New findings on antidepressants during pregnancy are reason for caution, not alarm

Until recently, antidepressants - especially selective serotonin reuptake inhibitors (SSRIs) - were considered fairly safe for pregnant women.

But late last year, citing evidence from several sources, the FDA warned that infants of women who took the SSRI paroxetine (Paxil) during the first trimester had an increased risk of birth defects and might develop transient withdrawal symptoms. Fortunately, studies of other SSRIs and tricyclic antidepressants indicate they are relatively safe, reports the March issue of the Harvard Mental Health Letter.

The FDA warning has many women reconsidering their options, says the Harvard Mental Health Letter. Some may be inclined to avoid all antidepressants during the first third of pregnancy. But the evidence has to be viewed in a larger context: The findings are reason for caution, but not for alarm.

"Luckily, there are many good treatment options, with or without drugs," says Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter. "Women with milder depression may want to gradually reduce the dose of medication and rely on psychotherapy and family support from the time they try to get pregnant until the middle of the pregnancy. But that may not be a good choice for women with moderate to severe depression. For them, antidepressant treatment may sometimes be necessary."

That kind of planning isn't always possible. A woman taking paroxetine might become pregnant unexpectedly and may need to choose between the increased risk of birth defects and the risks of untreated depression. Depressed mothers are more likely to miss doctors' appointments, drink alcohol, use drugs, and give birth to low-birthweight babies. Dr. Miller advises that women who stop or switch medications should make any change gradually.