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Know the Facts about Pregnancy & Antidepressants

Submitted by Tor Hoerman on September 23, 2011 – 9:07 am

Depression is among the most common problems seen in primary-care medicine.

According to the American College of Obstericians and Gynecologists (ACOG), reproductive-age women have the highest prevalence of major depressive disorders; approximately 1 in 10 women will have major or minor depression sometime during pregnancy and the postpartum period.

For years, doctors have prescribed antidepressants to treat depression. Given these statistics, it should come as no surprise to find a large number of pregnant women worried about the effects of these drugs on their unborn children and confused about their options.

Although the Web is filled with support forums for women that find themselves in this situation, the drug companies and the Food and Drug Administration (FDA) have been slow in responding to these women’s pleas for information.

What Happens?

Selective serotonin reuptake inhibitors (SSRIs), the most widely prescribed antidepressants, have been known to cause withdrawal symptoms — often severe — when usage is stopped suddenly. Obviously, women should not make the decision to go off these drugs entirely without first discussing it with their physician.

However, recent studies show that staying on these drugs could harm the unborn child. The sad fact is that the public has not been provided with the known risks to unborn children exposed to SSRIs, so a risk-benefit analysis is very difficult — if not impossible — for pregnant women and women looking to become pregnant. during pregnancy, medications taken by the mother can cross the placenta and enter the developing baby’s bloodstream. A medicine’s effect on the unborn baby depends on the medication and the trimester in which the medicine is taken.

SSRIs (selective serotonin reuptake inhibitors) include:
» Paxil (paroxetine)
» Zoloft (sertraline)
» Prozac (fluoxetine)
» Effexor (venlafaxine)
» Celexa (citalopram)
» Lexapro (escitalopram)
» Symbyax (olanzapine/fluoxetine)
» Wellbutrin (bupropion)
» Cymbalta (duloxetine)

Drugs and Their Effects

In order to assist pregnant women with their decisions about whether or not a drug could be harmful to her fetus or newborn, the FDA provides drug categories based on information the agency has gathered in initial studies and as a result of informa tion the drug companies provide. The five categories are divided as A, B, C, D and X, with A being the weakest warning and X being the strongest.

Most SSRIs are Category C, which generally means they are neither safe nor unsafe for use in pregnancy. The exception is Paxil, which is a pregnancy Category D medication. Here is a complete list:

Category A » Drugs that were tested and found to be safe during pregnancy. Includes folic acid, vitamin B6 and some thyroid medications in prescribed doses.

Category B » These drugs are frequently used during pregnancy and do not ap-pear to cause major birth defects or other problems. Category B includes some antibiotics, acetaminophen (Tylenol), aspartame (artificial sweetener), famotidine (Pepcid), prednisone (cortisone), insulin (for diabetes) and ibuprofen (Advil, Motrin) before the third trimester.

Category C » Animal reproduction studies have shown an adverse effect on the fe-tus and there are no adequate and well-controlled studies in humans, but, potential benefits may warrant use of the drug in pregnant women despite potential risk.

Category D » There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Category X » Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience. The risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Historically, Paxil has received the most attention regarding injuries relating to its use during pregnancy. Studies have concentrated on the effects thatPaxil has had on the unborn child, rather than the other SSRIs.

In fact, the ACOG recommends that Paxil should be avoided, when possible, by pregnant women or women planning to become pregnant due to the potential risk of fetal harm. That said, researchers are quickly learning more about each of the SSRIs and the effects they could potentially have on unborn children. Early studies led researchers to believe that injuries from fetal exposure to SSRIs were limited to the lung and heart. But recent studies link many more life-altering and debilitating defects to the usage:

» Anencephaly
» Autism
» Cerebral palsy
» Chiari malformation
» Club foot
» Cleft lip and/or cleft palate
» Craniosyostosis
» Heart defects, including :
• Atrial septal defects
• Patent ductus arteriosus
• Patent foraman ovale
• Tetralogy of fallot
• Transposition of the great arteries & bicuspid aortic valve
• Ventricular septal defects
» Hypospadias
» Omephalaocele
» Plagiocephaly
» PPHn (persistent pulmonary hypertension of the newborn)
» Pulmonary stenosis
» Respiratory distress
» Spina bifida
» Tethered spinal cord

Feelings of Guilt

Often, mothers feel an immense sense of guilt when they think that something they ingested during pregnancy may have caused these injuries/defects. This guilt, while understandable, is misplaced. The guilt should be on those that did not properly study and/or disclose the risks associated with their products when used by pregnant women.

Furthermore, it is understandable that many women are afraid to stop taking the medication that prevents them from going into depression, especially when that woman is soon to be responsible for a new life.

However, if there is any chance that the drug could harm the baby, these women must be advised upfront so theycan discuss their medical options with their physician after they have the opportunity to make a decision on their own.

— Tor Hoerman is an attorney with TorHoerman Law in Edwardsville, Illinois.