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Are Antidepressants Safe During Pregnancy?

Report Offers Guidelines for Treating Depression in Pregnant Women
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Miscarriage, Low Birth Weight, and Preterm Birth

SSRI use during pregnancy has also been linked in some studies to an increased risk for miscarriage, low birth weight, and preterm delivery.

But once again, the report found no definitive link between the use of the antidepressants and these pregnancy outcomes.

"Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or behaviors that can adversely affect pregnancy," the joint panel writes.

The report was published in both the American Psychiatric Association journal General Hospital Psychiatry and the American College of Obstetricians and Gynecology journal Obstetrics and Gynecology.

The joint panel concludes that a gradual reducing of antidepressant dosages and stopping antidepressants altogether may be appropriate for women who hope to become pregnant if they have had mild or no symptoms for six months or longer.

The group also recommended that:

  • Women who are already pregnant should not attempt antidepressant withdrawal if they have severe depression.
  • Psychiatrically stable women who want to stay on antidepressants during pregnancy should consult with their psychiatrist and ob-gyn about the potential risks and benefits.
  • Women with recurrent depression or those who have symptoms despite drug treatment may benefit from psychotherapy when available.

Psychiatrist Ariela Frieder, MD, who specializes in treating pregnant women with depression at Montefiore Medical Center in New York City, tells WebMD that her patients tend to be very concerned about how antidepressants will affect their baby and much less aware of the dangers posed by untreated depression.

Frieder was a practicing ob-gyn in her native Argentina before moving to New York where she did her residency in psychiatry.

"Many women want to stop treatment abruptly and even stop on their own, but this can be very risky," she says.

Jennifer Wu, MD, an ob-gyn who practices at New York's Lenox Hill Hospital, agrees.

"The old conventional wisdom was that pregnancy was a honeymoon period for depression and that patients would be able to come off their medications and be OK," she tells WebMD. "But we have learned that this is not true. It has become more and more apparent that pregnancy is a vulnerable time for patients with a history of depression."

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