A few antidepressants linked to birth defects

“Reassuringly, we found that we could not replicate five earlier reported links with birth defects for sertraline, which is the most commonly used SSRI in our US study population”, said Jennita Reefhuis, a birth defects epidemiologist at the US Centers for Disease Control and Prevention in Atlanta, Georgia, and lead author of the investigation.

Researchers in the United States focused on selective serotonin reuptake inhibitor (SSRI) antidepressants, which they said are increasingly being used by women of reproductive age and during pregnancy. The team recorded use of the following SSRIs among the women from 1 month before conception up until the third month of pregnancy: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft).

They gathered data on 17,952 mothers whose children were born with birth defects and 9,875 mothers with children born without defects from 1997 to 2009.

But the study didn’t prove that the medications cause birth defects, and experts aren’t advising women to stop taking the drugs entirely.

Researchers are quick to note that even in the case of paroxetine and fluexetine, the absolute risk of these defects is still very small.

In an interview, Reefhuis said: “The main message is that depression and other mental health conditions can be very serious and many women need to take medication to manage their symptoms”.

Earlier studies had reached conflicting conclusions, leading to uncertainty around the safety of using antidepressants during pregnancy.

But they stated: “Although our analysis strongly supports the validity of the associations that were observed, the increase in the absolute risks, if the associations are causal, is small”.

The data suggests that a few birth defects occur more frequently among the infants of women treated with paroxetine or fluoxetine in early pregnancy, said the researchers. Two birth defects were associated with fluoxetine: heart defects and irregular skull shape.

The Food and Drug Administration issued a warning in 20005 that the risk for birth defects, and heart defects in particular, could be increased by Paxil.

Treatment guidelines regarding depression during pregnancy published in 2009 by the American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend discontinuing antidepressants if women are minimally symptomatic for a long period of time, but allow for the initiation or continuation of antidepressants if a woman is experiencing a moderate or severe episode or has a history of them. Zoloft, made by pharmaceutical giant Pfizer, is the subject of a major lawsuit over charges of birth defect. No links were found between birth defects and Zoloft, by far the most commonly used antidepressant, researchers say. “This paper showed that those antidepressants that appeared to be less safe do not show as high a risk of birth defects as some of the earlier reports showed, so that’s also reassuring”.

McCabe told NPR he hopes women will understand that “being on an antidepressant should not keep them from having a pregnancy, because they can be put on a drug that’s safe for their baby and will control their depression”.