Mother's depression vs. concern for fetus

Decision: With conflicting research, many pregnant women wrestle with whether to remain on anti-depressants.

October 03, 2004|By David Kohn | David Kohn,SUN STAFF

By any measure, July Flowers is deeply depressed. She feels sad all the time and is prone to crying jags and fits of rage. When she gets home from work, she sometimes goes straight to bed, leaving her two daughters, who are 11 and 5, to make dinner for themselves. "I just want to sleep and ignore it all," Flowers said. "I don't want to deal with anything."

Until two months ago, Flowers, a 33-year-old computer specialist in Warner Robbins, Ga., was taking the anti-depressant Effexor, which kept her symptoms at bay. Then she found out she was pregnant. Her family doctor said he didn't know if the drug would harm her fetus, so she stopped taking it. Within weeks, she descended into misery. Now she doesn't know what to do.

Researchers say that as many as 1 in 5 pregnant women - more than 750,000 a year in this country - suffer from depression. Many, if not most, find themselves in the same uneasy position as Flowers: desperate to feel better but worried that the medicine might endanger their children.

"Some pregnant women suffer terribly with this dilemma," said Tim Oberlander, a University of British Columbia developmental pediatrician who has been studying the prenatal effects of anti-depressants for almost a decade.

Although there is conflicting research on the effects of anti-depressant use on fetuses, most experts say the hazards of taking the medicine are usually less serious than those of the illness itself.

"Right now, the literature is saying that exposure to maternal depression causes more problems than exposure to anti-depressants," said psychiatrist Jennifer Payne, co-director of the Women's Mood Disorders Center at Johns Hopkins Hospital.

Although many women with depression are taking medication, some researchers say many more probably should be.

But women often get conflicting advice - and sometimes no advice at all. Many physicians, including obstetricians, know little about the subject. And some tell patients that pregnant women rarely suffer from depression because of hormonal changes - a myth refuted by research.

"It's not often that these women find someone to talk to," said University of Toronto pediatrician Gideon Koren, director of Motherisk, a program that studies medication risk during pregnancy. Every week, his office hears from 20 or so pregnant women looking for advice on their anti-depressant use.

Most researchers believe that the more recent class of anti-depressants, including Prozac and Paxil, pose a relatively small risk to pregnant women and their fetuses. Known as selective serotonin reuptake inhibitors (SSRIs), these drugs work primarily by increasing the brain's level of serotonin, a neurotransmitter that helps regulate mood, sleep and appetite.

Like most drugs, SSRIs cross the placenta, leaving the fetus exposed to them. Several studies have found that the drugs do not cause birth defects, and don't affect early intellectual and emotional development.

"There were no neurocognitive deficits," said Harvard Medical School psychiatrist Lee Cohen, an expert on pregnancy and depression. Nevertheless, he said, anti-depressants "get a very negative rap."

Part of the problem, Payne said, is the controversy over the possible link between anti-depressant use and suicide. Some patients incorrectly assume that if a drug poses potential problems for children and teens, then it must be harmful for fetuses and infants.

But not everyone agrees that the drugs are safe to use during pregnancy. Some scientists say anti-depressants have not been studied extensively in the context of pregnancy and may pose more risks than realized.

"We are working from a faulty assumption that SSRIs don't have any ill effects," said University of North Carolina pediatrics professor Sandy Zeskind, who has studied the effects of prenatal anti-depressant exposure. "We should not be dismissing that possibility."

Zeskind said most research on the topic has been flawed, using older measures of developmental health that can't detect subtle problems.

In his research, Zeskind placed electronic monitors on infants' hands and feet, and discovered that those exposed to anti-depressants during gestation were more likely to be jittery and startled more easily. He also found that they were less alert, slept more and tended to have slightly more erratic heartbeats. He suspects that the anti-depressant group was going through drug withdrawal.

Other studies have found similar evidence of such symptoms. Zeskind worries that long-lasting developmental problems may result.

"My impression is, these SSRIs are being given out like M&Ms," he said. "There should be a more careful risk-benefit analysis."

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