SSRI Anti-Depressants Increase Congenital Abnormality Risk

Most medications have warnings on their package insert stating that the drug may not be safe in pregnancy and during breastfeeding. The reason for this is because clinical studies are not done on pregnant women, in order to determine what outcomes these medications could have on them and their unborn children, since it would be unethical to expose these individuals to any unwanted side effects and risks.

Studies regarding pregnant women and new mothers and their newborns are then done by looking at data retrospectively. That is to say that information is collected after the fact and it is then analyzed and compared in order to determine whether certain medications do cause these individuals to be exposed to any problems.

A hypothesis existed that certain anti-depressant medications, used by mothers during pregnancy, had an increased chance of causing congenital defects in these babies. Researchers then decided to look at this topic and determine whether the hypothesis was true or not.

The study

Researchers from Swansea University analyzed data from the EUROmediCAT studies of more than 500,000 babies from Denmark, Norway and Wales. They discovered that women who had used anti-depressants belonging to the group known as selective serotonin re-uptake inhibitors (SSRIs), during the first trimester of pregnancy or during the first three months before pregnancy, had an increased risk of their unborn babies developing congenital abnormalities, such as cardiac defects, or having a stillbirth compared to those women who didn't take this anti-depressant.

6 in 200 pregnancies, where SSRIs were not used, had an adverse outcome of a major congenital abnormality or stillbirth, but this risk increased to 7 in 200 pregnancies in those who used the medication. Although the increase in risk is 1 in 200, the researchers stated that the severity of the outcomes is of public health importance because SSRIs are prescribed to over 2% of pregnant women in Denmark, over 1.5% in Norway and 5.5% in Wales. Therefore, the issue isn't that the increase in risk is small, but rather that SSRI use is high and can have a significant impact on the health of babies whose mothers use this medication. 

READ Baby Blues and Postpartum Depression (PPD): Causes and Treatment

The clinical significance

The researchers of this study made the suggestion that physicians and ante-natal nurses perform the following actions:

• Review all women needing SSRI medication and not just those who are planning on becoming pregnant.
• Evaluate pre-pregnancy care when SSRIs are prescribed.
• Consider women who use alcohol or substances in excess as being at higher risk of adverse pregnancy outcomes when prescribed SSRIs.
• There should be a consideration of offering enhanced scans to at-risk women in order to detect serious cardiac defects.
• Ensure that women at risk of adverse pregnancy outcomes have appropriate levels of neonatal care when they give birth.

The message is clear though that women using SSRIs shouldn't stop taking their medication without consulting their doctors, and also discussing the benefits and risks of this medication and possible alternative natural therapies because good mental health is important for both mother and baby. 

Post-Partum Depression

A mix of emotions can occur after you give birth and this is given the name "The baby blues". It can occur after delivery of your newborn baby and symptoms include mood swings, anxiety, crying spells and difficulty sleeping. These start a couple of days after delivery of the baby and can last for a couple of weeks.

Unfortunately, in some cases, this can become a more severe and long-term problem known as post-partum depression. This form of depression has nothing to do with the affected individual's personality and it isn't a character flaw, but rather a complication of giving birth that can be effectively managed with prompt treatment.

Causes

Physical issues:

• Drop in hormone levels such as oestrogen and progesterone after delivery of the baby.
• Sudden drop of thyroid hormones that results in fatigue and depression.
• Low omega-3 levels due to the baby using this essential fatty acid for its development.

Emotional issues:

• Issues with self-image due to the physical changes of pregnancy.
• Sleep deprivation can increase anxiety.
• Anxiety over worrying whether you'll be a good mother or be able to take care of your baby can affect your mood.

Risk factors

Postpartum depression can develop in women who have the following risk factors:

• Diagnosis of post-partum depression after a previous pregnancy.
• History of depression, either during pregnancy or at other times.
• Bipolar mood disorder.
• Family history of depression or other mood disorders.
• Experienced stressful events during the preceding 12 months.
• Lowered immune system.
• Difficulty experienced with breastfeeding.
• There are health related problems with the baby.
• Financial problems.
• Problems in your relationship with your partner or spouse.
• The pregnancy was unwanted or unplanned.

Complications 

For mothers, this condition can last for months or years and develop into a chronic depressive disorder that becomes difficult to treat. For fathers, their risk of depression increases when they become a new dad and then again when the mother becomes depressed. For the child, he/she has an increased risk of developing behavioural and emotional problems that can lead to developmental delays.

READ Treat Depression Naturally: Natural and Herbal Remedies for Depression

Management

"Baby blues"

When you experience the issues of the "baby blues", there are a few suggestions that you can follow that will allow you to get through this until the symptoms resolve within a couple of weeks.

• Accept help from family and friends. They are sincere when it comes to babies, so accept the opportunity.
• Get as much rest as you can, especially when the baby is asleep.
• Connect with other new moms.
• Create time to take care of yourself.
• Avoid recreational drugs and alcohol as they can worsen mood swings.

Post-partum depression

Depression is best managed with the combined treatment of psychotherapy and anti-depressants.

Psychologists can be consulted to help discuss any concerns that you may have, and they will help you address these issues by finding healthy coping skills that you can use to solve problems and therefore reduce the anxiety caused by these issues.

Safe anti-depressants may be prescribed by your doctor to help lower anxiety and elevate your mood. Other supplements may also be prescribed to elevate depleted levels of essential vitamins, minerals and fatty acids.