Why are SSRIs Still Prescribed?

Up to twenty percent of women have clinical depression during their lives and for many, depression does not improve during pregnancy.

Pregnant women whose depression is not adequately treated may make decisions that can harm the baby such as not eating well or using alcohol, or continuing to take SSRIs - a group of antidepressants that include Paxil and Zoloft.

In July 2006, The FDA warned about the correlation between SSRIs and birth defects, particularly persistent pulmonary hypertension (PPHN) in newborns. Two years earlier, in August 2004, Health Canada warned that taking Paxil during late pregnancy could put babies at risk: international and Canadian reports indicated that some newborns developed complications at birth requiring prolonged hospitalization, breathing support and tube feeding.

It wasn't until December 2006, that the American College of Obstetricians and Gynecologists published in its journal, Obstetrics & Gynecology, a warning to women who are pregnant, or plan to be, to avoid taking Paxil because of a risk of birth defects.

There are, of course, other and safer drugs to alleviate depression, such as the tricyclic antidepressants. Still, SSRIs continue to be the big sellers, even though two recent studies raised concerns about the safety of SSRIs during pregnancy.

In February 2006, researchers conducting a study in San Diego proved PPHN to be six times more common in babies whose mothers took an SSRI antidepressant after the 20th week of pregnancy compared to babies whose mothers did not take an antidepressant. The study, published in The New England Journal of Medicine, emphasized concerns from earlier reports that infants of mothers taking SSRIs late in pregnancy could experience a range of problems, including difficulty breathing. (Around the same time, the labeling for Paxil was changed to warn that exposure to the drug in the first trimester of pregnancy may be associated with an increased risk of cardiac birth defects.)

Even now, with this evidence, pregnant women are advised not to discontinue use of SSRIs before speaking to a doctor. But for some babies, their mother's visit to the doctor to discuss whether or not to continue taking Paxil or Zoloft or any other SSRI may come too late.