For people taking antidepressants who get pregnant, the question of whether to stop or continue these medications has no clear-cut answer. Pregnancy is already a time of vulnerability, and if you’re managing depression, making health decisions can feel fraught — especially when experts seem to disagree. While this issue isn’t a new one, it’s been in headlines recently because a U.S. Food and Drug Administration (FDA) panel met in July to discuss the use of the most common class of antidepressants, called selective serotonin reuptake inhibitors (SSRIs), in pregnancy. About half the assembled experts said that women should receive a more clear and forceful warning about potential risks to the fetus.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293811fedd-2fdf-4e0a-a536-4853848a90e2e60dc2a1-f33c-4a05-9b50-8e3e8e597629a4d616ec-84d2-4fb6-afdb-9988322c9881 But critics of this point of view believe those panelists are relying on outdated research about the risks posed by SSRIs during pregnancy, and that one-size-fits all decisions about whether SSRIs in pregnancy are “safe” or “unsafe” aren’t appropriate.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c7939478-1c15-41b6-a9e7-cdf557f0e238 They argue that in order to make this complex decision, each woman needs to weigh the risks of her untreated depression against the potential risks of medication in an open discussion with her healthcare team.
Decisions About Antidepressant Use in Pregnancy: Weighing Risks vs. Risks Risk vs. Risk About 1 in 5 women experience depression at some point during pregnancy and in the year after giving birth, known as perinatal mood and anxiety disorder (PMAD). The majority of these are not treated to remission (meaning that while treatment may improve symptoms, they are still living with some level of depression), says Julia N. Riddle, MD, a psychiatrist and clinical researcher with a focus on reproductive mental health at the Center for Women’s Mood Disorders at the UNC School of Medicine in Chapel Hill, North Carolina.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a0b019f1-ca8d-4b33-b86c-bf68b3cbb6de “Most of these women don’t even get access to appropriate assessment and care,” says Dr. Riddle. “In reproductive psychiatry — as should be the case in all of medicine — we have ‘risk-risk’ conversations,” she says. “We are discussing the risk of untreated illness compared to the risks of treatment options.” It’s important to frame these discussions appropriately, she says.“We are not talking about giving otherwise healthy women, without any illness, a medication. Yet that’s how the data is sometimes presented: all women without a medicine versus women with a medicine,” says Riddle. Instead, the comparison needs to be women with an untreated mental illness and women with a mental illness that has been well-managed by medication, she says.
Risks of Depression During Pregnancy Risks of Depression There are risks associated with untreated mental illness, says Riddle. Those include: Reduced self-care, such as poor nutrition and missed prenatal visits Higher risk of substance use, including smoking, alcohol, or drugs Increased likelihood of developing postpartum depression Impaired infant bonding and attachment Lower rates of breastfeeding “Mental health conditions are a leading cause of maternal death in the United States,” says Emily Miller, MD, MPH , an adjunct associate professor and obstetrician-gynecologist specializing in maternal-fetal medicine at Northwestern Medicine in Chicago. “Depression is a condition we know how to identify and treat.” Too often, decision-making focuses almost exclusively on rare or short-term risks to the unborn child, Dr. Miller says, while overlooking the profound impact of untreated depression on the pregnant person’s health, safety, and well-being.
