New study warns fertility patients of SSRI pregnancy risks

A new study published in the January 2013 issue of the Oxford Journals publication Human Reproduction finds that SSRI antidepressant use during pregnancy is associated with increased risks of miscarriage and several life-threatening birth defects with little evidence of any benefit. The study examined use of Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants such as Zoloft and Paxil by infertility patients and concluded that women who are pregnant or wish to become pregnant should consider other treatments for depression. The authors, affiliated with Harvard Medical School and Tufts University School of Medicine, summarized their findings as follows:

At the current time, there is minimal evidence that antidepressants provide a significant benefit to women struggling to conceive. On the contrary, there is mounting evidence that SSRIs may, in fact, decrease the pregnancy rates from fertility treatment, increase the risk of pregnancy loss and be associated with risks to the fetus throughout the pregnancy and beyond.

The new antidepressant study was designed to address one specific question: “What is the current literature on the safety and efficacy of selective serotonin reuptake inhibitor (SSRI) use in infertile women?”

To answer that questions, the researchers reviewed all published literature on the use of SSRI antidepressants by women experiencing infertility. While the studies reviewed often were small, they demonstrated consistent results in several areas. By integrating the findings, the authors were able to reach a number of conclusions regarding the effects of SSRI antidepressants like Zoloft on infertility, pregnancy, and neonatal health.

Perhaps the most important findings of the review relate to the relatively high risks of taking SSRIs during pregnancy compared to the questionable benefits of the drugs. Risks found in the studies reviewed include miscarriage, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn (PPHN), pre-eclampsia, and possible longer term neurobehavioral effects. Each of these complications can be life-threatening for the baby and traumatic for the parents. In addition, the research reviewed does not demonstrate improved outcomes for depressed women who continue SSRI use during pregnancy. No significant benefits have been proved. To the contrary, the researchers found that use of SSRI antidepressants by infertile women was associated with less-effective outcomes of infertility treatments. The data reviewed calls into question the efficacy of SSRI medications in cases of mild or moderate depression and suggests that the drugs may be of little use where major depression symptoms are not present.

These findings have profound implications on medical practice issues relating to pregnancy and the treatment of depression. Conventional wisdom among practitioners is that the risks of discontinuing antidepressant use during pregnancy outweigh the potential pregnancy side effects. This view proposes that women who otherwise would be prescribed a SSRI may be at an increased risk of self-harm, especially those experiencing infertility. In reality, given the serious risks SSRI use poses to the child, the old position is questionable. Researchers found no results showing better outcomes for depressed pregnant women after the prescription of SSRIs. In contrast, the prescription of SSRI antidepressants like Zoloft during pregnancy may be putting the child at risk of injury or death without giving the mother any benefit.

Based on these findings, the authors of the study recommended that caretakers explore alternative treatments with pregnant women who find themselves depressed. These non-pharmacological treatments may alleviate symptoms of depression without the risks of an SSRI. Psychotherapy, relaxation training, exercise programs such as yoga, acupuncture, and nutritional supplements have all been shown to alleviate depression in some cases. In truth, despite the ongoing promotion of these drugs by manufacturers such as Pfizer (maker of Zoloft), healthcare providers and patients should approach their use with great caution.

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