by Iman Ashour

Created on: September 22, 2007

When I got pregnant I was already on Effexor an antidepressant- that is considered a category C pregnancy drug. This means that not enough studies or research exists to fully understand the effects of this drug on pregnancy.

Having to discontinue this medication was one of the hardest things I had ever had to do on a physical, emotional and mental level as I had to tolerate extensive withdrawal symptoms that lasted a good 3 months for the sake of the baby.

Affective disorders such as depression are common among women of childbearing age and it is advised that all pregnant women should be screened and treated for depression. Given that untreated depression can have serious clinical and social perinatal consequences, it would be difficult to avoid all use of antidepressant medications during pregnancy.

In this article I have focused my attention on pregnancy and the use of anti-depressants, a situation more and more women are finding themselves in this day and age as at the present time there is limited information on the use of antidepressants during pregnancy.

Here we refer to the first trimester as the time ranging from the last menstrual period through the following 90 days, the second trimester as the next 90 days, and the third trimester as the remainder of the pregnancy.

The main source of reference here is the JUNE 2007 issue of American Journal of Obstetrics & Gynecology. William O. Cooper et al. Where they noted an increasing trend in the use of anti-depressants starting from the years 1999 through 2003. By 2003, more than 13% of pregnancies had an antidepressant exposure. SSRIs (selective serotonin reuptake inhibitors), a commonly used class of antidepressants accounted for most of the increase in antidepressant exposures, with use of these drugs by more than 10% of pregnant women by 2003 (One can only conclude that this trend continues to be on the rise.)

Though this study showed that mothers most likely to have pregnancy- related antidepressant exposures included older women, white women, and women with more than 12 years of education. Interestingly, some population based studies have suggested that maternal depressive symptoms occur more frequently among racial and ethnic minorities.

The study also showed that SSRI (Selective serotonin reuptake inhibitor anti-depressants) exposure occurred most commonly in the first trimester. There was less frequent use during pregnancy of serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and other antidepressants, but, as was the case for the other antidepressants, such exposure was most frequent during the first trimester. One can explain this as was my case- that women on these medications accidentally find out they are pregnant while on the drug then discontinue it for the remainder of the pregnancy.

Although the available data suggest there are adverse effects associated with foetal exposure to some antidepressants, these data are limited, particularly with regard to the effects of individual drugs, especially the newer ones that are being introduced as medicine advances and with medical ethics limiting research.

Thus, there is an urgent need for further studies that better quantify the foetal consequences of exposure to antidepressants.

The dilemma remains: should a pregnant woman stop or continue an anti-depressant that has been minimally researched with regards to its effects on pregnancy and foetal development Or should she switch to one that is safer but poorly controls her symptoms?

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