Read the headlines below and it’s easy to surmise that you should not take antidepressants if you’re pregnant. Why would you? How could any pregnant mother do something to help herself and knowingly harm her child at the same time?
Common Antidepressants Too Risky During Pregnancy, Researchers Say (US News & World Report)
Study of Antidepressants In Pregnancy Finds More Risks Than Benefits (CBS News)
Research Suggests Pregnancy Women Forego Antidepressants, With One Exception (Psych Central)
This week, the media outlets above and many others reported on a paper published on October 31 in the medical journal Human Reproduction. This paper concluded that, “Antidepressant use during pregnancy is associated with increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn and possible longer term neurobehavioral effects. There is no evidence of improved pregnancy outcomes with antidepressant use.”
Wow. That’s pretty clear. Antidepressants taken during pregnancy don’t help moms and they hurt babies.
Except, what if a whole hell of a lot of data is missing? What if those conclusions are completely misleading?
What if I told you that this piece, reported in many outlets as a research study, is not in fact even a study; it’s simply a summation of a review of other studies’ results on antidepressants in pregnancy. Not only that, but it’s not a review of all studies on antidepressants in pregnancy, but only studies that had negative outcomes. Bias, anyone?
I have to ask why Boston.com would publish a sentence like, ” … experts agree that research studies to date haven’t established a connection between depression and poor pregnancy outcomes ….” in their article on this paper. Really? Did they look at any of the studies cited by the National Academies in its report on parental depression, studies which found depression during pregnancy can negatively affect childbirth?
Antenatal depression, as well as stressful life events and anxiety, which often co-occur with depression, have been linked to complications of pregnancy or delivery (e.g. preeclampsia) and adverse pregnancy outcomes (e.g. low birth weight), at least partially as a function of poor prenatal care and unhealthy habits (smoking, alcohol drugs). Among low-income African American women, those with a high level of depressive symptoms were nearly twice as likely to have spontaneous pre-term births (Orr, James & Blackmore Prince, 2002). This was true even after controlling for other health risks related to premature birth. In a more recent large, prospective cohort study that began early in pregnancy (Li, Liu & Odouli, 2009), clinically significant levels of depressive symptoms were associated with almost twice the risk of preterm delivery relative to women with no depressive symptoms … Thus depressive symptoms in the mother, although associated with other health risks, played the central role in association with negative outcomes for infants.”
What if I told you that there’s been even more research conducted since that 2009 report from the National Academies that finds untreated depression during pregnancy is bad for babies?
According to the Massachusetts General Hospital’s Center for Women’s Mental Health in its review of a recently published small but significant study, “This study failed to find an effect of antidepressant medication on children’s intellectual or behavioral outcomes. However, it did demonstrate that exposure to untreated maternal depression in utero and during early childhood is associated with worse cognitive and behavioral outcomes.” Let me repeat: The children of mothers who had depression during pregnancy had worse outcomes than the children of mothers who took antidepressants during pregnancy. I note that US News didn’t make mention of this. Or Babycenter. I’m actually blown away that a respected online mental health outlet like Psych Central would publish a sentence like, “Most women who are taking popular antidepressants — such as Prozac, Paxil or Celexa — would help their unborn child by discontinuing the medication.”
What if I also told you that women who are already being treated with antidepressants for depression who quit when they become pregnant have a 50-75% relapse rate of their depression during their pregnancy, and that depression during pregnancy is the single biggest risk factor for postpartum depression?
What if I told you that research shows the absolute risk of birth defects for babies whose mothers take antidepressants is essentially the same risk as for those who don’t? The researchers want you to the think the risk is much higher, but science isn’t bearing that out.
Motherisk found that of all women who give birth, .05% will have a child with a septal heart defect, while of all women who give birth who take SSRIs during the first trimester, .09% will have a child with a septal heart defect. Just ask advocate Kristine Brite McCormick, whose daughter died from a congenital heart defect, whether articles like these serve to confuse parents unnecessarily. “As a congenital heart defect prevention advocate, seeing all of the headlines ‘SSRI’s cause birth defects’ and often followed by ‘Sue! Sue! Sue’ are really frustrating,” McCormick says. “The evidence doesn’t match the headlines … Also interestingly enough, there’s a current study that’s being done looking at low serotonin causing heart defects. So far, results are showing it very well might. The inflammatory headlines cause pregnant women to refuse medication or stop medication suddenly without doing further research or listening to their doctors.”
What if I also told you that some women have killed themselves, leaving their children motherless, because they had serious untreated antenatal or postpartum maternal mental illness, and often the reason that it went untreated was because they were afraid to take medication because of the stigma that results from media stories like these? I find it shocking that anyone would suggest that only pregnant women at risk of suicide should take antidepressants. Heed the words of Sara Ziegler, whose sister Aimee committed suicide:
My sister died because of postpartum and postpartum psychosis. I can’t begin to describe the what ifs that run through my life daily, and one of those is what if she would have taken her prescribed medicine? Would she still be here? I have to believe it would have helped and she would have been able to manage the intensity of this illness.
I know from her previous battles with postpartum (she suffered with her first two children and ultimately lost her life and battle with her third child) she battled with taking her medicine fearing it would harm her baby, effect her breast milk, make her less of a mom, etc. I believe if there were more balanced and positive info out there to support mothers with any mental illness taking medicine as a treatment, my sister might have been more at ease and open to taking it. I also feel like medicine that is held off until suicidal ideation occurs is less effective than medicine taken early to manage the imbalance before it gets to that stage.
