A new study shows antidepressant use during pregnancy may increase the risk of miscarriage, casting even further doubt on what the hell depressed moms-to-be are supposed to do.
According to a EurekAlert press release, the study by researchers from two Canadian universities found a 68% increased risk of miscarriage among women who took antidepressants. The risk was greatest for those who took paroxetine (Paxil) or venlafaxine (Effexor), and those who took higher doses of the drugs or combinations thereof also saw increased risk. The study comes, as always, with a few caveats — a commentary (not online) notes that there's no "gold standard for studying the safety of drugs during pregnancy, because all methods have strengths and limitations," and that the study fails to take into account some confounding factors. Time's Alice Park notes a potentially significant one: some other studies have suggested that depression itself is a risk factor for miscarriage, and it's possible that the disorder, not its treatment, was responsible for ending some pregnancies. Lead study author Anick Bérard says, "The effect is too big, and while [depression itself] may explain a small portion, it wouldn't explain the totality of the effect." But if depression explains even a part of the increase in miscarriages, the study is yet another example of how difficult depression treatment can be for pregnant women, when both their problems and the medications that alleviate them may pose a risk to the fetus.
Miscarriage risk notwithstanding, the study press release notes that "discontinuing treatment can result in a depressive relapse which can put mother and baby at risk." Park is more specific, writing,
Past studies have shown that pregnant women who are depressed are more likely to have premature births and low birth weight babies. Their infants are also at increased risk of irritability, sleep problems and high blood levels of the stress hormone cortisol, compared with babies born to mothers without depression.
And irrespective of these postnatal health concerns, Park notes that depression treatment is key "for women who otherwise would struggle to function at their best, much less under the added stress of expecting a child." More and more, depressed pregnant women are caught in a double bind, where it can seem that anything they do may harm their kids. In a report last year, the American College of Obstetricians and Gynecologists recommended talk therapy as a first line of defense, but also advised that for some depressed women, remaining on medication might be the best course. But even without the new warnings about miscarriage, these guidelines may be too vague to help many women.
It's possible that new treatments for depression may offer a way out — one animal study has found a single brain pathway that may be responsible for "anti-depressant behavior." This study could help researchers develop targeted drugs that use this pathway only, rather than blanketing all serotonin receptors and causing a variety of side effects. But such drugs are obviously many trials away, and in the meantime depression sufferers have to manage with the flawed medications we have. These flaws notwithstanding, it's important to remember that depression is a serious disease and that forgoing treatment can have severe consequences. If the side effects of medications prove too severe, depression sufferers need real, viable alternatives — not guilt.
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