Mom Alert: Would you want a 68% Higher Risk of Miscarriage?

June 2nd, 2010. By LucyC

A new study out yesterday—June 1, 2010—has revealed a higher rate of miscarriages in women who were taking antidepressants during pregnancy. How much higher? Sixty-eight percent—yes —that’s 68%—higher. Frankly, that is nothing short of shocking.

Published in the Canadian Medical Association Journal, the study was done in Canada through the University of Montreal. FYI—This was no small study either—the investigators used data from 5,124 women who are part of a large, population-based study of pregnant women who had clinically verified miscarriages, and a large sample of women from the same registry who did not have a miscarriage. Among the women who miscarried, 284 or 5.5 percent, had taken antidepressants during their pregnancy.

In fact the findings are so robust that the physicians who did the study are suggesting that this is a class effect—in other words the effect could be attributed to all selective serotonin reuptake inhibitors—or SSRIs. Here’s what’s being reported in the press:

“These results, which suggest an overall class effect of selective serotonin reuptake inhibitors, are highly robust given the large number of users studied,” the study’s senior author, Dr. Anick Berard, said in a statement. (UPI.com)

The antidepressants that showed a particular association with miscarriage in the study were paroxetine (trade names: Seroxat and Paxil) and venlafaxine (trade names: Effexor, Efexor, Alventa, Argofan, Trevilor). The investigators also found that the risk of miscarriage doubled with a combination of different antidepressants.

Just for the record, the antidepressants “investigated” in the University of Montreal study are serotonin reuptake inhibitors (citalopram, fluoxetine, fluvoxa-mine, paroxetine and sertraline); tricyclic antidepressants (ami-triptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, trimipramine), serotonin– norepinephrine reuptake inhibitors (venlafaxine) and “other antidepressants” (serotonin modulators, monoamine oxidase inhibitors, tetracyclic piperazino-azepines, and dopamine and norepinephrine reuptake inhibitors).

This study is just the latest to show an association between, well, for lack of a better term let’s say “serious adverse events” and SSRIs and SNRIs in particular. SSRIs and SNRIs, which go by the trade names Prozac, Zoloft, Paxil, Symbyax, Celexa, Cymbalta, Effexor and Lexapro, have been linked to serious birth defects including persistent pulmonary hypertension of the newborn (PPHN), and a litany of other unwanted outcomes including developmental delays, brain and spinal cord and other physical defects.

Encouraging, no? I’m not trying to make light of it—quite the opposite in fact. What kills me is that the authors of this latest study suggest that as a result of their findings doctors should discuss the risks and benefits of antidepressant use during pregnancy with their patients. What doctor worth his credentials wouldn’t already be doing that—especially given the litany of alleged serious adverse events already associated with antidepressants. Personally, I don’t think you need a medical study to suggest doctors ought to inform their patients prior to prescribing these drugs. Sorry—but that’s a no brainer.

Where the problem lies, for doctors and their patients, is in finding a safe treatment for depression during pregnancy. As Dr. Berard added, stopping antidepressant medication can result in a depressive relapse that can put mother and baby at risk. And that’s an issue that no one currently has a satisfactory answer for—other than possibly avoiding pregnancy altogether. What we need is King Solomon—but maybe even he wouldn’t know what to do. Mother or baby? You decide.

Finally, while it is essential to have studies like this latest one from Montreal, because it is credible science that improves our ability to make informed decisions, what we really need is a means of dealing with depression and a host of other related illnesses that don’t put people’s lives at risk. If we’re lucky, some bright young things will figure out the answer to that dilemma very soon.

Tags: Celexa, Cymbalta, Effexor, Lexapro, paxil, paxil-heart-defects-newborn, Prozac, SNRI, SSRI, Zoloft

This was posted on Wednesday, June 2nd, 2010 at 4:26 pm and is filed under Drugs/Medical . Feel free to respond, or trackback. Read our comments policy.