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The risk of antidepressant use in pregnancy has been an active area of research lately. Last month The Pulse reported on a new study linking antidepressant use to growth restriction in babies. Late this summer, researchers from the Centers for Disease Control and Prevention (CDC) reported on a new study warning about specific birth defects linked to the antidepressant venlafaxine (Effexor).
CDC starts out by saying some women with mental health conditions need to take medication to stay healthy during pregnancy, and explains that the purpose of their study is to add information on the risk of specific antidepressants and specific birth defects. They hope their study, published in the American Medical Association journal JAMA Psychiatry, may help women and their doctors weigh the risks and benefits.
Why Antidepressants Are Prescribed During Pregnancy
The reason is that untreated depression is dangerous during pregnancy. It could interfere with prenatal care, like not eating well, not sleeping well, or the danger of self-treatment with drugs or alcohol. Untreated depression has been linked to a higher risk for premature birth, low birth weight babies, and postpartum depression. You can read about these risks in more detail here.
Although there is a known link between antidepressants and birth defects, the risk is mainly during the first trimester and is low. Generally, most doctors feel the benefits outweigh the risks and try to limit antidepressants to the lowest effective dose, especially during the first trimester.
Are Some Antidepressants Safer Than Others?
That is the question the CDC researchers are trying to answer. The new study used data from the National Birth Defects Prevention Study to shed light on which antidepressants are responsible for specific birth defects. They also looked at how much depression and anxiety may contribute to the risk of birth defects without medication.
The researchers looked at antidepressant use in over 30,000 mothers of babies born with birth defects and compared them to a control group over 11,000 mothers of babies without birth defects. Just over 5 percent of the birth defect group reported taking an antidepressant compared to just over 4 percent of the control group. These were the key findings:
- Venlafaxine (Effexor) in early pregnancy was linked to several birth defects including heart, brain, spine, cleft lip and palate defects, hypospadias, and gastroschisis (an abdominal wall defect).
- Selective serotonin reuptake inhibitors (SSRIs), including sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil) and citalopram (Celexa) were linked to a small number of birth defects including heart defects. However, the risk for heart defects also occurred in women with depression not taking an SSRI during the first trimester, so it may be due to the mental health condition and not the SSRI medication.
Selective serotonin reuptake inhibitors (SSRIs) are generally considered the safest antidepressants for pregnancy. Most studies show no link to birth defects or just a small link to heart defects for Paxil. The CDC study seems to support this view and adds the reassuring information that even this link may be due to untreated depression rather than an SSRI.
Effexor is a different class of antidepressants called a serotonin and norepinephrine reuptake inhibitor (SNRI). Although SNRIs have also been considered an option for pregnancy depression, the CDC study is a flashing warning for Effexor. Effexor was associated with the highest number of birth defects and this risk was not decreased by accounting for mental health conditions.
This study does not suggest that women who are pregnant and on an antidepressant should stop taking their medication! Stopping an antidepressant during pregnancy may be more harmful than taking it. It does suggest that SSRI antidepressants are safer than Effexor.
CDC suggests if you are pregnant with depression, talk to your doctors about the risks and benefits of an antidepressant. If you suffer from depression and may become pregnant, talk about the options for managing depression before you become pregnant. A commentary included by JAMA Psychiatry reminds doctors that psychotherapy without medication may be another option.