Antidepressants During Pregnancy - Does The Risk Outweigh The Benefit?

Antidepressants During Pregnancy - Does The Risk Outweigh The Benefit?

Introduction

Description of the Problem

Depression is recognized as a mental illness, which is most prevalent in women, twice as often than males. In Canada and the U.S. anti-depressants are widely used by pregnant women - to 3.7% of women will use them at some point during the first trimester. Doctors have proved that the class of drugs selective serotonin reuptake inhibitor (SSRI), especially paroxetine, and venlafaxine significantly increased risk of miscarriage. The higher daily doses were consumer products, the higher risk of unsuccessful pregnancy outcome. In addition, the combination of different antidepressants doubled the risk of miscarriage (Yonkers et al. 2009).

According to the World Health Organization, significant depression is the second contributor to the global burden of disease in people 15-44 years old. Unfortunately, pregnancy is not protective against depression with 5-7% of pregnant women suffering unusual symptoms. Women who are depressed during pregnancy are less likely to get prenatal care and more likely to abuse drugs and alcohol. Depression during pregnancy is associated with poorer obstetrical outcomes such as preterm birth and low birth weight. Mothers taking antidepressants during pregnancy are likely to give birth to children with persistent pulmonary hypertension. This rare disease is characterized by high blood pressure in the lungs (Deave et al. 2008).

In this essay, we will be discussing that antidepressants during pregnancy increases the risk and outweighs the benefits because it results in serious consequences for not only the mother, but also for the child.

Discussion

For pregnant women with moderate to severe depression, antidepressant medication should be considered alone or in conjunction with psychotherapy. Antidepressants are unlikely to cause significant congenital malformations with first trimester use. However, their use has been associated with third trimester risks such as preterm birth, poor neonatal adaptation syndrome and persistent pulmonary hypertension (PPHN) of the newborn. On average, infants exposed to the third trimester antidepressant use are born a week early, and poor neonatal adaptation syndrome resolves within a week making these two adverse effects clinically minor (Robinson 2009).

Summary of the Articles

PPHN is serious but has been associated with only a small (<1%) risk when antidepressants, particularly serotonin reuptake inhibitors, are used in the third trimester. The APA (American Psychiatric Association) has stated in their depression treatment guidelines that in PPHN “the preponderance of evidence from published studies on this topic does not support an association” because the data have been conflicting. The use of the different classes of antidepressants is beyond the scope of this editorial, but we refer the reader to reviews on the topic. The long-term impact on children exposed to antidepressants during pregnancy has been incompletely explored, but the data to date are reassuring. In general, the use of antidepressants for moderate to severe depression during pregnancy outweighs the risk, but this must be decided by each patient and her physician. We recommend that patients who are concerned about the use of antidepressants during pregnancy consult with ...