Risks of Antidepressants During Pregnancy Risks of Taking Antidepressants During Pregnancy Most of the evidence on drug safety during pregnancy comes from observational studies, which makes it difficult to separate the effects of medication from those of underlying depression. In fact, many of the risks once linked to antidepressant use in pregnancy came from studies that didn’t distinguish between the effects of the medication and the effects of depression itself, explains Miller. That doesn’t mean SSRIs are risk-free — but it does mean it’s important to interpret the evidence carefully, says Miller. Here’s what the most up-to-date research has found on SSRI use during pregnancy, according to the MGH Center for Women’s Mental Health at Massachusetts General Hospital in Boston:e60dc2a1-f33c-4a05-9b50-8e3e8e597629f9dd7f8b-1f52-4e53-b653-de2e0eedf38a No Increased Risk of Miscarriage When adjusting for the severity of depression, SSRIs don’t appear to increase the risk for miscarriage. No Increased Risk of Birth Defects Large studies in the United States and Europe do not show a significant increase in birth defects in babies exposed to SSRIs during pregnancy. May or May Not Cause a Small Increase in Risk of Preterm Birth and Low Birth Weight Some studies suggest a small increase in these outcomes in SSRI users, but both issues are also more common in women with untreated depression. “When researchers apply more advanced methods that account for this, the apparent link between antidepressants and preterm birth largely disappears,” Miller says.”In other words, what those early studies were really showing was the impact of the illness, not the drug.” Rare Risk of Persistent Pulmonary Hypertension of the Newborn (PPHN) This is a life-threatening condition that happens when the newborn doesn’t adapt to breathing outside the uterus. SSRI use, especially late in pregnancy, has been linked to a slightly increased risk of PPHN, but the overall risk is small — about 0.3 percent, or 3 out of 1,000 pregnancies. No Increased Risk of Neurodivergence Large studies have not found a higher risk of neurodevelopmental disorders such as ADHD or learning disabilities in children exposed to SSRIs during pregnancy. No Clear Link to Increased Risk of Autism . Overall, most studies on antidepressant use and autism have shown either a small risk or no risk at all.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c64e0bbd-6e7d-4b19-9ac5-74f2d3613744 While early studies raised concerns, more recent, well-designed research finds no clear link between SSRI use in pregnancy and autism.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ec6d2689-677e-48ba-8f3f-72fbcf9d9c99 About 1 in 4 Risk of Transient Neonatal Adaptation Syndrome This condition describes a newborn not adapting well to life outside the womb and includes mild, short-term symptoms like fussiness or feeding issues. It occurs in about 25 percent of infants who have been exposed to SSRIs, says Riddle. “The condition is self-correcting, nonfatal, and brief — usually less than 48 hours,” she says.
Questions to Ask Your Doctor About Antidepressant Use During Pregnancy Questions to Ask Your Doctor Pregnant people deserve clear, rigorous information, says Miller. “Each person’s circumstances are unique. The most meaningful way to weigh risks and benefits is through open, individualized conversations with a trusted clinician who can interpret the existing evidence appropriately and center your concerns, values, and goals,” she says. Some of the key issues to discuss include: Severity of the Depression and Past History of Symptoms Pregnancy and the postpartum period are a vulnerable time for people with mental health conditions, says Riddle. “There are biological and psychological changes that place them at high risk of worsening or recurrence,” she says. Medication Choice Two common SSRIs, sertraline (Zoloft) and fluoxetine (Prozac), have a lot of registry data that place them in the low-risk category based on current, well-designed evidence, says Riddle. The Decision to Continue a Current Antidepressant or Switch That may be challenging because of the many factors involved in deciding on a treatment regimen. That may be a good conversation to have prior to pregnancy, says Miller. “Medications are not interchangeable even within the same class — patients have different responses and may experience different side effects,” she says. The Possibility of Tapering the Dose or Trying Nondrug Therapies The guiding principle is “fewest number of medications at the lowest effective dose(s),” says Miller. Turning to psychotherapy or support groups, in addition to or instead of antidepressants, may be the best choice depending on the person. In a best-case healthcare scenario, “All options to treatment are provided to patients, including discontinuing medications, but couched in a conversation about their prior history, their prior pregnancies, their risks while ill, and the risks of the medications,” Miller says. Nondrug therapies can often be effective for treating mild to moderate depression, but not everyone has access, Miller says. “Additionally, many patients do not only have depression; they may also have an anxiety disorder or post-traumatic stress disorder,” she says, the combination of which may respond best to medication. If you’re currently taking an antidepressant, whether you are pregnant or not, always talk with your doctor before you stop taking it.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b3fae7a7-812f-4475-8c2c-a9240835592f
The Takeaway Antidepressant use during pregnancy isn’t a question of “safe versus unsafe,” but about balancing the risks of untreated depression with the risks of medication. Outdated or oversimplified research fails to account for the potential harms of untreated mental illness during pregnancy, and may skew the benefits-versus-risks assessment. Decisions about which medications to take or pause during pregnancy should be made individually, in consultations with medical providers.
Great Job Becky Upham & the Team @ google-discover Source link for sharing this story.
