Go Ahead Soon-To-Be Mommies, Pop that SSRI For Your Depression

by Monica Joshi

The use of antidepressants has been controversial since, well, forever. They have been even more controversial regarding their use during pregnancy. In 2006 the FDA warned the public, based on a single study, that the use of common antidepressants – Prozac and Paxil – late in pregnancy could put the baby at risk for respiratory failure. Many women were then faced with an equally tough decision: put their soon-to-be born child at risk or sacrifice their own mental health. 

When the FDA issued a Public Health Advisory in 2006 warning that the use of antidepressants in late pregnancy may increase risk of persistent pulmonary hypertension of the newborn (PPHN), they cited a study that pointed to a six-fold increased risk in PPHN. PPHN is a condition that typically occurs in term or near-term infants and presents within hours of birth with severe respiratory failure that requires immediate incubation and mechanical ventilation.

The epidemiologic study had found a six-fold increase in risk associated with exposure to selective serotonin reuptake inhibitors (SSRI), commonly prescribed antidepressants like Prozac, after the twentieth week of pregnancy. However, based on a review of additional studies with conflicting findings, the FDA concluded in 2011 that it had been a mistake to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN, and updated the advisory accordingly.

The latest study from Brigham and Women's Hospital (BWH) and the Harvard T.H. Chan School of Public Health examines the risk of PPHN associated with both SSRI and non-SSRI antidepressants in a group of publicly insured pregnant women across the United States. The research, published in JAMA, demonstrates that while the possibility of an increased risk of PPHN associated with maternal use of antidepressants in late pregnancy cannot be entirely excluded, the absolute risk is small and the increase in risk, if at all present, appears to be far less than that has been suggested in previous studies.

Krista Huybrechts, co-author of the study, said that:

"Clinicians and patients need to balance the potential small increase in the risk of PPHN, along with other risks that have been attributed to SSRI use during pregnancy, with the benefits attributable to these drugs in improving maternal health and well being.”

The study included 3,789,330 pregnant women enrolled in Medicaid from two months or less after the date of last menstrual period through at least one month after delivery. Of those in the study, 128,950, or 3.4 percent, had filled at least one prescription for an antidepressant late in pregnancy. Among those women, 102,179 or 2.7 percent of the total had used an SSRI and 26,771 or 0.7 percent of the total had used a non-SSRI antidepressant.

Overall, 20.8 per 10,000 infants not exposed to antidepressants during the last 90 days of pregnancy had PPHN compared with 31.0 per 10,000 infants exposed to antidepressants. This higher risk among exposed infants was observed for both SSRI (31.5 per 10,000 infants) and non-SSRI (29.1 per 10,000 infants) antidepressants, representing a 40 to 50 percent increase in risk. After taking into consideration possible differences in the characteristics of women who did and did not take antidepressants, there seemed to no longer be a significant increase in the risk of PPHN associated with SSRI or non-SSRI antidepressants.

The research suggests, all in all, that while an increased exposure to antidepressants might pose some amount of threat to the unborn child, it is quite likely that the threat is minimal. While PPHN is a disease that affects newborn children, it would be interesting to see further research done on other ill-effects of commonly prescribed antidepressants, if any, to a child from the time that they are born to any psychological or physiological illnesses stemming from their mother's antidepressants use.

It might also be interesting to see whether, like Julie Holland says, the mothers given antidepressants were prescribed them for “legitimate reasons” to begin with. If not, we have to wonder, is it worth it to even take that much of a risk with regards to PPHN?