Is it Safe to Use Anti-Depressants During Pregnancy?
A new study out this week in JAMA Pediatrics show changes in the emotion centers in the brains of newborns that may be related to their mothers’ use of a common type of anti-depression medicine. UW Health psychiatrist Dr. Zachary Stowe offers his view on what the study does and doesn’t tell us about the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Dr. Stowe specializes in maternal depression and researches how anti-depressants and other medicines affect the health of mothers and their babies.
Why do women take SSRIs during pregnancy? Shouldn’t all drugs be avoided?
Ideally, women with histories of anxiety and depression would remain well and off medications during pregnancy, but they must have their symptoms under control and be able to function, including caring for their other children. Thus, we look for non-medication ways to manage depression. But there is pretty good agreement that untreated maternal depression and anxiety have risks for mothers and their unborn babies. And just as we treat women with epilepsy or insulin-dependent diabetes during pregnancy, there are times when SSRIs lower the overall risk to mothers and their babies.
How alarmed should we be about this new study?
My concern is that women may overreact. While it’s good to see a comparison study like this, the sample size is small. There were 98 babies in the study and just 16 were exposed to SSRIs in pregnancy. The mothers weren’t randomly assigned to SSRIs or no drugs before pregnancy, so there may be other differences between the women contributing to the results. The study does not prove a cause, it indicates only a potential association. There is limited information about maternal daily dose, the extent and timing of exposure during pregnancy and whether the mothers who were taking SSRIs were more severely depressed or anxious than the other moms at the beginning of their pregnancy. As a class, anti-depressants have been rigorously studied. More is known about anti-depressant use during pregnancy than many common drugs. Not all the data shows they are safe, but the majority does, so we should be careful about making changes based on a single study.
In a perfect world, how would we treat depression during pregnancy?
While we have a glucose test for gestational diabetes and ranges for blood pressure during pregnancy, we still lack an understanding of what level of maternal mental health symptoms require treatment. If we had a “depression tolerance test” for pregnancy, it could guide women and their providers to know when treatment was necessary.
What is the safest antidepressant to use in pregnancy?
The simplest answer is the “one that works best for the patient.” The majority of obstetricians view sertraline (Zoloft) as the first choice, based more on their experience with it. Remember that many pregnancies are unplanned and often women are already taking antidepressants before they know they are pregnant. Once the baby is exposed – switching antidepressants is not the best idea, especially if the drug the mother is taking is effective. Switching also exposes the baby to two medications, and the second drug may not work as well as the first. I see this dilemma in the clinic nearly every week.
Susan Lampert Smith
Date Published: 04/09/2018