Antidepressants and Pregnancy: Weighing Risks

Antidepressants and Pregnancy: Weighing Risks

Women who take antidepressants and learn that they are pregnant must consider not just the potential risks of the drugs but also the impact of untreated depression on a developing fetus. Untreated depression could lead to low birth weight, irritability in the child and developmental delays. Side effects of antidepressants can be similarly harmful: miscarriage, premature birth, and breathing problems in newborns. “There’s no path that’s really risk-free,” Pec Indman, a therapist who specializes in perinatal mood and anxiety disorders, tells the Chicago Tribune. “Illness has a risk and treatment has a risk.” The question is, which is riskier?

One of the more common effects of antidepressant exposure in newborns is post-delivery withdrawal-like symptoms. These could include respiratory problems, tremors, feeding difficulties, and jitteriness. Last year one study linked use of antidepressants in the first trimester with a fourfold increase in the chance of a child having autism, though many experts warn that these findings are not conclusive, as it was the first and only study to make the association and there was evidence of methodological weakness. Preterm delivery has been associated with antidepressant exposure more consistently, but no long-term effects on children have been shown.

Dozens of studies have been focused on the safety of using antidepressants such as selective serotonin reuptake inhibitors (SSRIs) during pregnancy. The problem is that it is not clear whether adverse effects showing in newborns are the result of the medication or the depression itself. Babies born to depressed mothers can have elevated cortisol levels and reduced seratonin levels. Further complicating the matter is the evidence that depressed mothers tend to be more likely to smoke or drink alcohol and less likely to seek prenatal care or take prenatal vitamins. They also have more of a tendency to experience postpartum depression, which would hinder their ability to interact with their newborn, thus interfering with the child’s development.

What options could a woman on antidepressants have during pregnancy? One expert suggests that women with mild depression consider tapering off their dosage of the medication, either before conceiving (if they are able to plan ahead), or in the third trimester (if they cannot). This will decrease the withdrawal symptoms in the newborn child. Women should always consult their OB-GYN and mental health providers to decide the best course of action. It is not recommended to discontinue medication abruptly because this can also have negative effects on the patient, both physically and psychologically.

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