Antidepressants & pregnancy: minimal risk

Antidepressants in general do not seem to be associated with birth defects, according to a new meta-analysis led by Sunnybrook psychiatrist Dr. Sophie Grigoriadis.

"Conflicting reports about antidepressant use during pregnancy have made the process of making treatment decisions extremely complex for clinicians. Our hope is that by providing a stronger evidence base, our work will help to make this process easier," said Dr. Grigoriadis, also an associate professor at University of Toronto. 

Published in the April 2013 issue of The Journal of Clinical Psychiatry, the authors used a quality assessment tool they developed to select more than 60 studies to analyze. 

Results did reveal some negative effects of antidepressant exposure, including an increase in risk for poor neonatal adaptation syndrome (PNAS) and the individual signs of respiratory distress and tremors in infants. The authors identified a significant association between cardiovascular birth defects and exposure to any antidepressant during pregnancy, but they question its clinical significance. They also found that depression during pregnancy is modestly associated with increased risk for premature delivery and lower rates of breastfeeding initiation. 

Dr. Grigoriadis concluded that "although more methodologically rigorous research is needed," treatment decisions regarding antidepressant medication requires weighing not only the risks of the medication on the fetus as "the effects of depression were not without consequence and should be given consideration." In particular, "women who choose to use antidepressant treatment while pregnant should be counseled that the infant may develop PNAS and ensured that if complications arise, they will be identified and treated immediately."

"Deciding on the appropriate approach to medication use during pregnancy can be a challenge for both mothers and doctors," said Dr. Lori Ross, another lead author on this study and scientist at the Centre for Addiction and Mental Health. "We hope physicians will use this research to provide expectant mothers with the best available evidence to inform this decision, and work with them to develop a treatment plan that works for them and their families." 

» View the full news release on The Journal of Clinical Psychiatry website