serotonin reuptake inhibitors

Anti depressant & Miscarriage

by The Anti Depression Team on

It is not uncommon for pregnant women to suffer from depressive disorders. A new research suggests that pregnant women who take antidepressant medications to treat depressive disorders may have an increased chance of miscarriage.

Scientists at the University of Montreal reported that women taking the drugs most commonly prescribed to treat depressive disorders and anxiety such as selective serotonin reuptake inhibitors (SSRIs) had a significantly higher risk of miscarriage compared to women who did not take antidepressants. The study is the first of its kind to analyze the antidepressants and their doses which are most likely to cause spontaneous abortion. The research team noted that two SSRIs, paroxetine (Paxil) and venlafaxine (Effexor) are associated with the greatest risk.

Data from a pregnancy registry of 69,742 women in Quebec that collects records on births and spontaneous abortions occurring in hospitals in the Canadian province was analysed. Among the women who had miscarried, 5.5% had been on one prescription for an antidepressant to treat depressive disorders during pregnancy, compared with 2.7% of the control group. Researchers calculated that antidepressant users had a 68% higher risk of miscarriage than nonusers, with all other factors controlled.

Overall, the risk was greatest among women who used two or more classes of antidepressants. When researchers looked at the small amounts of data on patients using specific drugs, they found that those taking paroxetine alone had a 75% higher rate of miscarriage than women without depressive disorders, while women taking venlafaxine had a more than doubled risk.

However, the study was solely based on the data that was already collected, which means that there is a possibility that the miscarriage risk may be due to the depressive disorder itself rather than the drugs used to treat it. Indeed, the authors acknowledge that some past research has shown that women who display depressive symptoms during pregnancy are at increased risk of spontaneous abortion. But while acknowledging that limitation of the current study, it is still unlikely that such a large difference — the 68% increase — could be attributable to just underlying causes such as the depressive disorder.
Still, obstetricians continue to prescribe antidepressants for pregnant women with depressive disorders as the research done is limited and often inconsistent. Evidence for the risks associated with drugs used to treat depressive disorders has been increasing in recent years, however, with studies finding a link between the medications, particularly when used during the first trimester, and as much as a sixfold increase in lung, heart and other congenital birth defects in newborns.

Such findings leave women with depressive disorders facing increasingly complicated treatment decisions when they are pregnant or considering starting a family. According to the American Congress of Obstetricians and Gynecologists (ACOG), about 14% to 23% of pregnant women will experience depressive symptoms; in 2003, about 13% of women took an antidepressant to treat depressive disorders at some point during pregnancy. But both antenatal depressive disorders and the use of antidepressant medications are associated with health risks to the newborn. Past studies have shown that pregnant women who have depressive disorders are more likely to have premature births and low-birth-weight babies and that their infants are at increased risk of irritability, sleep problems and high blood levels of the stress hormone cortisol compared with babies born to mothers without depressive disorders.

As with many clinical decisions, a balance must be obtained when treating depressive disorders during pregnancy. Experts advise women to discuss with their doctor the severity of their depressive disorders or anxiety and weigh their past history of miscarriage before deciding whether to change medications or reduce their doses while carrying a child. Depressed women who are not taking antidepressants should seek treatment to help reduce the depressive or anxiety symptoms.
Although the analysis did not include a comparison of antidepressant use in alleviating women’s depressive or anxiety symptoms, other research has documented the importance of maintaining such treatment for women who otherwise would struggle to function at their best, much less under the added stress of expecting a child.