In a study done by the University of Montreal, 6 to 10% of the women that were recorded and participated in the study who were diagnosed with depression and prescribed antidepressants for the previous 6 months, were at a higher risk for giving birth to infants with birth defects.
“In pregnancy, you’re treating the mother but you’re worried about the unborn child, and the benefit needs to outweigh the risk,” said the study’s senior author, Anick Bérard, a professor at UdeM’s Faculty of Pharmacy and researcher at its affiliated children’s hospital, CHU Sainte-Justine.
A well-known expert in pregnancy and depression, Bérard has previously established links between antidepressants and low birth weight, gestational hypertension, miscarriages, and autism. Her new study is among the first to examine the link to birth defects among depressed women due to the usage of antidepressants during pregnancy.
Every year, about 135,000 Quebec women get pregnant, and of those, about 7 % of these women shows signs of depressive symptoms or already have diagnosed depression prior to becoming pregnant and their pregnancy has magnified their symptoms. Less than 1% of this population have severe depression.
In her study, Bérard looked at 18,487 depressed women in the Quebec Pregnancy Cohort, a longitudinal, population-based grouping of 289,688 pregnancies recorded between 1998 to 2009. Of the women studied, 3,640 — about 20 percent — took antidepressants in the first three months of their pregnancy.
“We only looked at the first trimester, because this is where all the organ systems are developing,” said Bérard. “At 12 weeks of gestation, the baby is formed.”
Antidepressant use during this critical time window has the potential to interfere with serotonin intake by the fetus, which can result in malformations. It is also important information to note, that these pregnant women diagnosed with depression may try to use unhealthy habits or coping mechanisms, such as smoking, drinking, and poor diet, which also has a major role in fetal development.
For example, when Celexa (the brand name for citalopram) was taken in the first trimester, the risk of major birth defects jumped from 5 per cent to 8 per cent, Bérard found. In all, 88 cases of malformations were linked to use of the drug.
Similarly, use of Paxil (paroxetine) was associated with an increased risk of heart defects; venlafaxine (Effexor), with lung defects; and tricyclic antidepressants (such as Elavil), with an increased documentation of eye, ear, face and neck defects. It seems like the different classes of SSRI’s had different effects on the development of certain organs in the fetus and it wasn’t just one single SSRI that affected all organs.
Depression is on the rise across the globe and is a leading cause of death, according to the World Health Organization. Depression is particularly serious during pregnancy, and doctors — especially psychiatrists, obstetricians and other specialists — are prescribing more antidepressants than ever to expectant mothers. This is only one way to treat an issue that is so ill-timed when a woman is carrying a child and doesn’t want the child to be exposed to the medication she is taking. Other resources that should be available in place of antidepressants, or alongside if passed by a healthcare official, should be therapy sessions and support groups for women who are also experiencing depressive symptoms whether they are currently pregnant, have postpartum depression, or have depression and want to conceive a child.
Over the decade or so that Bérard studied her cohort, the proportion of expectant mothers on antidepressants in Quebec doubled, from 21 users per 1,000 pregnancies in 1998 to 43 per 1,000 in 2009.
The women in this study that are prescribed these drugs and are taking them are usually older women who tend to live alone and don’t have much in the way of family or financial support or stability. In some cases, it seems like an easier route for them just to take medication instead of seeking non-medicative treatment out of fear that they won’t be able to afford therapist visits or they’ll face stigma and ridicule from their family or peers.
If a pregnant woman in the Quebec area has been experiencing depressive symptoms or has been diagnosed with mild to moderate depression before conceiving a child and is looking for treatment, there are plenty of websites online and even mental health facilities that can help them on their journey to treating their symptoms and having a safe and enjoyable pregnancy, even if the woman is lacking in sufficient funds, she will still be able to reach out to a program or other people who are just like her.