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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.
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.
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.
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.
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
Many experts disagree, however.
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
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
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.
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."