Depressed women who are pregnant or planning to be have two new studies to draw on when weighing their decision to continue to take antidepressants. The New York Times reports today that one observational study, published last week in the Journal of the American Medical Association, found that women with major depression who stopped taking their medication during pregnancy relapsed more than two and a half times as often as women who continued to take antidepressants. The study goes against the widely held belief that pregnancy can provide protection against psychiatric distress, and suggests that stopping antidepressants could be dangerous for mothers and babies. "Depressed mothers don't eat properly, they don't tend to their prenatal care and they're more likely to be smoking," Margaret G. Spinelli, an assistant professor of clinical psychiatry at Columbia, told the Times. "Many physicians just stop the medicine without even thinking. We have to be aware of these things."
The other study, published yesterday in the Archives of Pediatrics & Adolescent Medicine and also mentioned in the Times article, confirms previous research that found that about 30 percent of babies exposed to selective serotonin reuptake inhibitors (SSRIs) in utero experienced drug withdrawal symptoms, including crying, tremors and sleep problems, for about 48 hours after birth. While the symptoms don't usually require treatment, the Israeli researchers who conducted the study wrote, "The long-term effects of in utero exposure to S.S.R.I.'s have not been demonstrated clearly."
What's a woman to do? The choice between putting one's own mental health in jeopardy for nine months and risking the physical health of a newborn is not much of a choice. But while the studies don't provide any easy answers, they do underscore the need for women to weigh all the risks with their doctors and consider their treatment options carefully.
"Hopefully decisions can now be made in a more informed fashion so that we worry not just about the risks of exposure to antidepressants but also about risks to the patient from depression if they stop their medicine," Lee S. Cohen, the lead author on the observational study, told the Times. "My hope is that it will be less of a reflex to stop the medicine and more a collaborative decision that weighs all the risks."