Families & Mental Illness

http://news.yahoo.com/s/nm/20090925/hl_nm/us_antidepressants_heart

NEW YORK (Reuters Health) – If you take antidepressants such as fluoxetine (marketed as Prozac) early in your pregnancy, you may be doubling the risk that your newborn will be born with a heart defect, according to a new study.

However, the vast majority of children born to women who take such antidepressants - known as selective serotonin reuptake inhibitors (SSRIs) - do not have such defects, the researchers are quick to note.

Earlier studies have tied SSRIs during pregnancy to heart defects, but also to even more serious birth defects. According to the new study of nearly half a million children born in Denmark between 1996 and 2003, however, only heart defects are likely to be associated with the antidepressants, note co-author Dr. Lars Henning Pedersen, from Aarhus University, Denmark, and colleagues.

Along with fluoxetine, sertraline (marketed as Zoloft) and citalopram (marketed as Celexa) seemed to increase the risk more than others, as did using more than one antidepressant at a time, according to the report in the September 25th Online First issue of BMJ.

Overall, SSRI use in early pregnancy, defined as 28 days before to 112 days after conception, doubled the risk of a particular kind of heart defect involving a piece of tissue that separates parts of the heart.

Sertraline more than tripled the risk, while citalopram more than doubled it. Using more than one SSRI nearly quintupled the risk of the heart defect.

However, the number of children born with such defects was still quite small: For about every 250 pregnant women who did not take SSRIs, one infant was born with the defect, while about two were born with the defect for every 250 women who took one SSRI, and four for every 200 mothers who took more than one.

Pedersen told Reuters Health that the results surprised the team.

Still, in an accompanying editorial, Dr. Christina Chambers, from the University of California, San Diego, comments that doctors and patients "need to balance the small risks associated with SSRIs against those associated with undertreatment or no treatment."

SOURCE: BMJ, online September 25, 2009.

>>doctors and patients "need to balance the small risks associated with SSRIs against those associated with undertreatment or no treatment<<

The bottom line. Untreated depression is, IMO, more risky to the fetus than the Prozac.

I agree with you both. The other thing is, that since the damage is done so early in the pregnancy and many pregnancies are unplanned, by the time they knew, it would be too late in the game to change it anyway.

I suffered some depression while pregnant, not enough to be medicated, probably, mostly reactionary due to some circumstances around me, but my childs well being was in direct correlation with mine. I was able to use counseling and shear will to pull myself through.

I hope this research isn't used indiscriminately by OB/GYNs, who are not mental health professionals, to deter woman from taking the meds they need to while pregnant. They can tend to run amock with any negative research at times, without looking at the overall, big picture.

Please forgive the hat. I'm CL of the PPD Board as well as the Pregnant & Depressed board.

The IMPORTANT thing to note about this study is the type of study performed. The researchers reviewed a national registry then cross referenced with filled prescriptions. There was absolutely no way for the researchers (via their own admission nonetheless) to verify that these prescriptions were taken at all and/or taken properly at that. What's really fascinating about this study is that of all the AD's they noted, Paxil was the least likely to be involved in septal heart defects, absolutely fascinating considering that Paxil is the only AD with a FDA black box warning specifically about heart defects.

There is of course a risk to anything you do during pregnancy. The most important thing to do is to have a discussion with your caregiver if you are thinking of getting pregnant and are already on meds, are at high risk for depression/mental illness and may need meds, and of course if you develop depression you would want to discuss treatments with your doctor and go from there. Depression DOES cross the placenta and comes with it's own set of issues such as early delivery, higher cortisol levels which can affect neural development, etc.

It's so important to remember to educate yourself and really investigate the information set forth to you during such a sensitive and important time in your life and your child's life.

Warmest,
Lauren

P.S. You can read a longer piece I wrote about this (which includes a reaction from Dr. Shoshana Bennett) at my blog: http://unexpectedblessing.wordpress.com/2009/09/28/danish-research-and-ssri-use-during-pregnancy/