Debate Rages Over Potential for SSRI Birth Defects vs. Health of Mom

Washington, DCThe debate over SSRI birth defects continues, despite many studies. It's not that there is grave concern with regard to potential birth defects present in babies born from mothers taking an ssri antidepressant. Rather, the debate centers on what's the best road to take?

The US Food and Drug Administration (FDA) continues to caution expectant mothers with regard to SSRI (selective serotonin reuptake inhibitors) antidepressants and the concern, albeit rare, of persistent pulmonary hypertension (PPHN), which is a serious and life-threatening lung condition that occurs soon after birth of the newborn.

According to the FDA, a study published by Christina Chambers et al in the New England Journal of Medicine in February, 2006 found that PPHN was six times more common to babies whose mothers took an SSRI antidepressant after the 20th week of pregnancy compared to babies whose mothers did not take an antidepressant at all.

However, the issue of potential risk to the infant is debated against the potential risk to the mother if a woman taking antidepressants stops for the potential benefit to the child.

Writing in the Women's Health section of the June 8th issue of TIME magazine, reporter Bonnie Rochman makes the point that chronic illnesses such as depression, "don't magically disappear during pregnancy."

SSRI antidepressants are not approved for use during pregnancy by the FDA. And yet the FDA cautions mothers-to-be who are already taking them, to not automatically stop without consulting with their physician.

The conundrum over pregnancy and drugs is best illustrated by two patients about whom the reporter in TIME writes. One woman, who received a diagnosis of Hodgkin's disease at the end of her first trimester, had to petition the medical authorities to give her the medications she sought. Her doctors eventually delivered her healthy son 5 weeks early to spare the infant additional rounds of chemotherapy. His mother has now been cancer-free for 10 years.

On the other end of the scale is a 21-year-old mother who learned she had melanoma while in the early stages of pregnancy. The woman underwent surgery but took a pass on chemo, fearing for the life of her child. She died when her healthy daughter was 9 months old.

Stopping an SSRI antidepressant during pregnancy could have serious consequences for both mother and child. But then SSRI birth defects are also a concern. In the end, while birth defects are always at the center of the debate, each case has to be debated individually—and there are compelling arguments on both sides.