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July 23, 2007

antidepressants and pregnancy: good, bad, or...

Here's something on Huff Post that would have opened a big old can of antenatally depressed worms had it been written (or performed) by Tom Cruise. But it comes instead from a boring, old doctor. His heavily footnoted message is thus: antidepressants are not a good idea for pregnant women.

The headlines and the CDC press release were incredibly misleading. In the CDC study, several severe birth defects were doubled or nearly tripled in frequency when SSRIs were taken in the first trimester. This combined with the other known toxic effects of SSRIs, including brain damage and dysfunction, make these drugs contraindicated in pregnancy.

Here's one of the headlines he refers to: Antidepressants Rated Low-Risk in Pregnancy (New York Times: June 28. 2007). The guy is not a quack. He has a good resume but he obviously has a HUGE beef with SSRIS.

The studies are clearly being interpreted differently depending on who is doing the analysis. This guy thinks it's a big deal when there are 2.8 times as many babies getting fetal (fatal) deformaties. But if the risk is only 4 in 10,000 births to start with that's still a very small number, even when multiplied by 2.8. I'm not sure if his article is hugely significant from a medical standpoint. It's certainly upsetting to anyone who feels miserably depressed in the first trimester of pregnancy and has been given the OK to use SSRIs. I do buy his argument that the perhaps overly enthusiastic headlines may increase prescriptions for even mildly depressed patients for whom the cost/benefit analysis hasn't been thoughtfully applied. Maybe that's the real question to think about: not whether SSRIs in pregnancy are good or bad but whether they are being over-prescribed.

by ceridwen at 9:59 AM
in pregnancy


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