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Antidepressant safety ?Do you have doubts about antidepressant safety in pregnancy? The subject of whether or not to treat with antidepressant medication during pregnancy remains controversial amongst doctors. Many primary care physicians, and indeed psychiatrists, still advise patients who are taking antidepressant medication at the time of conception, to wean their medication. 
If you have developed depression in your pregnancy you may have been advised to avoid taking medication or you may be worried about taking drugs that have been prescribed to you. This page looks at what is known about antidepressant safety in pregnancy and what is cause for concern. Four categories of risk are usually examined with respect to the potential use of medication in pregnancy.
1. Miscarriage 2. Deformities 3. Fetal growth problems 4. Withdrawal Miscarriage?Firstly, does the drug increase the risk of miscarriage or pregnancy 'loss'? No evidence has been found to suggest that exposure to the newer antidepressants (the SSRIs) during pregnancy, increases the risk of pregnancy loss.Deformities?Secondly, what are the risks of organ malformation or deformities if the medication is taken in pregnancy? No studies have shown there to be an increased incidence of major birth defects above the population average with ANY of the antidepressant groups.Oh I know you are saying, "But how can I believe this? Where can I find proof of antidepressant safety in pregnacy?" Here is something to look at. One very good review of all the studies that have been conducted looking at this issue was published in the Journal of the American Medical Association (JAMA) in 1999. Here is the link to this article on antidepressant safety. There is also a link at the very bottom of this page to a web site where you can find all these studies documented. But, moving on to the other two questions.... Effect on fetal growth?
Thirdly, has there been any evidence that fetuses who are exposed to antidepressant medication don't grow as well as they ought to? A large multicentre Canadian trial found that average birth weights among babies exposed to SSRIs were similar to babies who were 'medication-free', as were the timings of their births. Another study did find that babies exposed to fluoxetine (the most commonly prescribed SSRI, otherwise known as 'Prozac') in the third trimester had lower birth weights than controls, but this was also related to mothers not gaining enough weight in the third trimester. So this COULD be explained by these women actually having had depression that was not adequately treated.
Low birth weight is a known outcome of mum's depression in pregnancy.
'Withdrawal' in baby?Case reports have been written describing a wide range of newborn distress syndromes, thought to be the result of baby's 'withdrawal' from antidepressants after delivery. Most commonly mentioned signs are mild respiratory distress, excessive crying, eating and sleeping difficulties, slight transient 'floppiness' and irritability. One study has suggested that babies exposed to antidepressants as fetuses tend to be slightly more 'lethargic' than the babies of mums who were not on antidepressants but who were also depressed. This study also found that SSRI-exposed babies had significantly more rapid eye movement (REM) sleep. However, a large study published in 1997, looking at the neurodevelopment of children exposed to antidepressants in fetal life, found similar cognitive (thinking) abilities, behaviour and temperament in babies who had been exposed to antidepressant medication as in non-exposed babies. Only the newborns who had been exposed to the older antidepressant group (tricyclics) were found to display features of withdrawal with significant frequency. There are, as yet, no long-term follow-up studies of children exposed to antidepressants in utero and there is little to indicate that treatment with antidepressants during pregnancy has a harmful effect on the child, except perhaps in the very short-term post-delivery period.
IN CONTRAST, research evidence that untreated depression in pregnancy is positively associated with cognitive, behavioural and mood state abnormalities in offspring, in the long term, is mounting. Click here to read more about depression effects on baby. The purpose of this page is not to say 'Antidepressants are entirely safe and everyone should take them'! It's meant to put antidepressant safety in a logical perspective. Information gives you power and ignorance leaves you with fear. If your doctor has suggested you take antidepressants in pregnancy and you would like to know more about your specific antidepressant safety profile look at this excellent website that gives information on the safety of ALL medications in pregnancy, not only antidepressant safety.
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