Rethinking Prozac and Pregnancy

Researchers from the University of California published a study last week in the New England Journal of Medicine that appears to put a damper on the long-held belief that today's most popular antidepressant medications are really safe in pregnancy. Selective Serotonin Reuptake Inhibitors (SSRIs) are the mainstay of today's medical therapy for depression, because they usually work, and their safety and side-effect profiles are attractive. This class of medications includes the popular brand-names Prozac, Zoloft, Paxil, Celexa and Lexapro.

Although the usual warnings about unknown risks are always given to pregnant patients on these medications, until now, we've had little reason to worry about serious consequences of taking these commonly prescribed antidepressants while pregnant. This study suggests that women who take SSRIs after the 20th week of pregnancy have s sixfold increased risk of giving birth to a newborn with persistent pulmonary hypertension. Also known as persistent fetal circulation, this condition is a rare life-threatening lung condition that affects newborn infants immediately after birth. It is so rare, in fact, that a sixfold increase in risk only translates to about a 1% risk for women who take these medications in the last half of pregnancy.

The good news is that women who become pregnant while taking these medicines need not worry: the risk is only increased if they take them beyond twenty weeks. They will have plenty of time to get off the meds if they can. But, making that decision is tricky business. Some women might be just fine if they stop them, but many need these prescriptions to function. And, probably every woman who has a history of depression is at risk for postpartum depression, so stopping the medications mid-pregnancy might not be in their best interest.

I believe that this knowledge calls for even closer coordination of care among the patient, her ob team, and a psychiatrist. Each patient needs to be carefully and timely counseled, and if a decision is made to stop the meds, she should be monitored carefully for deterioration of her mental health status. The recommendation of whether to stop the medication or stay on it must be individualized and taken seriously, because clearly, the benefits of the medications do outweigh the risk in some patients. And, I agree with the authors: we need to know more about the management of depression during pregnancy in order to provide expert care for these patients.

RW, MD

Related Topics: Facing Depression During Pregnancy, Infants and Antidepressant Withdrawal

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