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Debate Over Antidepressants in Pregnancy Ongoing

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WebMD Health News
Reviewed by Louise Chang, MD

Oct. 31, 2012 -- The debate over the safety of antidepressants during pregnancy has been going on for a long time, and a new review may keep the debate alive a while longer.

The research review finds little evidence that the most widely prescribed class of antidepressants benefits pregnant women and growing evidence that they cause harm.

But one expert calls the findings "nonsense."

Investigators of the review concluded that selective serotonin reuptake inhibitor (SSRI) antidepressants should be prescribed "with great caution" during pregnancy.

They point to studies that have linked SSRI in pregnancy to preterm birth, miscarriage, and autism and developmental delays.

“We have never before in human history chemically altered fetal development in the way that we have done with these drugs,” says researcher and ob-gyn Adam Urato, MD, of Boston’s Tufts Medical Center and the Metro West Medical Center. “This is a massive experiment and we don’t know what the outcome will be.”

Review Is 'Nonsense,' Doctor Says

But psychiatrist Kimberly Yonkers, MD, calls the reviewers’ conclusion that women who are pregnant and depressed do not benefit from SSRIs “nonsense.”

Yonkers is a professor of psychiatry and obstetrics and gynecology at Yale University, and she served on a 2009 joint panel of psychiatrists and obstetricians that established guidelines for the treatment of depression during pregnancy.

“For many women with severe major depression, treatment with an antidepressant is not optional, just like treatment with insulin is not optional for a woman with (type 1) diabetes,” she says. “To give these women the message that treatment is optional and that it doesn’t work anyway does us all a disservice.”

Millions of Pregnant Women Have Taken SSRIs

Since the introduction of Prozac in 1987, millions of pregnant women have taken SSRI antidepressants. They are the most prescribed drugs among people aged 18-44.

Women who have trouble getting pregnant and who are being treated for infertility may be especially vulnerable to depression, says review co-author Alice Domar, PhD, who is executive director of the Domar Center for Mind/Body Health at Beth Israel Deaconess Medical Center’s Boston IVF.

When she analyzed electronic data from the center, she found that around 1 in 10 infertility patients were taking an SSRI for depression.

Domar, who is a psychologist, says she has long suspected that antidepressant use is linked to lower pregnancy rates among women undergoing infertility treatments.

But she acknowledges that there is little research to show this because few of the studies of antidepressant use have involved infertile women.

SSRIs Linked to Worse Birth Outcomes?

Domar says there is mounting evidence linking SSRI use during pregnancy with poor birth outcomes, including miscarriage, early delivery, and a rare but potentially life-threatening condition known as persistent pulmonary hypertension.

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