Antidepressants and pregnancy: weighing the choices

Pregnant women facing depression may also face the dilemma of whether or not to treat the depression with antidepressants.

Depression is common during pregnancy, affecting about one in eight pregnant women.

Left untreated, depression during or after pregnancy has been linked to an increase in poor outcomes in both mother and child.

However, depression in pregnancy often goes untreated because of concerns about possible negative effects of antidepressant medications on the fetus.

Researching the evidence

A study on antidepressants in pregnancy, and whether they are linked to negative birth outcomes, was carried out by Dr. Lori Ross and Dr. Sophie Grigoriadis. The study looked at all available evidence about the risks and benefits of antidepressant medication during pregnancy.

“We wanted to provide women and their health-care providers with all the evidence they needed to make the best possible decisions about whether or not to use antidepressants during pregnancy,” says Dr. Ross, senior scientist at the Centre for Addiction and Mental Health (CAMH) and adjunct scientist at Women’s College Research Institute.

Balancing risks

The researchers looked at results such as the baby’s gestational age at birth, birth weight, and Apgar score.

For most factors, they did find statistically significant differences between women who took antidepressants and those who didn’t. However, the differences were small, and the results for women who took antidepressants were still within the normal range.

One example is birth weight. Babies born to moms who took antidepressants weighed an average of about 75 grams (about 2.6 ounces) less than those born to women who did not take the medication. The difference was statistically significant, but not very likely to have a big impact on the babies’ health.

The study did not find any significant difference in miscarriage rates between women who took antidepressants and other women.

“The overall message for me coming out of the paper, is that there are some potential risks of using antidepressants, and women should definitely be made aware of them,” says Dr. Ross. “But they also need to be made aware of the magnitude of the risk, considering whether a 75-gram difference in birth weight is worth all the difficult things that come with experiencing depression.”

Help is essential

Whether or not a woman should take antidepressants while pregnant depends on the individual woman’s needs and her experiences and preferences, Dr. Ross says.

She stresses that it’s essential for women who are suffering from serious depression to get some form of help. The form of that help depends on that person’s needs, how severe the depression is and what they are comfortable with.

There can be times when the symptoms of depression are more consequential to the health of the mother and baby than the effects of the antidepressant medications.

“Our research concludes that antidepressants may be a reasonable option,” says Dr. Ross. She adds that there is good evidence supporting other depression treatments as well, such as certain forms of psychotherapy. However, those treatments may not always be available.

Dr. Ross recommends that any woman suffering from depression while pregnant should talk to her healthcare providers about the evidence that is available for her circumstances, and make sure she has access to all possible options before making a decision about taking antidepressants.

About the research

At the time the study was carried out, Dr. Ross and Dr. Grigoriadis were the academic co-leaders of the Reproductive Life Stages Program at Women’s College Hospital. The study has produced several research papers: one published online in JAMA Psychiatry on Feb. 27, 2013 that reported the above results, a series of papers published in the April 2013 issue of the Journal of Clinical Psychiatry, and a recently published study in BMJ.