Celexa Birth Defect Studies: Thorough, But Limited

Washington, DCIn August, the online publication Slate (8/7/12), owned and controlled by the same organization that publishes The Washington Post, devoted some space to the ongoing debate over pregnancy and SSRI antidepressants, and the effect the latter could have on a fetus. Celexa, part of the Selective Serotonin Reuptake Inhibitor (SSRI) class, has been cited for rare Celexa birth defects.

Doctors continue to debate the issue—an issue that is decided according to the individual needs of the patient. And doctors, as Slate notes, have their own professional bias according to their practice discipline and how they are treating the patient.

A psychiatrist, treating a woman for depression, will be biased towards protecting the mother and will often accept the small risk of harm to the fetus. An obstetrician, on the other hand, will understand the risk of advanced depression on the fetus but will also be more wary about prescribing medication in view of the potential for Celexa side effects.

Thus, a pregnant woman suffering from depression could potentially be pulled in different directions between her psychiatrist or family doctor, and obstetrician whose emphasis of care will be towards the unborn child.

"No one wants to take medications during pregnancy of any kind," says Dr. Elizabeth Fitelson, director of the Women's Program at Columbia University, in comments appearing in Slate. "And no one wants to prescribe medication."

There is good reason for that, say health advocates. Because with SSRI antidepressants you just don't know. Even though the effects of SSRIs (the most prescribed class) are among the most studied in pregnant women, the research is based primarily on observational studies.

It is widely held that Celexa is linked to birth defects, albeit the risk remains small. While it remains a risk nonetheless, quantifying that risk is difficult because researchers cannot ethically conduct randomized studies involving pregnant women. Therefore, studies need to be observational.

Various studies on Celexa side effects have linked Celexa to birth defects, such as a study in 2006 from the New England Journal of Medicine that reported infants exposed to SSRI antidepressants in the last trimester were six times more likely to present symptoms of PPHN, a pulmonary problem.

And yet the US Food and Drug Administration (FDA) takes the view there can be no causal link to SSRI use and PPHN. While two studies suggested a link, three others did not.

Another study published in July 2011 in Obstetrics and Gynecology suggested a link between Celexa and neural tube defects

It leaves a pregnant woman suffering from depression in a conundrum. Slate related the story of a Canadian woman whose previous family doctor in Halifax, Nova Scotia prescribed Celexa for her depression. Upon moving to a small town three hours outside Halifax, the woman's newly-acquired family doctor would not renew her prescription due to concern over the potential for Celexa birth defects.

She went back to her former doctor in Halifax, who was less concerned about Celexa side effects and gave her the SSRI medication.

Americans, according to Slate, take antidepressants more than all but two kinds of prescription medications. Eight percent of those are pregnant women.

Advocates of SSRI antidepressants such as Celexa make the case that it can be potentially harmful to take a severely depressed woman off her medication—and that severe depression can, itself have a negative impact on a fetus. They also state that in most cases, the worst and most common impact on the fetus is noticeable withdrawal symptoms from the SSRI at birth.

Those symptoms usually wane after a few days. However, critics of SSRIs and Celexa point to such symptoms as proof that the SSRI crosses the placenta and affects the fetus. What other, unseen impact does an SSRI have on a child?

A Celexa lawsuit is a sign that, while rare—it can happen.