Two new studies appearing in this week's New England Journal of Medicine attempt to assess the real risks of antidepressant medication of the SSRI class on fetal development and neonatal health. The studies came to fairly similar conclusions: in a nutshell, that while some adverse health effects -- specifically, certain types of birth defects -- may indeed be linked to SSRIs taken during pregnancy by women with depression, the absolute risk is very low. And, as always, the substantial benefits of keeping depression under control must be considered before changing or suspending treatment.
One group, consisting of researchers from Boston University and the Harvard School of Public Health, used a method known as case-control, in which over 9,800 infants with various birth defects were compared to over 5,800 infants free of such problems, to see whether their mothers had used SSRIs during the first trimester of pregnancy. The other study, whose authors came from the University of British Columbia in Vancouver and the National Center on Birth Defects and Developmental Disabilities in Atlanta, used the same study design to compare 9,600+ affected infants with over 4,000 normal ones, and evaluated the relative risks among those whose mothers used SSRIs from one month prior to three months after conception.
The studies both found slightly increased risks of certain developmental abnormalities associated with specific SSRI drugs, but "the specific defects implicated are rare and the absolute risks were small," according to one of the study's conclusions.
We need to remember that all medications have the potential for side effects and toxicity -- but that the benefits almost always outweigh the risks in carefully selected patients. In February of 2006, my analysis of three new reports on this same topic appeared on HealthFactsAndFears. The conclusion I reached then should now be re-emphasized:
Some things, however, are certain: depression during pregnancy is a major problem; it is not eased by the pregnant state, and relapse is likely if medications are stopped, with attendant adverse effects on both mother and baby possible. Although there is some risk to the newborn from commonly used antidepressants, mothers and obstetricians who might have reflexively stopped medications when pregnancy occurs should at least now think twice.
Gilbert Ross, M.D., is Executive and Medical Director of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).
See also: ACSH's report and brochure on pharmaceutical benefits and risks.
