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Antidepressants and Pregnancy: No Easy Answers

I recently wrote about why I took Prozac while pregnant despite the potential risks. When my story ran on Yahoo’s Shine, I was slammed for my decision. People called me selfish for having children in the first place. Others said because I was “weak” for not kicking my “addiction,” my children were going to be born drug addicts. One person came right out and called me a “bad mother,” while another suggested “all the wrong people breed.”

The ignorance about depression and antidepressants stunned me. People still think of Prozac as a “happy pill” and believe that depression is something you can just kick if you have the will power.

Needless to say, I fear this latest news will make my decision to take Prozac while pregnant seem all the more reckless.

Time Magazine recently reported on a new study which linked certain antidepressants to a higher rate for miscarriages.

Scientists at the University of Montreal reported in the Canadian Medical Association Journal that women taking certain antidepressants had a significantly higher risk of miscarriage than a control group of pregnant women who were not taking antidepressants. The researchers found that two SSRI class antidepressants  — Paxil and Effexor – are associated with the greatest risk.

The researchers analyzed data from a pregnancy registry in Quebec that collected records on births and miscarriages at hospitals in the Canadian province. The study included 69,742 women from the registry, 5,124 of whom had suffered miscarriages. Among the women who had miscarried, 5.5% had taken at least one antidepressant during pregnancy, compared with 2.7% of the control group.

After controlling for other factors, researchers determined that antidepressant users had a 68% higher risk of miscarriage than those women who weren’t on antidepressants. Women who combined two or more classes of antidepressants were at a higher risk.

Since the study examined retrospective data, it’s possible that some of the miscarriage risk could be attributed to the underlying depression rather than the medication. Still, the 68% increase in miscarriages is significant.

Being depressed during pregnancy has its own risk. Research has shown that women who are depressed during pregnancy are at increased risk of miscarrying, premature births or low-birth-weight babies. Infants of depressed mothers are also at increased risk of irritability, sleep problems and high blood levels of the stress hormone cortisol compared with babies born to mothers without depression.

Luckily, I write this from hindsight since it all worked out for me — my girls, now 8 and 5, were born full-term and healthy. I admit that if I was pregnant now, I might reconsider my decision to take anti-depressants, but I have a strong hunch that I would reach the same conclusion.

About 14% to 23% of pregnant women experience depressive symptoms; in 2003, about 13% of women took an antidepressant at some point during pregnancy, according to the American Congress of Obstetricians and Gynecologists (ACOG).

A depressed expectant mother needs to weigh the severity of her depression as well as her past history of miscarriage before deciding whether to change medication, reduce dosage, or stop taking antidepressants, according to Time.

In a 2008 report, the ACOG recommended that women with severe depression stay on medication while pregnant. Women who are depressed, but stable may also continue taking antidepressants after consulting with their doctor.

The Mayo Clinic makes the point that not all antidepressants are appropriate during pregnancy. For instance, they don’t recommend Paxil. You can see their guidelines to antidepressant use during pregnancy here.

What’s most important is that whatever they decide, depressed women need to continue some sort of treatment during their pregnancy and get as much support and family and friends as possible.

Whether or not to take antidepressants during pregnancy is a personal decision. I don’t mind that others (like the commenters on Shine) might not agree with my choice. But by spreading misinformation, these anonymous online critics may prevent a depressed, expectant mother from getting the crucial help she needs.

Photo: http://www.flickr.com/photos/davidclow/2549129171/

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