A major review of published studies of depression in pregnant women has concluded that the use of SSRIs has significant risks but lacks clear benefits.
The review authors expressed particular concern about the implications for women receiving fertility treatment, of whom over 10% report taking SSRIs.
The development of selective serotonin reuptake inhibitors (SSRIs) such as Prozac has seen antidepressant use increase fourfold in the last two decades.
Researchers at three US medical centres (Beth Israel Deaconess, Tufts and MetroWest) found a pattern of risks associated with SSRI use in pregnancy, coupled with a lack of evidence of mental health benefits to these patients.
The risks noted include:
• Higher rates of miscarriage.
• Higher rates of congenital abnormalities – notably cardiac defects linked to use of paroxetine.
• Higher rates of premature birth, which increases the cost of neonatal care and the risk of many health problems.
• Higher rates of pregnancy-induced hypertension and preeclampsia.
• Increased incidence of dangerously low birth weight.
• Increased incidence of Newborn Behavioural Syndrome, delayed motor development, and autistic spectrum disorders.
Lead study author Alice Domar said: “There is enough evidence to strongly recommend that great caution be exercised before prescribing SSRI antidepressants to women who are pregnant or who are attempting to get pregnant.
“Depressive symptoms should be taken seriously and should not go untreated prior to or during pregnancy, but there are other options out there that may be as effective, or more effective than SSRIs without all the attendant risks.”