Up to 20 per cent of women experience depression during pregnancy and 13 per cent decide to take medication for it. Since we know that a woman’s risk of developing postpartum depression increases if her depression during pregnancy is left untreated, we know it’s important that she not only be identified and obtain access to treatment, but that the safety and most appropriate treatment is administered especially since we also know that postpartum depression can have lasting negative effects on the child.
According to a new study published in the JAMA (the Journal of the American Medical Association), the use of selective serotonin reuptake inhibitors (SSRIs) among pregnant women used to treat perinatal depression or anxiety is on the rise even though their impact on an infant’s health is still unclear.
For the first time ever, however, according to the authors of the study, researchers say they have found “increased volumes of the amygdala and insular cortex as well as increased white matter connection strength between these two regions in prenatally SSRI-exposed infants,” regions of the brain which are critical to emotional processing.
“Abnormalities in the amygdala-insula circuitry may be associated with anxiety and depression,” note the authors. “Increased amygdala volumes are seen in both children and adults with anxiety disorders.”
So what to do if you’re pregnant and experiencing a mental health issue such as depression or anxiety? Should you go on medication or not? That depends on what your doctor, obstetrician, or midwife recommends but ultimately, the decision is up to you.
Perhaps you’ll try therapy. Studies have found positive results from the use of therapy during pregnancy for women experiencing depression. In one study, women’s scores on the Hamilton Depression Rating Scale improved by participating in a 16-week interpersonal psychotherapy program.
But while therapy can be a fantastic option for some, for others with severe anxiety or depression, medication might be a necessity so it’s important to get to the bottom of whether they’re safe or not.
Studies on the effect of perinatal SSRI exposure in the offspring of rodents found brain alternations as well as increases in anxiety and depression-like behaviors in adults in rodents who had early-life exposure to SSRIs.
In studies in humans, SSRI exposure has been associated with a shorter gestational period, lower birth weight, lower Apgar scores, and neonatal abstinence syndrome. Another study with 15,000 participants who were exposed to SSRIs prenatally has found increased rates of depression in early adolescence.
A study by Women’s College Hospital in Toronto, Ontario, Canada and the Institute of Clinical Evaluative Sciences published in JAMA in 2017 found that taking antidepressants during pregnancy did not increase the risk of autism in children, as was previously feared.
In the most recent study, researchers began by asking the question: Is prenatal exposure to SSRIs associated with fetal brain development?
To obtain an answer, the brains of 98 infants were examined using magnetic resonance imaging (MRI) between 2011 and 2016. The mothers of 16 of the 98 infants took SSRIs throughout pregnancy, mothers of 21 of the 98 infants with maternal depression were untreated, and there was a control group of 61 health infants. Though researchers did find brain alterations in prenatally exposed infants, they recommend further long-term studies.
“Further study is required to better elucidate the effects of gestational SSRI exposure on fetal brain development and later life susceptibility to depressive, cognitive, and motor abnormalities,” write the researchers, “Such information may eventually allow more informed clinical decisions about how to best treat psychiatric disorders during pregnancy for the benefit of both mother and fetus.”
Though this most recent study has the potential to change what doctors recommend to their patients, a study in 2013 by Dr. Lori Ross, senior scientist at the Centre for Addiction and Mental Health and adjunct scientist at Women’s College Research Institute found that for outcomes such as gestational age at birth, birth weight and Apgar scores, though there were statistically significant differences between women who took antidepressants and those who didn’t, "the differences were small, and the results for women who took antidepressants were still within the normal range."
"There are some potential risks of using antidepressants and women should definitely be made aware of them," said Dr. Ross in a blog post on the Women's College Hospital website, "but they also need to be made aware of the magnitude of the risk, considering whether a 75-gram difference in birth weight is worth all the difficult things that come with experiencing depression...The reality is that many women end up taking antidepressants because there are no other treatment options for depression available to them. I wish there were more options for women, but antidepressants should not be ruled out.”
Claudia Lugo-Candelas, Jiook Cha, Susie Hong, Vanessa Bastidas, Myrna Weissman, William P. Fifer, Michael Myers, Ardesheer Talati, Ravi Bansal, Bradley S. Peterson, Catherine Monk, Jay A. Gingrich, Jonathan Posner, (April 2018), JAMA, Associations between brain structure and connectivity in infants and exposure to selective serotonin reuptake inhibitors during pregnancy, https://jamanetwork.com/learning/audio-player/16294901
Chaunie Marie Brusie, RN, Today's Parent, The Truth About Antidepressants and Pregnancy, https://www.parents.com/pregnancy/my-body/pregnancy-health/the-truth-about-antidepressants-and-pregnancy/
Teri Pearlstein, (2008), Journal of Psychiatry and Neuroscience, Perinatal depression: treatment options and dilemmas, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440793/
Press Release, (April 2017), Women's College Hospital, No association between antidepressants during pregnancy and autism spectrum disorder in children, http://www.womenscollegehospital.ca/news-and-events/press-releases/2017/No-association-between-antidepressants-during-pregnancy-and-autism-spectrum-disorder-in-children
Krystal Seecharan, (May 31, 2013), Women's College Hospital, Antidepressants and pregnancy: weighing the choices, http://www.womenshealthmatters.ca/feature-articles/feature-articles/antidepressants-pregnancy