Study: Link Between Antidepressants and Miscarriage

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Study: Link Between Antidepressants and Miscarriage

By Alice Park



UPDATED: 05/31/2010

Pregnancy is often fraught with complications, not least for women suffering

from depression while carrying a child: new research suggests that women who

take antidepressant medications during pregnancy may have an increased risk of

miscarriage.

Scientists at University of Montreal report Monday in the Canadian Medical

Association Journal that women taking the drugs most often prescribed to treat

depression and anxiety -- including selective serotonin reuptake inhibitors

(SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and the older

tricyclics -- had a significantly higher risk of miscarriage than a matched

control group of women who did not take antidepressants. The study is the first

of its kind to analyze which antidepressants and which doses are most likely to

be associated with spontaneous abortion. Led by Anick BÉrard at the Faculty of

Pharmacy at the University of Montreal, the research team also documented that

two SSRIs, paroxetine (Paxil) and venlafaxine (Effexor), are associated with the

greatest risk.

BÉrard analyzed data from a pregnancy registry that she established in Quebec,

which collects records on births and spontaneous abortions occurring in

hospitals in the Canadian province. The study included 69,742 women from the

registry, 5,124 of whom had had a clinically recorded miscarriage. Among the

women who had miscarried, 5.5% had filled at least one prescription for an

antidepressant during pregnancy, compared with 2.7% of the control group.

Researchers calculated that antidepressant users had a 68% higher risk of

miscarriage than nonusers, after controlling for other influences that could

potentially confound the association.

Overall, the risk was greatest among women who combined the use of two or more

classes of antidepressants. When researchers looked at the small amounts of data

on patients using specific drugs, they found that those taking paroxetine alone

had a 75% higher rate of miscarriage than women without depression, while women

taking venlafaxine had a more than doubled risk. " To my knowledge, we are the

only ones to go further and look at which class [of antidepressant], and which

dosage increased the risk most, " says BÉrard.

However, the study was an observational one that looked retrospectively at data

already collected, which means that it's possible that some part of the

miscarriage risk picked up by BÉrard can be ascribed to depression itself,

rather than the drugs used to treat it. Indeed, the authors acknowledge that

some past research has shown that women who are depressed during pregnancy are

at increased risk of spontaneous abortion. But while acknowledging that

limitation of the current study, BÉrard stresses that it's unlikely that such

as large effect -- the 68% increase -- could be wholly attributable to

underlying causes. " The effect is too big, " she notes, " and while it may explain

a small portion, it wouldn't explain the totality of the effect. "

Still, obstetricians are not ready to stop writing prescriptions for

antidepressants just yet. Taken together, research on the risks of using

antidepressants -- and most other prescription drugs -- for expectant moms and

their developing babies is limited and often inconsistent. Evidence for the

risks associated with depression drugs has been increasing in recent years,

however, with past studies finding a link between the medications, particularly

when used during the first trimester, and as much as a sixfold increase in lung,

heart and other congenital birth defects in newborns. BÉrard's study adds solid

evidence for a new risk factor, but because it is an observational study, says

Dr. Vidaeff, director of research in the division of maternal-fetal

medicine at University of Texas Medical School at Houston, " With this level of

evidence, immediate changes in practice may be ill-advised. "

Such findings leave women with depression facing increasingly complicated

treatment decisions when they are pregnant or considering starting a family.

According to the American Congress of Obstetricians and Gynecologists (ACOG),

depression during pregnancy is common: about 14% to 23% of pregnant women will

experience depressive symptoms; in 2003, about 13% of women took an

antidepressant at some point during pregnancy. But both antenatal depression and

the use of antidepressant medications are associated with health risks to the

newborn. 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.

As with many clinical decisions, depression treatment during pregnancy is a

matter of balance. Experts advise women to discuss with their physician the

severity of their depression or anxiety and weigh their past history of

miscarriage as well, before deciding whether to reduce their dose or change

medications while carrying a child. For its part, the ACOG recommends in a 2009

report that women with severe depression stay on medication during pregnancy,

and that women who are psychiatrically stable may also be able to continue

medication after consulting with their mental-health care provider and

obstetrician. Depressed women who are not taking antidepressants or are not

helped by them should seek treatment, whether it is psychotherapy or other

interventions that can help reduce symptoms of depression and anxiety.

Although BÉrard's analysis did not include a side-by-side comparison of

antidepressant use in alleviating women's depressive or anxiety symptoms, other

research has documented the importance of maintaining such treatment for women

who otherwise would struggle to function at their best, much less under the

added stress of expecting a child.

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