When it comes to taking antidepressants in pregnancy, women and their doctors have a difficult decision to make. Depression in pregnancy and following childbirth (the postpartum period) is common and has potentially serious consequences. Suicide is a leading cause of maternal death in the UK.
However, a number of studies over the past ten years have reported problems associated with taking antidepressants during pregnancy. These include impacts on the pregnancy, such as early delivery and lower birth weight; increased rates of malformations, such as heart problems in the baby; and an increased risk of autism in children. A paper published in JAMA adds to the evidence. It found that exposure to antidepressants in the womb is associated with a modest increased risk of speech and language disorders.
Listen: what is the best health care for you and your new family?
Based on the types of newspaper headlines that usually accompany these reports, it is likely that pregnant women and their partners will be very concerned. But interpreting these complex studies is difficult. So what do we know, and how should women, partners and their doctors respond?
The first important point is that women should not be taking medication in pregnancy unless it is of benefit. For a woman taking an antidepressant and who is considering starting a family, or finds that she is pregnant, this is an excellent time to consider whether the drugs are still needed.
It is important to consider all treatment options, not just drugs. Talking treatments, particularly for mild to moderate depression, may be a better option for some women. Sadly, access to psychological therapies is still problematic in many areas.
The studies have problems.
Although there are a number of studies now reporting problems, the cause of this relationship remains uncertain. It is possible that the problems are due to the antidepressants, but it may also be due to the effects of the mood disorder for which the drugs have been prescribed.