It seems like new studies about the risks of taking antidepressants while pregnant get announced almost every week, and the results have been mixed. The latest report — an analysis of medical records from Massachusetts General Hospital, released Tuesday — is a hopeful one for women suffering from depression or anxiety, as it shows no risk of autism or ADHD to fetuses with antidepressant exposure.
“It’s an individual decision, and I think that with pregnancy, every decision is very important and very scary,” Dr. Carly Snyder, a reproductive psychiatrist based in New York City, tells Yahoo Parenting. “Every woman wants to make the right choice for her baby, and many think, ‘If I just protect my baby by not taking the medication, then everything will be OK.’ But the underlying illness itself is a huge factor that must be considered in a thoughtful way, because you need to have a baseline of stability for mom. Healthy mom, healthy baby.”
The controversy over what’s best for baby reached a crescendo in mid- December, when a widely publicized study by Takoua Bourkhris was published in JAMA Pediatrics. Her findings suggested that women who take antidepressants known as selective serotonin reuptake inhibitors (SSRIs) had an 87 percent increased risk of having a child who would develop autism spectrum disorder.
The study prompted criticism, including from the organization Postpartum Support International, which noted on its website it was “deeply concerned by the possible harmful repercussions,” which “may frighten women who may previously, currently, or in the future need antidepressants during pregnancy for their mental health and well being.” The organization went on to point out what it called the study’s “serious methodological errors,” and made a charge of misrepresented statistics.
A 2014 New York Times article by Roni Caryn Rabin — which detailed a long list of potential problems for pregnant women taking SSRIs and compared the decision with smoking, drinking, and eating Brie — prompted a similar eruption from critics. The complex back-and-forth was detailed in a New Yorker feature by depression guru Andrew Solomon, who stressed the need to not blame mothers “for their children’s neurological challenges.” He added that the main problem here is that “this is a highly nuanced question to which there is no consistent answer, and about which we know too little. That makes everyone excruciatingly uncomfortable.”
A wide-reaching study published in July, meanwhile, found that fetal exposure to two specific SSRIs — Paxil and Prozac — were associated with a higher, though still relatively small, increase in birth defects. And then there’s the most recent analysis, from Massachusetts General, which found no inherent risk in prenatal antidepressant exposure, noting “that any increased incidence of autism or ADHD found in previous studies was probably associated with the severity of the mother’s depression — a known risk factor for several neuropsychiatric disorders — and not from antidepressant exposure during pregnancy.”
So how might a woman facing this question even begin making the right decision for her baby? Step one might be to consult with a psychiatrist specializing in reproductive health, such as Snyder.
“It’s her decision,” she says. “My goal is to help the woman understand her options.” To do that, she explains, she walks patients through the reams of research regarding risk, “including the numbers, because they can be very deceiving.” Then she looks at the factors of each individual’s mental illness with various questions: Has the patient been on meds for the past 15 years after a single depressive episode? Or have there been many episodes and relapses? Snyder says it’s important to take into account whether the woman is already pregnant or not. “If someone is planning a pregnancy and has been fine on medication, maybe we try lowering the dosage to see how she does,” the doctor says.
“In an ideal world, if you can get away with being off medication and [be] stable, great,” she adds. “There’s no reason to expose the fetus to medication if there is no pervasive mental illness.” If a woman is already pregnant and wants to experiment by stopping her meds, she says, “Worst-case scenario, you go off medication, do not do well, and we play catch up.”
Our culture, she explains, values pregnancy on one hand, but “devalues women” on the other. “If we were talking about any other illness during pregnancy, treatment wouldn’t be a discussion. But this is a much a medical illness as anything else, with as many negative consequences,” she says. “The mother is the most important figure in this equation. If mom is riddled with depression and anxiety, how will she be able to take care of herself during pregnancy? How will she be able to take care of her newborn?”
What women need to understand most of all when weighing the various factors in their decision, Snyder stresses, is this: “They matter. Their experience matters.”
(Top photo: iStock)