Antidepressant use during pregnancy: 5 things to remember

Depression and other mental health conditions can be serious, and many women need to take medications during pregnancy to appropriately manage their symptoms. Abruptly stopping the use of medications to treat these conditions can have serious consequences.

“Women should talk to a healthcare provider to make informed decisions based on their individual situation. Of course, ideally women would discuss treatment options for depression and other health conditions before pregnancy,” said Jennita Reefhuis, MD, epidemiologist with CDC’s National Center on Birth Defects and Developmental Disabilities.

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According to Dr Reefhuis, there are 5 important points to remember when using antidepressants during pregnancy:

• Depression and other mental health conditions can be serious. Many women need to take antidepressants during pregnancy to appropriately manage their symptoms.

• Abruptly stopping the use of medications, such as antidepressants, can have serious consequences. Women should not change medications or stop taking medications without first talking with a healthcare provider about available treatment options.

• Researchers found some birth defects occur about 2 or 3 times more frequently among babies born to women who took fluoxetine and paroxetine early in pregnancy.

• Researchers did not confirm 5 previously reported links between sertraline, the most commonly used selective serotonin reuptake inhibitor (SSRI) in this US study population, and any birth defects observed in previous studies.

• Despite the observed links between certain birth defects and some SSRIs found in this study, the actual risk for a birth defect among babies born to women taking one of these medications is still very low. Because these specific types of birth defects are rare, even doubling the risk still results in a low absolute risk.

In a CDC-funded study published in The BMJ, Dr Reffhuis and researchers assessed several previously reported links between SSRI use and birth defects using more recent data and results from previously published independent studies. Researchers found some birth defects occur about 2 or 3 times more frequently among babies born to women who took certain SSRI medications, such as fluoxetine and paroxetine, early in pregnancy.

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In this study, the researchers used an analysis strategy that allowed us to combine results from the published literature with more than 12 years of data from the National Birth Defects Prevention Study, a large study in the United States aimed to identify risk factors for birth defects. They compared women who took an SSRI in early pregnancy and who had a baby with a birth defect, with women taking the same SSRI who had live born babies without a major birth defect.

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“However, it is important to keep in mind that even for these confirmed links, the risk to an individual woman who is taking this medication is still small. Reassuringly, we found that we could not replicate five earlier reported links with birth defects for sertraline, the most commonly used SSRI in our US study population,” Dr Reefhuis said. 

The information in this study should be helpful in guiding formulary managers to the best treatment options for depression and other mental health disorders both before and during early pregnancy, she said.

“The best time to discuss the safety of medication use is before pregnancy, because early pregnancy is a critical time for a baby’s organs to develop,” she said. “These findings can be used to help minimize the risk of major birth defects while providing treatment to manage a woman’s symptoms. When treating women who are already pregnant, it is important for healthcare providers to discuss the risk and benefits of antidepressants as well as the safest options available based on their patient’s individual situation.”

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