Are Antidepressants Safe During Pregnancy?

Selective serotonin reuptake inhibitors linked to birth defects

(RxWiki News) The question of whether to take antidepressants during pregnancy is an intimate and complicated one. But if you're pregnant (or trying to be) and you have depression, you may want to consider the risks.

A recent study found that the selective serotonin reuptake inhibitors (SSRIs) paroxetine (brand name Paxil) and fluoxetine (Prozac) may be associated with birth defects in pregnant mothers. The SSRIs citalopram (Celexa), escitalopram (Lexapro) and sertraline (Zoloft) were not associated with any birth defects.

"It is important to keep in mind that the linkages might have other explanations such as underlying diseases among women who use SSRIs or other unmeasured factors," said lead study author Jennita Reefhuis, PhD, of the National Center on Birth Defects and Developmental Disabilities in Atlanta, GA, in a press release.

SSRIs are commonly prescribed antidepressants used to treat depression, anxiety and other mental disorders.

Jamie Walker Erwin, MD, an OB-GYN at Baylor All Saints Medical Center in Fort Worth, TX, told dailyRx News, "I typically try to avoid paroxetine and fluoxetine in pregnancy if possible because of the associations that have been found and since there are other SSRI anti-depressant options."

However, Dr. Erwin urges pregnant mothers to keep in mind that the increased risk for birth defects while taking these medications is still very small.

"I typically advise a patient to continue her medications, including antidepressants because our first priority is a healthy mother," Dr. Erwin said. "Maintaining mental health is a critical component of a healthy pregnancy, and antidepressants are sometimes necessary to accomplish that goal."

This study looked at the effects of five SSRIs: paroxetine, fluoxetine, citalopram, escitalopram and sertraline. Specifically, Dr. Reefhuis and team looked at pregnant women who took these SSRIs between one month before conception and the third month of pregnancy. Sertraline was the most commonly used SSRI among these women.

Dr. Reefhuis and team looked at data from the National Birth Defects Prevention Study on 17,952 women who gave birth to babies with birth defects. As a comparison, the researchers also looked at 9,857 women who gave birth to babies without birth defects. These births occurred at 10 different centers in the US between 1997 and 2009.

According to Dr. Reefhuis and team, citalopram and escitalopram were previously shown not to be linked to birth defects. This study also found no link.

Sertraline was previously shown to be linked to birth defects. However, this study showed that it was not linked in these cases.

Dr. Reefhuis and team found that paroxetine was linked to the most defects. These defects included anencephaly (a baby is born without parts of the brain and skull), atrial septal defect (a heart defect), right ventricular outflow tract obstruction defect (another heart defect), gastroschisis (a baby’s intestines are outside of the body) and omphalocele (a baby's intestines or other abdominal organs are outside of the body).

Fluoxetine was linked to right ventricular outflow tract obstruction defect and craniosynostosis (one or more of the joints between the bones of a baby's skull fuse before the brain is fully formed).

"Additional studies of specific SSRI treatments during pregnancy and birth defects are needed to allow women and their health care providers to make better informed decision regarding treatment," Dr. Reefhuis said.

This study was published July 9 in the journal The BMJ.

The Centers for Disease Control and Prevention funded this research. No conflicts of interest were disclosed.

Review Date: 
July 7, 2015