My sister might be raising her kids today and celebrating her birthday this Sunday with me and our family if she didn’t carry the stigma and scare of taking medicine. Can we please change this perception and make professionals understand the consequences of not understanding this illness and how reporting their research effects mothers?
I have to ask why this paper has been covered by so many media outlets in the first place. Many of our country’s top reproductive psychiatry experts are beyond upset about it, and are dashing off letters to Human Reproduction asking why it was ever published.
This matters. Let me shout that: THIS MATTERS! It matters because we’re talking about the future of families. We’re talking about tens of thousands of mothers, if not hundreds, who will sacrifice their health to continue to suffer depression and anxiety during pregnancy because of stories like these. We’re talking about babies who may suffer long-term harm. This affects mothers and their ability or willingness to get the help they need. If you don’t believe me, ask other moms who’ve been through antenatal or postpartum depression how they feel about media reports like this. I did. Here’s what some of them said on the Postpartum Progress Facebook page:
Even as angry as it makes me, it also makes me so sad. There are so many women who are so incredibly vulnerable that hearing a news story is all the confirmation they need that they are terrible mothers and it’s their fault they feel this way and there is no help for them. ~ Becca S.
The stigma kept me from doing anything about my first bout with PPD. It took a severely traumatic birth experience with my second child to allow me to be open to asking for and receiving help. The message is that you shouldn’t take care of yourself until you’re at the point of self harm, but it’s so much better for everyone involved (mother, baby family) if treatment prevents that from ever happening. ~ Jennifer C.
I was misinformed with my first birth and my family and I suffered needlessly. I wanted to get help but because of the stigma surrounding taking the medicines I didn’t. I think this led to the severe case of antenatal depression and PPD. ~ Jessica T.
I still remember vividly when Tom Cruise insulted all of us with his comments to and about Brooke Shields. I have lived with depression most of my life and felt, based on the data at the time, that I needed to stop my medication for both my pregnancies. As my pregnancies progressed, I became more and more ill. By the time each of my girls were born, I met the criteria for major depression. ~ Tammy D.
No woman relishes the idea of taking medication of any kind, especially while pregnant, but making it out to be the most dangerous thing you can possibly due is irresponsible. ~ Carrie V.
Antidepressants were an absolute last resort to me because of the stigma associated with them. Turns out they were the only thing that really helped me, meaning that stigma was the only thing standing between me and my recovery. Had I known that they could save my life, and the lives of my children, I would have started on them much, MUCH sooner – not three years into my illness. How many other women are being hindered in their recovery because of the media’s negative or false perspective? ~ Robin M.
It doesn’t just effect women who are on medication or might be discussing that option with their doctors. I worry that it keeps many, many pregnant women and new moms from even asking about treatment options. ~ Anne W.
What about the fact that the “defects’ that occur in babies born to women that take antidepressants occur at the same rate in women who take nothing (the general population)? ~ Elizabeth R.
I am having a tough time (having lots of guilt and shame) after reading the recent article on Babycenter about common antidepressants not being safe unless you are seriously suicidal. I was on an SSRI with my first pregnancy and afterwards and I breastfed. I decided to switch to another SSRI for this pregnancy because it has been deemed safer in pregnancy and breastfeeding. I have a great mental health professional supporting me. And yet with one article I came tumbling down… ~ Zoe L.
IF it weren’t for the meds, I wouldn’t have survived antepartum depression/anxiety, let alone postpartum depression/anxiety … I self harmed during pregnancy and who knows what else might’ve happened (to me and/or the baby) if I hadn’t taken medication? ~ Erin M.
Risk and benefits need to be weighed in each case. This only adds to the stigma of getting treatment, makes women who DO get treatment feel guilty, and ultimately is damaging for both women and babies. It also makes some providers less likely to use important medical intervention when warranted. ~ Gretchen J.
I’ve had enough. I’m beyond sick of this. I’m furious, as are all of my readers at Postpartum Progress. I have one major question for the media: If I, a mother with no medical education or training whatsoever, can figure this out, then why the hell can’t you?
UPDATE: Some readers have felt that this piece indicates I believe antidepressants are the only treatment for depression during pregnancy. Goodness no! I wanted to address that because it couldn’t be further from the truth, and I hate that I may have given that impression to anyone. Therapy is very effective for many women, whether they have postpartum depression or antenatal depression (depression in pregnancy). Also, there is promising research underway that looks at things like acupuncture to treat depression during pregnancy. What bothers me is the fact that antidepressants are made out to be so evil and dangerous that any woman for whom these other treatments are not effective may forego them entirely and suffer. I believe these researchers presented only one side of the story and I wanted to present the other side. Now you have two sides. This is why it’s important for women to know the risks on both sides, and then make the best decision for them as an individual, working with their doctor.
For an additional perspective on this, see An Expert Weighs In on Treatment of Depression in Pregnancy.
Photo credit: © Tatyana Gladskih – Fotolia.com
Katherine Stone writes here at Babble as well as at her own blog called Postpartum Progress, which is the leading blog on postpartum depression. You can also follow her on Twitter as she tweets inane things about her day.