Psychotropic medication during pregnancy

Young mother looking out from the window with her baby 2An estimated 50 million Europeans (11% of the population) experience a mental disorder at some time in their lives. With mental disorders so common, it is vital that women get the right advice on how to manage their condition during pregnancy.


Psychotropic medications during pregnancy: the facts

Despite the staggering prevalence of depression during pregnancy, huge gaps still lie in our knowledge about the safety of treating pregnant women with antidepressants.

  • Preterm birth is one of the risks most commonly associated with the use of antidepressants during pregnancy. In the US, rates of premature birth have been increasing over the past two decades and a recent review of 41 academic studies, revealed increased rates of preterm birth in patients taking antidepressants.
  • It has also been suggested that the use of SSRIs during pregnancy can cause heart defects in the unborn child. However a new study in the US, looking at the outcomes of 949,504 pregnant women, found no substantial increase in the risk of cardiac malformations attributable to antidepressant use during the first trimester.
  • This year, the alarm was raised over the possibility that mothers who had taken antidepressants during pregnancy were more likely to have children with attention deficit hyperactivity disorder (ADHD). The research, carried out in the US, looked at 7,800 children aged between two and 19 years old. However, the study was inconclusive as it was not possible to attribute causation to the use of antidepressants. Also, the study revealed that, once you took into account the severity of the woman’s illness, the link disappeared, suggesting the mother’s own condition, rather than her medication, could be what predisposed her child to ADHD.
  • It is thought that mood stabilizers such as Benzodiazepines may cause birth defects, especially if taken during the first trimester. Women are also advised to avoid Lithium during the first trimester, as it has been linked to increased risk heart defects.

Complications with withdrawals

Studies have shown that when women stopped taking their medication for bipolar disorder, relapse was common. This often results in manic episodes, which could be dangerous to both mother and child. One study indicated that 70.8% of the women who had come off their medication experienced at least one mood episode.

Women with major depression were five times more likely to relapse if they came off their antidepressants during pregnancy.

Weighing the risks

While some women will begin pregnancy with mental health issues, others may present with the first onset of psychiatric illness while pregnant. In either case, decisions about treatment must balance the risks associated with harm to the fetus with the dangers of leaving a condition untreated or terminating medication.

“Untreated depression can lead a woman to consider or even go through with suicide,” says Dr. Gideon Koren, founder of Motherisk and professor at the University of Toronto. “Suicide is the number one reason for death among young women and the number one reason for suicide is depression. Yet still, every week, we talk to scores of women who are told not to take their medication. Weighing up risk-benefit is critical.”

It’s clear that there needs to be more research so women have better options available to them and this is where both the pharmaceutical industry and healthcare professionals can step up.

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