By Dr. Mercola
It’s estimated that 14 percent of US pregnant women use antidepressants,1 and it’s often suggested to be safe to do so. New research, however, adds to the growing number of studies showing such drugs may harm your unborn baby while offering little benefits to mom.
The new study, published in BMJ, specifically looked at the effects of selective serotonin reuptake inhibitors (SSRIs) used during the first trimester of pregnancy and in the month before.
They analyzed data from nearly 30,000 women and revealed the use of the antidepressant Paxil (paroxetine) was associated with an increased risk of five birth defects, including heart defects, and anencephaly, which is abnormal brain and skull formation.2
The use of Prozac (fluoxetine) was associated with two birth defects, including heart wall defects and abnormal skull shape (craniosynostosis).
The increase in absolute risk was low; for instance, 10 out of 10,000 women may give birth to a baby with a heart defect but this increased to 24 out of 10,000 among those using Paxil.3
Still, some birth defects occurred two to three times more often in babies born women taking the drugs, and when the increased risk is combined with the many other studies showing harm, and few showing benefit, it poses a serious concern.
Tinkering with Serotonin in Utero Might Be Dangerous
The US Food and Drug Administration (FDA) first published a warning about the association between Paxil and heart defects in infants exposed in utero in 2005.4 In 2009, research again confirmed the SSRIs increase the risk of congenital heart defects when used in early pregnancy.5
Other reports have linked SSRIs to long-term developmental effects, both of which make logical sense when you consider SSRIs’ mode of action. The drugs work by blocking reuptake of serotonin, thereby altering levels of this neurotransmitter in pregnant women.
The drugs are also known to cross the placental barrier and reach the fetus. Dr. Adam Urato, a maternal-fetal medicine specialist at Tufts Medical Center, explained to The New York Times:6
“Serotonin is a critical neurotransmitter and cell-signaling molecule… From the brain, it signals the neurons where to go, what to do, and how to develop.
It signals the heart; it plays an active role in the gut; and it plays an important role in the formation of the lungs. What it does during development is basically everything.”
SSRIs Linked to Long-Term Developmental Effects, Heart Problems
Tinkering with serotonin levels in utero may have serious repercussions. To date, the drugs have been linked to a rash of serious side effects, including the following:
- Boys with autism were three times more likely to have been exposed to SSRIs before birth than boys without autism7
- Children born to women who took antidepressants during pregnancy were nearly twice as likely to develop attention-deficit hyperactivity disorder (ADHD)8
- Prolonged use of SSRIs during pregnancy was associated with lower language competence at the age of 39
- Women using antidepressants during the second and third trimesters are more likely to give birth prematurely10
- Babies exposed to SSRIs in utero have an increased risk of clubfoot, low birth weight and persistent pulmonary hypertension11
There’s even research showing babies exposed prenatally to SSRIs had lower Apgar scores at birth, which is a measure of newborn well-being.12 It’s also thought the drugs disrupt fetal deep sleep, which is crucial for normal growth and development.
They’ve also been linked to an increased risk of miscarriage,13 and many babies exposed in utero even display withdrawal symptoms to SSRIs at birth.
Do SSRIs Help Pregnant Women with Depression?
There’s no doubt that depression, whether it occurs during pregnancy or otherwise, is a serious issue that needs treatment. But whether antidepressants are the best treatment is easily debatable.
As Barbara Mintzes, an associate professor at the University of British Columbia School of Population and Public Health, pointed out in The New York Times, the drugs often appear to cause far more harm than good:14
“If antidepressants made such a big difference, and women on them were eating better, sleeping better, and taking better care of themselves, then one would expect to see better birth outcomes among the women who took medication than among similar women who did not…
What’s striking is that there’s no research evidence showing that… when you look for it, all you find are harms.”
Likewise, a study in the January 2010 issue of JAMA concluded there is little evidence that SSRIs have any benefit to people with mild to moderate depression (the group to which they’re most often prescribed), and they work no better than a placebo.15
Those researchers concluded:
“The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.”
A meta-analysis published in PLoS Medicine also concluded that the difference between antidepressants and placebo pills is very small — and that both are ineffective for most depressed patients.16 Only the most severely depressed showed any response to antidepressants at all, and that response was quite minimal.
Antidepressants Might Promote Relapses into Depression
Meanwhile, in an interview, Pulitzer Prize nominee Robert Whitaker also explained that research suggests the use of antidepressant drugs may actually result in more relapses back into depression in the long run. In other words, these drugs may be turning depression into a more chronic condition.
According to Whitaker’s research, this tendency to sensitize your brain to long-term depression appears to be the same both for the earlier tricyclic antidepressants and the newer SSRIs.
Another famous psycho pharmacologist named Ross Baldessarini at the Harvard Medical School also began asking whether or not these drugs may in fact be depressogenic (causing depression).
Unfortunately, the evidence points that way, and the long-term prognosis when taking antidepressants is quite bleak, as this type of drug treatment has a whopping 85 percent chronic relapse rate.
Making matters worse, if you do not have low serotonin levels when you’re depressed, but you start taking an SSRI drug that blocks the normal reuptake of serotonin, you end up with the very physiological problem the drug is designed to treat low serotonin levels.
Which, ironically, is the state hypothesized to bring on depression in the first place. In 1996, neuroscientist Steven Hyman, who was head of the National Institute of Mental Health (NIMH) at the time, published the paper “Initiation and Adaptation: A Paradigm for Understanding Psychotropic Drugs,”17 in which he explains this chain of events.
