Major Depressive Disorder

Antidepressants Safe During Pregnancy


By Pippa Wysong
The Medical Post, January 28, 1997

TORONTO - Women who suffer from depression may be cheered by news that it is safe to take antidepressants while pregnant.

After a follow-up study of children born to women taking antidepressants, researchers from the Hospital for Sick Children's Motherisk program found nothing unusual in terms of I.Q., language or other psychological or behavioral measures.

Tricyclic antidepressants

The study focused on children born to mothers who had been taking tricyclic antidepressants or fluoxetine.

"Depression is common among women of reproductive age," said Dr. Gideon Koren, head of Motherisk and professor of pediatrics at the University of Toronto.

An estimated 8% to 20% of women get depressed at some point in their lives yet the messages about taking antidepressants during pregnancy have been mixed.

Some doctors advise against taking the medications and others say it is probably safe, he said.

Generally, drug-induced malformations are triggered during the first trimester of pregnancy. The brain, however, develops throughout the entire nine months and potentially can be injured after the first trimester.

Fluoxetine

Both tricyclics and fluoxetine cross the placenta, though animal studies have shown large doses of the drugs do not cause malformations.

Depression is not a mild problem and can have severe consequences. "Untreated, depression can lead to suicide attempts," he said.

There can be a real balancing act when weighing the risk to the mother of untreated depression versus the risk to the fetus from taking a drug, he said.

Since 1985, 129 pregnant women who were taking antidepressants have been counselled by Motherisk staff. Out of the group 80 who had given birth were available for follow-up.

Some of the initial group were excluded from the study because they had been taking other medications as well, declined to participate or had either spontaneous or therapeutic abortions.

Forty of the women had taken tricyclic antidepressants during the first trimester, 36 took antidepressants throughout the whole pregnancy, two took them during the first and second trimesters and two during the first and third only.

Antidepressants

There were 55 women who had taken fluoxetine, 37 of whom took the drug during the first trimester, and 18 throughout the pregnancy.

The offspring of these women were compared to 84 controls who were born to women who had not taken any antidepressants.

When compared to the controls, the women taking antidepressants consumed more alcohol and smoked more. Those on fluoxetine had more pregnancies, more previous therapeutic abortions and tended to be from a lower socioeconomic group than women in the other two groups.

The rate of major malformations was similar among all three groups with three occurring in the children who had been exposed to tricyclics in utero, two in those exposed to fluoxetine and two in the controls.

Psychological and behavior tests done on the children had similar results among the three groups. The children, who were between one-and-a-half and six years of age had similar results on I.Q. tests, language skills and behavioral development, Dr. Koren said.

The severity of the mother's depression was taken into consideration in the analysis.

What was related to a negative result in terms of child development was a low socio-economic status. But this has been shown in other studies, he said.


Copyright 1997 Maclean Hunter Publishing Limited
Reprinted with permission.

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