Wednesday, June 9, 2010

Pregnancy Antidepressants

I have written before about the dilemma faced both by depressed pregnant women and their health care providers in trying to determine whether is best to take or stay on antidepressants during pregnancy. There is a lot that we do know but so much that we don't. Information is hard to come by as it is unethical to do any randomized prospective studies. But we do get new information at times that helps us a bit better in putting the pieces of the puzzle together. Two recent studies add to our knowledge. I will discuss one of them here.

At this time the American College of Obstetricians and Gynecologists (ACOG) and the American Psychiatric Association (APA) have issued a joint report with recommendations based upon current knowledge. I have previously discussed these recommendations and will not go into them here but for those who are interested a copy of the report can be obtained through the ACOG Office of Communications at communications@acog.org or The APA Office of Communications at press@psych.org

One very important study published in the May issue of the Canadian Medical Association Journal indicates that not all antidepressants are the same in terms of risk. The researchers looked here at risk of miscarriage. They examined data on 5124 women between the ages of 15 and 45 years who had clinically verified miscarriages. Two antidepressants used alone as well as the use of combination antidepressants were associated with higher rates of miscarriages. Those two antidepressants are paroxitine (Paxil) and venlafaxine (Effexor). Paroxetine has been previously shown to result in a small increased risk of congenital malformations when taken in the first trimester and at this point clearly should not be used in any woman of childbearing age who may become pregnant. Other alternatives to venlafaxine should be considered in this age group as well although the increased risk of miscarriage overall is small.

This study did not evaluate overall risk vs. benefits of taking antidepressants during pregnancy and it needs to be kept in mind that untreated depression has an adverse effect on the developing fetus. We don't know though how to compare this risk to the risks of taking medication. One thing we do know however is that the factor with the greatest adverse effect on the developing infant is having a mother who is depressed.

So the decision about whether or not to take antidepressants during pregnancy remains a highly individualized decision but we now know some antidepressants that it would be better to stay away from.

Thought for the day

God is "indescribable, uncontainable, none can fathom".

Chris Tomlin

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CARF - Commission on Accreditation of Rehabilitation FacilitiesNATSAP | National Association of Therapeutic Schools and ProgramsNBCCNAADAC