It is readily apparent that increasing numbers of women are using antidepressant drugs, mostly selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs). SSRIs are used to treat anxiety, depression and certain personality disorders. The most common brand names include Prozac, Zoloft, Lexapro, Paxil and Celexa. A significant percentage of reproductive age women (including infertility patients) are taking these medications before and during pregnancy.
Over the past 10 years, numerous studies and review articles have discussed whether SSRIs and SNRIs pose risks to the developing fetus. Doctors who take care of pregnant women with depression need to balance the maternal well-being with any potential fetal risks of these medications.
Some studies have suggested that SSRIs taken during pregnancy may be associated with poor birth outcomes such as congenital cardiac abnormalities, as well as miscarriages and an increased risk of pregnancy-induced hypertension.
There is a reassuring new Swedish study in the Journal of the American Medical Associationthat found no link between antidepressant use during pregnancy and an increased risk of infant mortality. In this study Swedish researchers looked at a total of 1,633,877 singleton births and found no association between the use of SSRIs and stillbirth, neonatal mortality or post neonatal mortality in women with single births once they took into account maternal factors such as advanced maternal age, smoking and increased severity of the psychiatric disease.
In addition, a large expert review in the Sept. 2012 issue of the American Journal of Obstetrics and Gynecology concluded that when a psychiatric condition requires medication, the benefits of the treatment far outweigh the potential minimal risks of cardiac malformations, primary pulmonary hypertension of the newborn or poor neonatal adaptation syndrome. These conclusions are very reassuring. It is also very important to note that adults who abruptly discontinue their SSRI medications often experience various degrees of withdrawal. More importantly, uncontrolled, untreated depression during pregnancy has been linked with increased risk of miscarriage, prematurity and low birth weight. Furthermore, 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 also 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.
These recent studies and reviews indicate that the benefits of antidepressant therapy far outweigh the potential marginal risks. These findings are therefore very reassuring.