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Reassuring News about Use of Antidepressants during Pregnancy and Fertility Treatment
Recent studies and reviews indicate that the benefits of antidepressant therapy far outweigh the potential marginal risks. This is good news because increasing numbers of women — and a significant percentage of reproductive age women — are using selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs) to treat anxiety, depression and certain personality disorders. The brand names for these medications include: Prozac, Zoloft, Lexapro, Paxil and Celexa.
Past studies and review articles have suggested that SSRI use during pregnancy may be associated with poor birth outcomes, such as congenital cardiac abnormalities, miscarriage and an increased risk of pregnancy-induced hypertension. However, the latest Swedish study in the Journal of the American Medical Association finds no link between antidepressant use during pregnancy and an increased risk of infant mortality.
The Swedish researchers looked at women with singleton births at various times from 1996 to 2007 in Denmark, Finland, Iceland, Norway and Sweden — a total of 1,633,877 singleton births. In an analysis that accounted for maternal factors such as advanced maternal age, smoking and increased severity of psychiatric disease, they found no association between the use of SSRIs and stillbirth, neonatal mortality or post-neonatal mortality.
Another large expert review in the September 2012 issue of the American Journal of Obstetrics and Gynecology offers the reassuring conclusion that when a psychiatric condition requires medication, the benefits of treatment far outweigh the potential minimal risks of such things as cardiac malformations, primary pulmonary hypertension of the newborn or poor neonatal adaptation syndrome.
Discontinuing use of a needed SSRI may be far worse than any risk of staying on it during pregnancy. An adult who abruptly discontinues SSRI medication often experiences various degrees of withdrawal. In addition, uncontrolled, untreated depression during pregnancy has been linked with increased risk of miscarriage, prematurity and low birth weight. Untreated depression during the latter stages of pregnancy is the strongest predictor of a woman developing postpartum depression, which can be a serious and life-threatening problem. There are also concerns about the child’s well-being since other studies show that untreated maternal depression may lead to long-term detrimental effects on child neurodevelopment.
Antidepressant use during infertility therapy such as in vitro fertilization (IVF) and/or pregnancy is not an easy decision, but should be discussed with your doctor regarding risks and benefits. When counseling infertility patients or pregnant women regarding medications for their psychiatric conditions, it is critical to weigh the risks and benefits of the medications vs. the risks of untreated depression to the mother and baby.