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Antidepressants and pregnancy: What to do now

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A recent research paper published in the British Medical Journal reported that taking serotonin reuptake antidepressants (SSRIs) like fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) during the second half of a woman’s pregnancy could more than double the risk that babies will develop persistent pulmonary hypertension of the newborn (PPHN).

This finding supports a warning issued by the FDA during 2006 that alerted women that those taking SSRIs were six times more likely to deliver babies with PPHN.

PPHN is high blood pressure in the arteries of the lungs.  It causes the right ventricle of the heart—which must pump blood through the lungs to pick up oxygen—to work harder too hard.  This can ultimately cause weakening of the heart and heart failure.

Pulmonary hypertension affects about 1 in 1,000 newborns, but more than double that number of newborns of mothers taking antidepressants in the second half of their pregnancies seem to be affected.  And an increased risk—though lower—appears to be present in those babies born to mothers who take the antidepressants in the first half of their pregnancies, too.

Antidepressants of one kind or another have been implicated in—but not proven to be absolutely responsible for—increasing the risk of low birth weight, prematurity and low blood sugar.

So, women should stop antidepressants when they learn they are pregnant, right?  Not exactly.  There are reasons to stop and there are reasons to continue.

First of all, the British Medical Journal data is unreliable.  The study did not exclude other causes of pulmonary hypertension that might, for some reason, be more common in depressed women taking antidepressants but not be due to the antidepressants themselves.  Mothers who are overweight, diabetic or asthmatic also deliver children at increased risk.  Some studies suggest children of mothers who deliver by cesarean section are, too.  Is it possible that these mothers are also more likely to use antidepressants and that their other characteristics are the concerning ones—not the medicine itself?

Secondly, the study also found that having been psychiatrically hospitalized prior to pregnancy increased the risk of pulmonary hypertension in newborns, whether or not a mother was no taking antidepressants before delivering.  Could it be that depression in mothers causes pulmonary hypertension in newborns?

Third, it is not clear whether stopping antidepressants during pregnancy might lead to withdrawal affects in women and their fetuses, with unknown consequences.

And, fourth, it is not clear at all what the toll of untreated maternal depression might be on fetuses and newborns.

So, my advice is this:  
1) If you are a woman considering pregnancy, try to stop or not to start antidepressants—as long as your symptoms are relatively mild.  If you require treatment for depression, try psychotherapy or transcranial magnetic stimulation (rTMS), which treats depression with magnetic pulses delivered to the head and which has no known contraindications in pregnancy.  But if you have serious symptoms of depression, use SSRIs, with the advice and under the care of your physician.

2) If you find out you are pregnant while you are already taking antidepressants, talk to your doctor about very slowly stopping them, but only if you can do so safely, without severe symptoms of depression returning.

3) Never stop antidepressants all of a sudden.  This can cause serious symptoms that affect you and your unborn child.  And do not stop antidepressants if the consequences will be moderate to severe symptoms like low mood, tearfulness, sleeplessness or decreased or increased appetite.

4) Do not stop antidepressants during pregnancy if you have become suicidal while depressed in the past and antidepressants have been necessary to ward off thoughts of harming yourself.

As a final note, while many obstetricians and many primary care doctors are comfortable treating depression, I believe it is best to be seen by a psychiatrist if you are taking antidepressants and want to have a baby.  

Dr. Ablow is the author of "Inside the Mind of Casey Anthony." He is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at info@keithablow.com. His team of Life Coaches can be reached at lifecoach@keithablow.com.

Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at info@keithablow.com.