Antidepressants & Birth Defects: Weighing the Risks and Benefits during Pregnancy

In observance of the National Council on Alcoholism and Drug Dependence (NCADD) Alcohol and Drug-Related Birth Defects Awareness Week, LawyersandSettlements.com reached out to Dr. Anick Bérard, director of the medications and pregnancy unit at Ste-Justine University Hospital, and a professor at the pharmacy faculty of the Université de Montréal, to weigh in on the debate regarding SSRI-related birth defects.

San Diego, CA: There’s a major row brewing among scientists and doctors over the risk and benefits of prescription antidepressants for pregnant women. The Centers for Disease Control (CDC) instructs pregnant women and women planning a pregnancy to “check with their doctor” before making a decision about the use of SSRIs or selective serotonin reuptake inhibitors like Paxil, Zoloft and other antidepressants.

The general premise is that insufficient levels of serotonin, a neurotransmitter in the brain, is the root physiological cause of a number of mood disorders, such as anxiety, obsessive compulsive behaviors and especially depression. These drugs have been used as common treatment for these disorders over the last two decades.

At the same, there has been increasing awareness that many women suffer real and serious bouts of depression during pregnancy. According to the literature, somewhere between eight and 20 percent of expectant mothers worldwide have used antidepressants during their pregnancy.

According to a National Center for Health Statistics Data Brief (Number 76, October 2011), antidepressants, or serotonin receptor reuptake inhibitors known as SSRIs, were the third-most prescribed prescription drug during the years 2005-2008. Over the last several years, SSRIs have become the most commonly prescribed drug among pregnant women, according to the information posted on the CDC website.

Until recently, it was believed that the use of SSRIs posed little to no risk to the fetus, and that, in fact, the benefits to the mother far outweighed any possible risk to the unborn baby. That view is being seriously challenged as both studies pointing to SSRI birth defects as well as antidepressant birth defect lawsuits continue to emerge.

“Over the past twenty years, we are being better at identifying the risks of antidepressant use in pregnancy. The cohorts are getting larger, more and more people are being prescribed antidepressants, so we are better at detecting risks,” says Dr. Anick Bérard, director of the medications and pregnancy unit at Ste-Justine University Hospital, and a professor at the pharmacy faculty of the Université de Montréal.

“There is a lot of evidence to show that antidepressants are risky to use during pregnancy,” Dr. Bérard says. “The scientific data shows us there is risk of pregnancy induced hypertension for the mother, and for the newborns there is a risk of neonatal withdrawal (withdrawal from the SSRIs) symptoms, spontaneous abortion, heart and other birth defects, prematurity, and possibly autism, and so there is a lot of evidence.”

In addition, there are a growing number of litigations in progress both in the US and in Canada where mothers who took SSRIs had babies born with complications, including birth defects; some babies even died. There are an estimated 2,500 cases in the US, and one major class action now underway in British Columbia, Canada.

Among those that believe in the benefit of SSRIs for pregnant women is the internationally heralded Motherisk centre in Toronto. Motherisk studies have found no risk to the baby from the mother’s use of SSRIs. Motherisk is led by the well-known physician and researcher, Dr. Gideon Koren. He declined to be interview by LawyersandSettlements for this story.

Dr. Bérard says that pregnant women who are treated with SSRIs are usually mildly to moderately depressed. The drugs are often prescribed by GPs with no specific screening to diagnosis depression.

“The association (between SSRIs and pregnant women) was probably there in the early 1990s,” says Dr. Bérard, “but now we are seeing much larger cohorts of women on SSRIs and we are able to detect an association, so there is a lot of evidence to show that there are birth defects in these pregnancies.”