November 7, 2012
SSRI Use by Pregnant Woman May Be Too Risky,
Boston—Selective serotonin reuptake inhibitors (SSRIs) may be too risky for use during pregnancy by depressed women, according to a new study.
Researchers from Beth Israel Deaconess Medical Center, Tufts Medical Center, and MetroWest Medical Center warn of the elevated risk of miscarriage, preterm birth, neonatal health complications, and possible longer term neurobehavioral abnormalities, including autism, and recommend that SSRIs be prescribed with great caution and only with full counseling.
“Depression and infertility are two complicated conditions that more often than not go hand in hand. And there are no definitive guidelines for treatment,” said lead author Alice Domar, PhD, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Executive Director of the Domar Center for Mind/Body Health at Boston IVF. “We hope to provide a useful analysis of available data to better inform decisions made by women and the providers who care for them.”
For the study appearing recently in the journal Human Reproduction, Domar and colleagues conducted a review of published studies evaluating women with depressive symptoms who took antidepressants while pregnant.
“There are three main points that stand out from our review of the scientific studies on this topic,” explained senior author Adam Urato, MD, chairman of Obstetrics and Gynecology at MetroWest Medical Center and a Maternal-Fetal Medicine specialist at Tufts Medical Center. “First, there is clear and concerning evidence of risk with the use of the SSRI antidepressants by pregnant women, evidence that these drugs lead to worsened pregnancy outcomes. Second, there is no evidence of benefit, no evidence that these drugs lead to better outcomes for moms and babies. And third, we feel strongly that patients, obstetrical providers, and the public need to be fully aware of this information.”
Antidepressants are the most commonly prescribed medication for Americans between 18 and 44 years of age, coinciding with childbearing years for most women.
Infertility becomes more common for women in their late 30s and early 40s. “According to the Centers for Disease Control, more than 1 percent of the babies born in the USA each year are the result of an IVF cycle,” the authors write. “And most women will report symptoms of depression during infertility treatment, especially following unsuccessful treatment cycles.” In fact, the report points out, as many as 11% of women undergoing fertility treatments are on SSRIs.
“There is enough evidence to strongly recommend that great caution be exercised before prescribing SSRI antidepressants to women who are pregnant or who are attempting to get pregnant, whether or not they are undergoing infertility treatment,” added Domar. “We want to stress that depressive symptoms should be taken seriously and should not go untreated prior to or during pregnancy, but there are other options out there that may be as effective, or more effective than SSRIs without all the attendant risks.”
The authors recommend psychotherapy, including cognitive-behavioral therapy, and physical exercise as good alternatives.
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