Antidepressants Linked to Baby Heart Problems
> 12/3/2008 12:40:38 PM

Approximately one in seven women suffers from depression during pregnancy, and many of these women take a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Some doctors have become concerned that SSRIs can cause congenital problems, but this danger has not been adequately investigated. Towards this end, Dr. Orna  Diav-Citrin led a study to determine whether SSRIs raise the risk of congenital heart problems. Her results appear in the British Journal of Clinical Pharmacology.

Dr. Diav-Citrin focused on two specific SSRIs, paroxetine and fluoxetine. She followed more than 2,000 women, half of whom used one of the drugs during their first trimester and half of whom formed the control group. Babies born to women who took paroxetine were 2.66 times more likely to have major heart anomalies and babies born to women who took fluoxetine were 4.47 times more likely. This is comparable to rates found in women who smoked more than ten cigarettes a day (5.4 times higher risk).

These increased risks are quite worrying, but they do not mean that women should automatically discontinue antidepressant use when pregnant. Firstly, only one class of antidepressant, SSRIs, is implicated here. Secondly, only two SSRIs were examined, and there were significant differences in their respective risks. This suggests the more moderate option of switching to less risky SSRIs. Hopefully, future research will delineate the risks associated with each depression medication.

Even if no very low-risk medications are identified, expectant mothers should consider the countervailing risks of facing depression without medication. The latest guidelines from the American College of Obstetricians and Gynecologists strongly warns that untreated mental illness, "may result in poor compliance with prenatal care, inadequate nutrition, exposure to additional medications or herbal medicines, increased alcohol and tobacco use, deficits in mother-infant bonding, and disruptions within the family environment.” The guidelines single out depression specifically for increasing the risk of low birth weight and all of its accompanying problems. Because of these complicated factors, it is always best to consult a doctor before ceasing any medication regimen.

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