If there's one thing that seems clear about the murky subject of antidepressants during pregnancy, it's that there has never been a definitive answer about the risks these medications may cause to unborn children -- and without a standard, treatment decisions will continue to be made on a case by case basis.
That's not terribly comforting, and neither are the latest medical opinions on the topic, which came up during the American Society of Reproduction conference that happened earlier this week in San Diego. According to leading doctors in the field, the results of "study after study" show that most popular antidepressants, seratonin reuptake inhibitors (SSRIs), are in fact associated with several dangerous pregnancy complications, such as premature birth and pre-eclampsia.
One professor of maternal-fetal medicine went so far as to call the practice of prescribing antidepressants during pregnancy "a large scale human experiment."
Doctors pointed to 40 studies that have linked taking SSRIs during pregnancy with causing birth complications, including new research that suggests that SSRIs can double the chance for autism in children, and pose a threat of lung and bowel diseases.
Of course, there's more to the story. As Jezebel reports,
Although the FDA issued warnings about taking SSRIs during pregnancy, a study published last year in the Obstetrics and Gynecology International found that for every study about the risks of SSRIs, there's another that negates it.
The only risk that seems consistent among all of these drugs is for infants' withdrawal symptoms, which include jitteriness, irritability, respiratory problems, and in very rare cases, convulsions. However, the authors of the paper describe the majority of these symptoms as "mild and transient." This paper, which is an analysis of more than 100 other studies on SSRIs and pregnancy done over the course of the past 20 years, concludes that "the general benefit of treatment seems to outweigh the potential small risk of untoward effects on the embryo, fetus, or neonate."
Doctors will agree on one thing: they're not saying every pregnant woman should go off her medication, or downplay the seriousness of her depression. But some are suggesting that general practitioners are often too quick to prescribe a pill rather than suggesting alternative treatments such as cognitive behavior therapy:
You come in and you say I’m not feeling very well, I’m feeling lethargic, so the physician writes a prescription. (...) If you add up all the potential risks, a lot of people would say they are unacceptable.
Personally, I can see both sides of this. I absolutely believe that too many Americans are taking antidepressants -- it's impossible for me to look at the numbers (1 in 10! Usage has increased 400 percent since 2008!) and not be convinced that as a nation, we're taking far more pills than we need to be.
On the other hand, there are plenty of pregnant women who truly need these medications to protect their own health, and doctors need to be on their side for that. I can understand the difficulty in weighing risk, because I myself had to take a Class C drug (i.e., the classifcation that reads, "Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks") during pregnancy. It was scary, I wished I didn't have to, but it kept me healthy -- and my children, thank god, were perfectly fine.
I don't know if there's any sort of conclusion to reach from this latest news about SSRIs and pregnancy, only that it's important to talk to your doctor and be as informed as possible. As with most things in parenting, there's really no one right answer that works for everyone.