Ever since I first started reading about congenital heart defects, an article would pop up about a link between antidepressants and CHD every few days. The articles seem to largely be stirred up by law firms looking for clients, parents of children with birth defects that took antidepressants during pregnancy in particular. Obviously the law firm has something at stake and isn’t the best source. But, there has been at least one study that found a real link.
To be clear, I’m not a medical professional, but decided to take a look at this. When I was pregnant with Cora, I suffered from prenatal depression. I was offered antidepressants on several occasions but refused to take them. I was terrified to take anything while pregnant. Next time I’m pregnant, if I have depression, I’ll take antidepressants. I don’t find the link between these drugs and birth defects, in particular CHDs, compelling. That’s not to say there isn’t a link. But after battling depression the first time around, I would take antidepressants while pregnant. The risk from untreated depression outweighs the unproven birth defect risk. In fact, studies are looking at low serotonin levels being linked to birth defects, including some heart defects. Many antidepressants raise serotonin levels.
I’m particularly look at one type of antidepressant, SSRIs (Selective Serotonin Reuptake Inhibitor) because this family seems to be in the news more than most and also what most doctors seem to prescribe for pregnant women.
SSRIs
Different types of antidepressants and the impact on neonatal health including CHDs has been studied. SSRIs, a family of antidepressants that include Zoloft, Prozac and Lexapro are generally cleared by the medical community, with data backed by research studies, for used during pregnancy. Yet, not a week goes by that I don’t see a law firm commercial advertising law suits against the drug company for congenital heart families that used drugs like Zoloft and Paxil.
These drugs have been found safe for use during the first trimester when the heart is formed and CHDs develop. In fact, any concerns are about use late in pregnancy because babies born with SSRIs in the system sometimes have symptoms like respiratory distress.
Paxil
Just a few months after I started this CHD journey, news reports starting rolling in linking Paxil to CHD. I fell for it myself and started to suggest that women look for other antidepressants. Paxil, or parxotene was generally thought safe until a research study by Glasxo SmithKline, the maker of Paxil, studied retrospective epidemiological data in both the United States and Sweden and found an increase risk of babies being born with congenital heart malformations compared to other SSRIs. At the time, GSK wasn’t even looking at Paxil information, but was conducting the study to examine if Wellbutrin was associated with higher birth defects (it was not). This report is conflicting to others looking at Paroxtene that found no link, both before and after the GSK report.
With the report, came an FDA warning against taking while pregnant. And, with the multitude of SSRIs on the market, avoiding this particular one might be a good idea when possible.
The law firms soon picked up on the report and the family of a child born with a heart defect whose mom used Paxil during the first trimester won $2.5 million in one suit. I feel for the family, and of course am not a doctor to rule out the link.
But, the ensuing law firm hype gives a biased picture. Google “paxil and birth defects” and a multitude of law firms pop up, all giving a biased view of the true effect of Paxil. In fact, these law firms most likely employed top-notch SEO experts to get to the top of the search engines. Press releases sent to news agencies sealed the deal. The law firms of course have a motivation to seek clients and to make the link, money.
I have a little bit of inside knowledge about law firms that seek clients for these types of law suits. One summer I worked at a law firm on Wall Street calling potential clients that had entered information on a website about damages from a pain relief medication. The clients sometimes were obviously lying or unsure, but we were told to just check “yes” if they said they were injured. Lots of money went into this project, meaning of course the firm needed to recoup this costs. While this is a tiny bit of conjuncture, it’s not a far leap to connect
Risks of Untreated Depression
I haven’t hidden my prenatal depression. I was exited to be pregnant, but also have a long history of depression and being unmedicated and going through all those changes to my body, depression was almost a given. I’ve had so many bouts, I feel like it gets easier to handle each one, however. But, looking back to my first few bouts with depression, I can only imagine how much more difficult it would be to be depressed and pregnant for women that haven’t gone through clinical depression.
Untreated depression can be harmful both to the mother and the baby. A mom might have trouble remembering prenatal vitamins, doctor’s appointments and other treatments leading to a skewed treatment schedule. I didn’t miss an appointment while pregnant, but was also unemployed at the time, so it was the only thing I HAD to do.
Moms are also less likely to eat healthy and exercise. I started out eating healthy, but… I planned on exercising, but… I found both of these to be true. And, a healthy diet and exercise are good for mom and baby.
Conclusion
I think this quote from a research study looking at the risks of untreated depression sums things up well.
No in-depth discussion of the role of psychotherapy is available. Because they are not aware of the potentially catastrophic outcome of untreated maternal depression, this imbalance may lead women suffering from depression to fear teratogenic effects and refuse treatment.
I know the fear of birth defects scared me away from getting depression treatment. Obviously, my daughter still was born with a birth defect.
As mothers, we all want to do what’s best for our babies. I know moms like to be able to say, “I took nothing the entire time I was pregnant.” And, that’s quite noble. I think avoiding unnecessary medications is absolutely the way to go.
But, for many women, myself included, the risks of untreated depression are much worse. You might endanger your future child by refusing medication. It’s hard to make that connection and to admit that you “have to take something” while pregnant.
I also don’t want to be a drug pusher. The point is this, the decision to take antidepressants or not during pregnancy is up to each woman. Everyone is different and unique. Think about it and talk it over with experts. Just don’t fall for the law firm hype.
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