According to Dr. Hyman, once your brain has undergone these compensatory adaptations to the drug, your brain operates in a manner that is “both qualitatively and quantitatively different than normal.” As Whitaker explained, antidepressants are not actually “normalizing” agents but could be more aptly described as “abnormalizing” agents.
Antidepressants Are Found in Water Supplies
If you’re considering taking an antidepressant while you’re pregnant, you should discuss it carefully with your holistic physician. However, even pregnant women not directly using such drugs may be exposed via another route – their drinking water.
In an analysis of marine water from 30 sites in Australia, significant levels of painkillers and antidepressants were detected.18 It’s thought that sewage water may be leaking into storm water pipes and contaminating the water. Other chemicals of concern were also detected, including beta blockers, an epilepsy medication, and pesticides.
Although the levels detected were generally low, it’s unknown what health effects such exposures will have on the general population, especially one that’s particularly vulnerable, such as pregnant women. Your best protection at this point is to install a high-quality water filter in your home (at both your tap and your shower/bath) to minimize your exposure to pharmaceuticals and other contaminants in your drinking water.
Most Medications Are Not Tested for Safety During Pregnancy
It’s not only antidepressants that deserve careful consideration before use if you’re pregnant. The truth is you need to be very careful when taking any drugs during this time. The nine months of development that take place in the womb are the most rapid and most vulnerable period of your baby's life. For this reason, it is generally best to avoid taking any medications unless absolutely necessary, including while you're trying to conceive, as you could become pregnant and not know it.
Most medications have never been tested on pregnant women and their effects on a developing baby are completely unknown. Even the U.S. Centers for Disease Control and Prevention (CDC) acknowledges that very little is known about the impacts of most medications on unborn babies:19
"We do not have enough information about the effects of many medications when they are taken by pregnant women… All prescription and over-the-counter medications are tested to see if they are safe and effective before they become available to the public.
Pregnant women usually are not included in these tests because of the possible risks to the unborn baby. As a result, little information is available about the safety of most medications during pregnancy — including those available over the counter — when they first become available."
Even presumably “safe” medications like acetaminophen (Tylenol) can be risky. For instance, acetaminophen use during pregnancy was linked to a 30 percent increased risk for ADHD in the child, and a 37 percent increased risk of hyperkinetic disorder (HKD), a severe form of ADHD.20
If You’re Pregnant and Depressed, What Options Do You Have?
If you are experiencing severe depression and you’re pregnant, please seek help from a professional. For milder depression, and in addition to professional treatment for severe depression, the place to start is to return balance — to your body and your life. Fortunately, research confirms that there are safe and effective ways to address depression that do not involve unsafe drugs. This includes addressing your gut health and more, as described below:
- Dramatically decrease your consumption of sugar (particularly fructose), grains, and processed foods. (In addition to being high in sugar and grains, processed foods also contain a variety of additives that can affect your brain function and mental state, especially MSG and artificial sweeteners such as aspartame.) There's a great book on this subject, The Sugar Blues, written by William Dufty more than 30 years ago, that delves into the topic of sugar and mental health in great detail.
- Increase consumption of probiotic foods, such as fermented vegetables, to promote healthy gut flora. Mounting evidence shows that having a healthy gut is profoundly important for both physical and mental health, and the latter can be severely impacted by an imbalance of intestinal bacteria. Avoiding sugar will also help toward this end.
This is especially important during pregnancy, because if mother's flora is abnormal, her baby's flora will also be abnormal. Whatever organisms live in her vagina end up coating her baby's body and lining his or her intestinal tract.
- Get adequate vitamin B12. Vitamin B12 deficiency can contribute to depression and affects one in four people.
- Optimize your vitamin D levels, ideally through regular sun exposure. Vitamin D is very important for your mood. In one study, people with the lowest levels of vitamin D were found to be 11 times more prone to be depressed than those who had normal levels.21 The best way to get vitamin D is through exposure to sunshine. Optimizing your vitamin D levels is also essential during pregnancy.
- Get plenty of animal-based omega-3 fats. Many people don't realize that their brain is 60 percent fat, but not just any fat. It is DHA, an animal-based omega-3 fat, which, along with EPA, is crucial for good brain function and mental health.22 Unfortunately, most people don't get enough from diet alone. Make sure you take a high-quality omega-3 fat, such as krill oil, or consume sardines or anchovies regularly.
Dr. Stoll, a Harvard psychiatrist, was one of the early leaders in compiling the evidence supporting the use of animal based omega-3 fats for the treatment of depression. He wrote an excellent book that details his experience in this area called The Omega-3 Connection. Here again, consuming adequate levels of omega-3 fats will also promote better pregnancy outcomes.
- Evaluate your salt intake. Sodium deficiency actually creates symptoms that are very much like those of depression. Make sure you do NOT use processed salt (regular table salt), however. You'll want to use an all-natural, unprocessed salt like Himalayan salt, which contains more than 80 different micronutrients.
- Get adequate daily exercise, which is one of the most effective strategies for preventing and overcoming depression. Studies on exercise as a treatment for depression have shown there is a strong correlation between improved mood and aerobic capacity. So there's a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place.
- Get adequate amounts of sleep. You can have the best diet and exercise program possible, but if you aren't sleeping well you can easily become depressed. Sleep and depression are so intimately linked that a sleep disorder is actually part of the definition of the symptom complex that gives the label depression.