Antidepressants May Cause Premature Delivery
But SSRIs don't result in birth defects, research finds
TUESDAY, Dec. 10, 2002 (HealthDayNews) -- Pregnant women who take antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be at higher risk of premature delivery, a new study says.
SSRIs include the popular antidepressants fluoxetine (brand name Prozac), paroxetine (Paxil) and sertraline (Zoloft).
However, the news is by no means all bad. On the plus side, researchers found no link between SSRIs and birth defects or developmental delays.
"Our results offer some reassurance and some cause for concern," says Dr. Greg Simon, lead author of the study and an associate investigator and psychiatrist at Group Health Cooperative's Center for Health Studies in Seattle. "The reassurance is SSRIs are not associated with any risk of birth defects or malformations. The concern is that SSRIs appear to be associated with an increased risk of premature delivery."
The study appears in the December issue of the American Journal of Psychiatry.
Researchers examined the medical records of 185 women and their babies who took antidepressants during pregnancy and 185 women and their babies who were treated for depression during pregnancy but did not take any drugs for the condition.
Women taking antidepressants were twice as likely to give birth prematurely. About 10 percent of women who took SSRIs at any time during their pregnancy gave birth before 36 weeks, the standard definition of premature labor, compared to only 5 percent of women who didn't take SSRIs.
The women on SSRIs gave birth, on average, a week earlier than those not exposed to these drugs.
"While this risk of premature delivery is low, the findings affect a large population of women," Simon says.
So what's a woman to do?
"Each woman has to consider her own situation and decide what to do," Simon says. "A woman who has severe depression while not using this drug would probably continue to take it. But a woman who has relatively mild depression might choose to stop using it during pregnancy."
Women are more than twice as likely to suffer depression as men, according to the American Psychological Association. And women are most likely to be depressed during their childbearing years, from about ages 20 to 50.
Dr. Milton Anderson, a psychiatrist at the Oschner Clinic Foundation in New Orleans, says the danger of depression to a mother and child should not be underestimated.
Depressed women often don't sleep well, eat well or get the medical care they need. Pregnant women who try to commit suicide can severely damage their baby, Anderson adds.
"Severe depression is toxic to mothers and babies," Anderson says.
While premature delivery is of concern, he believes the more crucial finding is that SSRIs are otherwise safe.
"The bigger importance of the study is the reassurance that there wasn't an increased rate of fetal abnormalities of birth defects," Anderson says. "We worry about that with any drug during pregnancy."
Given the new research, Anderson says he would recommend that women who have serious depression -- a lifelong history, recurrent suicide attempts -- remain on the medicine. Women who have milder depression -- perhaps a single bout and who've been in remission for six months or more -- should slowly come off antidepressants.
Either way, he'd make the decision with the woman and her obstetrician.
"We would like to have pregnant women off any and all medicine during the pregnancy," he says. "But in those moms who have severe depression or who are at risk of severe depression, this looks like a relatively manageable risk of early delivery."
The study found the older generation of medicines called tricyclic antidepressants, which include imipramine and amitriptyline, had no effect on the risk of premature delivery.
Researchers did not look at some of the newest antidepressants on the market, including Wellbutrin, Effexor and Remeron.
What To Do
Find out more about depression, including symptoms and treatments, at the National Institutes of Health. Meanwhile, the University of Michigan Health System has information about depression during pregnancy.