Thousands of pregnant women at risk from antidepressants, doctors warn — (The Telegraph)

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The Telegraph

9:14AM BST 25 Oct 2012

 Doctors are putting thousands of pregnant women and their unborn children at serious risk of harm by prescribing them anti-depressants, senior doctors are warning.

Senior doctors say that “study after study” shows the most widely used class of anti-depressant, called selective seratonin reuptake inhibitors, or SSRIs, cause pregnancy complications including premature birth and pre-eclampsia, which can both be fatal.

Emerging research also suggests SSRIs can double the rate of autism in children, and increase the risk of lung and bowel diseases.

The situation amounts to “a large scale human experiment”, according to Dr Adam Urato, assistant professor of maternal-fetal medicine at Tufts University School of Medicine in Boston, Massachusetts.

Drugs firms were overstating the benefits and underplaying the risks for the sake of profit, he claimed. Family doctors were failing to grasp the true dangers and tell pregnant patients of them, he argued.

He said: “Study after study shows increased rates of newborn complications in those babies who were exposed to SSRIs in-utero. The Federal Drugs Administration [in the US] and Health Canada have put out warnings specifically regarding this issue.”

At least 40 studies had shown a link between taking SSRIs in pregnancy and birth before 37 weeks, which can endanger the child, he said.

And four had shown an increased risk of pre-eclampsia, a type of pregnancy-related high blood pressure that occasionally leads to serious complications including liver problems, stroke and even stillbirth.

A recent study indicated double the rate of autism of children whose mothers had taken SSRIs in pregnancy, he said. Although this link was far from proven, he said: “The available evidence raises serious concerns.”

He said doctors were still prescribing SSRIs to pregnant women with mild-to-moderate depression because they believed the drugs worked to control her mood, which would lead to “a better pregnancy result”.   But he claimed: “There really is not a shred of evidence to support that. Yet still this myth persists.”

Pharmaceutical firms had no reason to shout about the risks, he said, but every incentive to broadcast the apparent benefits.   He said: “It is a fact that these antidepressants have been very lucrative for the pharmaceutical industry and it is a fact that many of the users of these drugs are women of childbearing age.

“It stands to reason to me that the drug makers would rather that the risks of these agents in pregnancy not receive widespread attention as that would be a reason for many women to not take the drugs in the first place or to stop taking them—both of which are not good for sales of the product.”

Dr Alice Domar, a psychologist and assistant professor at Harvard Medical School, said: “The group of people most likely to prescribe them are general practitioners, not psychiatrists.

“You come in and you say I’m not feeling very well, I’m feeling lethargic so the physician writes a prescription.”

She clarified: “We’re not saying that every pregnant woman should go off her medication. Obviously you don’t want a pregnant woman to attempt suicide.”

Evidence showed SSRIs did help those with severe depression, she noted.

But she said doctors and patients must be better informed about the possible harms.

“If you add up all the potential risks, a lot of people would say they are unacceptable,” she said.

Pregnant women should be offered alternatives to pills such as ‘talking cures’ like cognitive behavioural therapy (CBT), she urged.

Dr Domar raised the subject this week during a talk at the annual conference of the American Society of Reproduction in San Diego.

She was presenting new figures indicating about one in 10 American women undergoing IVF take anti-depressants, more than double existing estimates.

Dr Urato and Dr Domar will outline their concerns next week (w/c 29/10) in the journal Human Reproduction.

In Britain it is thought about 20,000 pregnant women take SSRIs every year. The Medicines and Healthcare products Regulatory Agency advises that decisions over whether to prescribe them to pregnant women need “very careful assessment of risks to the mother and foetus”.

It also states it is “not possible to give definitive advice” on SSRI use among pregnant and breastfeeding women due to “insufficient reliable data”.

A spokesman for the Association of the British Pharmaceutical Industry (ABPI) said treatment decisions were a matter for doctors to weigh up in discussion with their patients.

He said: “Clinical decisions about the treatment of depression are complex and must be made by clinicians in consultation with individual patients, regardless of whether or not they are pregnant.

“The decision about whether to prescribe a SSRI or to undertake a course of cognitive behavioural therapy, or a combination of the two, is therefore one that should be taken on an case by case basis and made in the best interests of the patient.”