Antidepressants found safe during pregnancy, but what else can you do?

2013-01-03 19:55
New study finds no link between infant deaths and antidepressant medication.

Researchers have taken yet another look at the safety of antidepressants during pregnancy. The finding, published in the Journal of the American Medical Association (JAMA), could put to rest fears have been raised that prescription drugs known as SSRIs could lead to higher infant mortality. It's also important to know there are non-drug approaches that can help with symptoms of depression during pregnancy.

The study included 30,000 women from Nordic countries who researchers tracked as having filled a selective serotonin reuptake inhibitor (SSRI) prescription during pregnancy.

They found no association between use of the drugs and deaths at birth, stillbirth or shortly after birth.

The debate about antidepressant use during pregnancy safety has been ongoing for several years.

One study, published January 2012 suggested SSRIs taken in the third trimester of pregnancy could cause infant seizures. There was also a link between stillbirths and use of the medications among women taking then earlier during pregnancy.

Olof Stephansson, M.D., Ph.D., of the Karolinska Institutet, Stockholm, Sweden and colleagues conducted the newest study that included in women from Denmark, Finland, Iceland, Norway, and Sweden during different times from 1996 to 2007.

The study found higher rates of stillbirth and postnatal death among women given the antidepressants. But the researchers say the reason is related to behaviors like smoking, advanced age of the mother and severity of the psychiatric disease being treated.

As in the past, experts recommend weighing the risk of the drugs against the benefits during pregnancy.

It’s estimated that between 14 and 23 percent of women experience pregnancy related depression that can also lead to negative outcomes, according to a 2009 report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists

The authors note earlier studies didn’t take into account the severity of maternal psychiatric disease, leading to reports that antidepressants are unsafe for pregnant women. The study was funded by the Swedish Pharmacy Company.

A non-drug approach

Non-drug approaches for treating mild to moderate depression include group or individual therapy, an important note for women who want to avoid medications.

Cognitive behavioral therapy or CBT has been found to help women beat gestational related depression, in findings published in 2003.

One clinical trial showed light therapy is both safe and effective. The study, published in 2003, showed morning light therapy relieved symptoms of depression by 49% after 5 weeks of treatment.

For severe depression, a combination of medication and psychotherapy is recommended.

The American Pregnancy Association recommends women seek help for symptoms that include sadness that persists, change in eating habits, anxiety, feelings of hopelessness, suicidal thoughts, change in sleep – either too little or too much – lack of pleasure from activities you usually enjoy and feelings of guilt or worthlessness.

A happier pregnancy

It’s important to note that exercise is a natural antidepressant. If you’re thinking of getting pregnant or already there, make sure you get plenty of regular activity, within guidelines recommended by your physician.

Avoid sugar and processed foods that are known to affect our mood. Caffeine, artificial food additives and eating too many carbs and not enough protein can affect mental (and physical) health.

The new study shows antidepressants known as SSRIs might be safe to take during pregnancy. Discuss the risks and benefits with your doctor if you feel the need for extra help with feelings of sadness or other symptoms that are not uncommon for pregnant women.

Citation:
JAMA. 2013;309(1):48-54

References:
Obstet Gynecol. 2009 September; 114(3): 703–713.
doi: 10.1097/AOG.0b013e3181ba0632

Am J Psychiatry. 2003 Mar;160(3):555-62.

Am J Psychiatry. 2002 Apr;159(4):666-9.

Image credit: Morguefile

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Comments

Isn't it wonderful how far medicine has come! Now we can medicate both mother and child at the same time! Just watch the anti depressant medication double in price. Who diagnoses the fetus? Did it require medication as well? Was the fetus depressed? This is disgusting!
It is scary, but severe depression is too. We need more alternatives.
I am old enough to remember Thalidomide, an anti-nausea and sedative drug developed by CIBA, to be used as a sleeping pill and to alleviate the effects of morning sickness. It was triple placebo tested and found to be safe for mother and fetus. It was withdrawn after being found to be a teratogen, which caused many different forms of birth defects. More than 10 000 children were born with multiple defects, and to this very day court battles are fought for compensation. Depression often relates to hormonal imbalances and can be overcome. Get allergy tested to find the cause of your depression. Prevention is soooooo much better that to take the risk of finishing up with a severely affected baby. I like to add that many drug companies are often in the news. Having to withdraw drugs for negative effects that were overlooked (?) in the triple placebo tested trials, and for doctoring the results of the very tests that are meant to insure safety in use.
Some hormones, such as those in cow's milk, have mood altering properties for the simple reason that the amount and combination of cow's hormones are different to the human ones. Avoidance of cows milk products can often alleviate depression. Vitamin D deficiency has been shown to cause depression as well, particular during the winter months (S.A.D). Sitting in the sun for an hour a day, or perhaps twice a day for 30 minutes can be the answer for some . Candidiasis is another depressant, as are food allergies, hypoglycemia, and, ironically, drugs, prescribed or otherwise. Poor diet quality, ubiquitous in the United States, may be a modifiable risk factor for depression. Zinc supplement and Vitamin C might also be indicated. Zinc is a 'brain food' and can influence the function of brain chemistry. Many researchers claim that zinc deficiency is very common, and easily overcome with safe supplementation.
Yes, we're back to food adulterants again. I avoid milk from cows raised on hormones or antibiotics. I agree about diet - high carbs and fat should be avoided during pregnancy in lieu of foods that are nutritious and boost mood. Did you see our piece about how a high fat diet leads to laziness and more? :)
No, I am a recent commenter on EmaxHealth, but will look it up in the near future. I would like to point out that milk is full of naturally occurring hormones, many of which have an influence on mammary growth and lactation. Milk fat is used by the neonate mammal for accumulating body adipose in the initial days after birth. Most mammalian neonates are born with little body adipose for insulation or as a source of stored energy. A few days after birth most neonates begin to be able to metabolize milk fat as an energy source. Antibiotics are found mainly in meat and to a much lesser extent in milk.
Thanks Hans!