Antidepressants and pregnancy: New review finds a risk

• Review's author cites risk with antidepressants during pregnancy
• Authors: Antidepressants have little or no benefit for pregnant women
• Use of such meds should depend on case, doctor says

Pregnant women who are depressed are generally told that continuing their medication will help them and their babies. A mother who is too sad won't take good care of herself, and the baby will suffer, the thinking goes.

But a new review of the scientific literature questions the assumption that depression is bad for a fetus, and concludes that antidepressants often confer more risk than benefit.

"There's clear and concerning evidence of risk with the use of these medications by pregnant women," says Adam Urato, obstetrician and chairman of the department of obstetrics and gynecology at MetroWest Medical Center in Framingham, Mass., and one of the authors of the paper published in the journal Human Reproduction.

Despite decades of antidepressant use, no one has ever done the kind of research that would definitively answer the safety question: following the pregnancies of two groups of depressed women, half on drugs such as Prozac, Paxil, Lexapro, Celexa and Zoloft, and half not.

That kind of research would be extremely expensive and ethically questionable, Urato says, because so many studies link antidepressants to miscarriage, preterm birth, rare heart defects and behavioral problems.

More controversially, Urato and his co-author, Alice Domar, a psychologist and Harvard Medical School assistant clinical professor, also claim that antidepressants have little or no benefit for pregnant women. Domar, an infertility expert, says that a form of talk therapy known as cognitive behavioral therapy is just as effective as common antidepressants at treating depression.

Many experts disagree, however.

"I would say the authors of this article went overboard in terms of their negativity," says Gregory Moore, director of health services at Georgia Tech in Atlanta and a member of the American College of Obstetricians and Gynecologists' committee on ethics. "Depression can be a fatal disease."

The decision of whether to use these antidepressants during pregnancy should be between a woman and her doctor, says Shari Lusskin, an adjunct associate professor of psychiatry, obstetrics, gynecology and reproductive sciences at Mount Sinai School of Medicine in New York City.

Drug companies that make antidepressants declined to comment or did not return e-mailed requests. An industry group, the Pharmaceutical Research and Manufacturers of America, says the federal drug approval and review process is designed to guarantee drug safety.

Kimberly Yonkers, a Yale University psychiatrist with expertise in women's mental health, says she agrees with Domar and Urato that a mother's depression is not inherently bad for a fetus. And women with mild to moderate disease may do OK weaning themselves off antidepressants during pregnancy.

But women who consistently relapse when they go off antidepressants should be confident that taking antidepressants is best for both them and their babies, she says.

"It's a dangerous message for women who are pregnant and depressed to say that antidepressants don't benefit them," says Yonkers. "To take someone who is stable (on medications) and tell them they shouldn't take it because of all the harm is ridiculous."