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Pregnancy and Antidepressants: One More Worry?

by Jane Wangersky | November 7th, 2012 | Pregnancy

“Expect to go through mood swings” and “Stay in a calm, happy mood for the good of your baby” are two of those contradictory pieces of advice that you get while you’re pregnant. It seems they’re saying that a pregnant woman’s state of mind is both terribly important and terribly fragile.

And now a study published in Human Reproduction says that some of the more popular antidepressants — the selective seratonin re-uptake inhibitors, or SSRI’s like Prozac, Zoloft, Paxil and Lexapro — put pregnant women at higher risk of miscarriage, premature delivery, pre-eclampsia, and other health crises.

Though this is cause for concern, it’s hardly unexpected — meds strong enough to make a difference are usually going to have side effects, some of them severe. What’s harder to deal with is the study’s second conclusion: there’s “no evidence that these drugs lead to better outcomes for moms and babies”. The antidepressants, it says, are no more effective, or only slightly more effective, than a placebo.

Better outcomes compared to what? Nobody knows what would’ve happened if the women in the study had been left completely on their own with their depression, which none of them were, even the placebo group. All of them were taking something which might or might not help, as far as they knew, which must’ve given them at least a little hope; all of them were presumably in regular contact with the researchers, that is, with people who were taking an interest in their depression. There’s no telling what misery and even worse things might’ve happened otherwise.

And what does “slightly more effective” mean? Did the group with the anti-depressants average more days without collapsing on the laundry room floor to cry over nothing? Believe me, when you’re depressed, even one day like that is something to celebrate.

Maybe the biggest question of all — if these antidepressants aren’t helpful enough to be worth the risk of giving them to a pregnant woman, why prescribe them to anyone at all? Do they help or don’t they?

The researchers say they’re just trying to point out that pregnant women should be  informed, and they and their doctors should use “great caution” when considering SSRI’s. Agreed on both counts — but the way this study comes across, it raises fears and questions that probably won’t help anyone.

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