Usage of common antidepressants called selective serotonin reuptake inhibitors (SSRIs) should only be prescribed with "great caution" and counseling for women who are trying to get pregnant. This finding comes from a new study published this week in the journal Human Reproduction that shows SSRIs carry an "elevated" risk of miscarriage, preterm birth, neonatal health complication, and "longer term neurobehavioral abnormalities, including autism.
"Depression and infertility are two complicated conditions that more often than not go hand in hand," said Dr. Alice Domar, lead author of the study and OB/GYN at Beth Israel Deaconess Medical Center. "And there are no definitive guidelines for treatment. We hope to provide a useful analysis of available data to better inform decisions made by women and the providers who care for them."
Domar's study is a review of other published studies that evaluate women with depressive symptoms who took SSRIs while pregnant. The researchers found that antidepressant usage has increased 400% over the past 20 years, particularly for those between ages 18 and 44 - childbearing age for women. For women undergoing fertility treatments, they found no evidence of improved pregnancy outcomes with antidepressant use, but "mounting evidence" that SSRIs decrease pregnancy rates for these women. In addition, long-term SSRI exposure "appears" to correspond with an increase in the risk for early delivery, low birth weight, and Newborn Behavioral Syndrome.
"There are three main points that stand out from our review of the scientific studies on this topic," said Dr. Adam Urato, chairman of OB/GYN at MetroWest Medical Center. "First, there is clear and concerning evidence of risk with the use of the SSRI antidepressants by pregnant women, evidence that these drugs lead to worsened pregnancy outcomes. Second, there is no evidence of benefit, no evidence that these drugs lead to better outcomes for moms and babies. And third, we feel strongly that patients, obstetrical providers, and the public need to be fully aware of this information."