Some Antidepressants Might Be Safer To Use In Pregnancy Than Others, A New Study Suggests

Using Antidepressants in Pregnancy

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Note: always follow your doctor’s instructions. Never change your medication regimen on your own.

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For some women, the glow of pregnancy refers only to their complexion, not to their mood.

In fact, women of reproductive age and those who are pregnant increasingly are using SSRIs—for serotonin-reuptake inhibitors—the most commonly prescribed antidepressants. Such drugs include Prozac, Zoloft, and Paxil.

But at least a couple of studies suggest pregnant women would rather not have to take them due to concerns about their safety.

One study of women who’d given birth found that nearly 4 out of every 100 reported using an SSRI antidepressant sometime between 3 months before they conceived and the day they delivered. However, a substantial number of the women said they stopped taking antidepressants around the time they learned they were pregnant.

Another study found that about two-thirds of women surveyed thought it was definitely or probably acceptable to take antidepressants when not pregnant or breast feeding, but only a third felt the same about taking them when pregnant.

It’s no wonder that women might be nervous about taking SSRIs during pregnancy, because research into whether the drugs are linked to birth defects has reached conflicting results.

Now a new study by researchers at the Centers for Disease Control and Prevention provides reassurance about sertraline, the generic name for Zoloft, the most frequently used SSRI, but confirms some of the previously reported links between other SSRIs and some birth defects.

The CDC researchers used new data from the National Birth Defects Prevention Study to look at the previously reported links between SSRIs and birth defects.

They couldn’t confirm any of the links that had been observed between sertraline and birth defects. However, they did observe 5 out of the 7 previously reported links between paroxetine, the generic name for Paxil, and birth defects. They also observed 2 out of 4 previously reported links between fluoxetine, the generic name for Prozac, and birth defects. Babies born to women who had taken Paxil or Prozac were 2 or 3 times more likely to have one of the birth defects associated with those drugs than babies whose mothers had not taken them.

But you shouldn’t abruptly stop taking Paxil or Prozac because you’re pregnant, the CDC advises. As the scientists who conducted the latest study note, even if Paxil or Prozac increases the risk of birth defects—their study wasn’t designed to prove the drugs caused birth defects—the risk is still exceedingly low, because the birth defects are rare to begin with.

The strongest links were seen between Paxil and two different birth defects: anencephaly, which involves the brain and skull, and a heart defect involving the blockage of blood flow out of the right side of the heart.  Still, the actual numbers were quite small. If Paxil caused anencephaly, the risk would rise from 2 per 10,000 babies born to women who had not taken the drug to 7 per 10,000 babies whose mothers had taken it early in pregnancy. If Paxil caused that heart defect, the risk would rise from 10 per 10,000 babies to 24 per 10,000.

“This analysis confirms the need to assess the association between specific SSRIs and specific birth defects,” rather than lumping all SSRIs and all birth defects together, the scientists write in their report.

“Meanwhile,” they continue, the current analysis can help guide healthcare providers and women to the safest options for treatment during early pregnancy to minimize the risk of major birth defects, while providing adequate treatment of maternal depression.”

You may also want to read the following related post in The Pulse: Treating Depression in Pregnancy: What’s New?

Rita Rubin
An ob-gyn's daughter and the mother of two teenage daughters, Rita Rubin has covered medicine ever since earning a BSJ from Northwestern. Based in Washington, D.C., Rita has written for WebMD, JAMA, POZ, and NBCNews.com and previously worked for USA TODAY. She has won numerous awards for her stories and authored What If I Have a C-Section? Rita earned an MA in writing from Johns Hopkins and spent a year as a fellow at the Harvard School of Public Health. You can follow her on Twitter @RitaRubin.

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