Pregnancy, Depression, and SSRIs

The American Psychiatric Association issued the following news release:

“Therapeutic Dilemma for Pregnant Women with Depression? Higher Premature Birth Rates for Both Untreated Depression and Antidepressant Treatment.”

The study found that women with untreated depression during pregnancy and an increase in the rate of preterm births as compared to women who took SSRS antidepressants.

Both groups had higher rates of prematurity than women without depression or SSRI treatment during pregnancy.

In the study 238 pregnant women were divided into three categories, 1) those with no depression or SSRI treatment during pregnancy, 2) those with continueous depression but no SSRI treatment, and 3) those with depression and continuous SSRI treatment.

As expected, women with no depression or antidepressant medication had a low rate, (6 percent) of preterm births. But women exposed to SSRI treatment had a 23 percent rate and those with depression and no treatment had similar risks, 21 percent, for preterm birth.

According to Kathy Wisner, MD (lead author and renown PPD expert):

“Given the similarity in outcomes for continuous SSRI treatment and continuous depression, one possibility is that the underlying depressive disorder is a factor in preterm birth among women taking SSRIs.”

The take-home point (and dilemma) is this:

Though clearly this is more evidence that the use of SSRIs during pregnancy is associated with an increase risk of preterm birth, the risk of an untreated depression during pregnancy poses a similar risk. Suggesting that perhaps factors other than the SSRI treatment (such as the depression itself?) are linked with the preterm birth.

Katherine L. Wisner, Dorothy K.Y. Sit, Barbara H. Hanusa, Eydie L. Moses-Kolko, Debra L. Bogen, Diane F. Hunker, James M. Perel, Sonya Jones-Ivy, Lisa M. Bodnar, and Lynn T. Singer Am J Psychiatry (published online March 16, 2009; doi:10.1176/appi.ajp.2008.08081170)

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