Pre-publicity for the programme has incorrectly given the impression that if a mother takes a Selective Serotonin Reuptake Inhibitor (SSRI) in early pregnancy the risk of having a baby born with a heart defect increases from two in 100 to four in 100. Current evidence suggests that the risk is less than 1 in 100 and only a small increase on the 0.5 – 0.8 in a 100 risk found in the general population.
The Royal College of Psychiatrists statement aims to clarify that, although some studies have found that taking antidepressant medication in early pregnancy increases the risk of cardiac malformations in the baby, other studies have not shown this. In recent years there have been several studies from around the world of many thousands of women who have taken antidepressants in pregnancy. The better and larger studies find that the risk is much lower than indicated by the earlier research that is still sometimes referred to.
Women of childbearing age are prescribed antidepressants and it is estimated that approximately 3% of women take SSRIs in pregnancy. The baseline risk in the general population for congenital cardiac malformations in newborns is between 0.5-0.8%. Current evidence suggests that this risk might be slightly increased in babies exposed to an SSRI antidepressant in early pregnancy, but the rate of cardiac malformation is still less than 1%. It is also difficult to know whether this small increase in risk is due to the medication being taken, to the mood disorder itself, or to other factors such as smoking, high body weight, poor diet or alcohol use.
Dr Ian Jones, Vice Chair of the RCPsych’s Section of Perinatal Psychiatry, said: “Although it is still difficult to know for definite whether antidepressant medication increases the risk of malformations in babies, what we can be certain of is that any increase in risk is small. Depression in pregnancy and following childbirth (the postpartum period) is common, and is an illness with potentially serious consequences. It can be severe, with serious implications for the woman, her baby and her wider relationships. Suicide is a leading cause of maternal death in the UK.”
Dr Liz McDonald, Chair of the RCPsych’s Section of Perinatal Psychiatry: “Women should not be taking medication in pregnancy if they don’t need to. For a woman taking an antidepressant and who is considering starting a family, or finds that she is pregnant, this is an excellent time to consider whether the medication is still required. Women should not stop their medication suddenly and, if they are concerned about continuing the antidepressant in pregnancy, they should discuss the options with their doctor.”
For some women, episodes of depression may be mild and brief, while in others they may be very severe and long lasting. A range of different treatment approaches may help women with depression and may include improved support, specific psychological and social interventions and for some women treatment with medication. In general the National Institute for Health and Care Excellence (NICE) only recommends antidepressant treatment for people with moderate to severe episodes of depression. It is vital that women who become depressed in pregnancy can access appropriate and timely help. For some women with moderate to severe episodes of depression, or with a history of severe mental illness, taking medication in pregnancy may be the most appropriate decision.
Dr Liz McDonald said: “The decision to take medication in pregnancy is always difficult. It must be made by women themselves, following discussion with their doctors where they weigh up the risks and benefits of all options, taking into account their individual needs and circumstances. It is important to recognise that severe psychiatric illness may have negative consequences for the woman, her baby and her family, and these must be weighed against what is known about the risks of taking medication.
“Antidepressants definitely have their place. Not only is suicide a major risk, but if a woman has an episode of depression it can have profound implications for the mother, baby and the whole family. There may be risks with taking antidepressants, as with other medications, but the risks are small and women who are concerned should discuss the balance of benefit and risk with their doctor.”