregnancy.

In one study reviewing the obstetric and medical records of 70 infants whose mothers were exposed to antidepressants, there were no readily apparent negative outcomes associated with the use of antidepressants. But long-term neurological and behavioral effects of fetal exposure to these medications remain unknown.

That study was presented by Cohen and by Kimberly Pearson, MD, and Vicki Heller, MD, also of the department of psychiatry at Massachusetts General Hospital.

The study also concluded that it might be best to continue antidepressant medication through labor and delivery because after delivery, with the hormonal fluctuations, new expectations, and lifestyle changes placed on women, they are more vulnerable to postpartum depression.

A third study of 95 women compared obstetrical outcome for those who received antidepressant treatment with those who did not. There were no significant differences in obstetric outcomes between nonmedicated and medicated groups in each trimester, according to the study presented by Stowe and Noha Sadek, MD, of the department of psychiatry at Emory University School of Medicine in Atlanta.

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