SSRIs and the Warning Signs

San Jose, CAIncreasingly, new information and studies regarding SSRIs are warnings about the risks of birth defects if taken during pregnancy. It is now known that the use of any SSRI antidepressant in the first trimester of pregnancy is dangerous.

One study resulted in a 40% increase in birth defects and more specifically a 60% increased risk in cardiac abnormalities.

Even with this knowledge, with documented evidence, women continue to take SSRIs while pregnant. Some doctors believe that withdrawals from this group of anti-depressants are worth taking the risk. But tell that to the parents whose babies were born with congenital (found at birth) heart and lung defects.

One baby girl's problems included a Ventricular Septal Defect (VSD), Pulmonary Obstruction, Overriding Aorta and hypertrophy. From the time she was born, their baby went through several life-threatening procedures. In November, 2002, she had her first of several surgeries to place a shunt in her heart. At six months old, she had her second surgery which attempted to correct her pulmonary artery. A few months later, she had a surgery to insert a feeding tube in an effort to help her gain weight. Finally, in June, 2004 she was sent to Children's Hospital in Columbus, Ohio where she was to undergo the placement of a stent. During this procedure, it became apparent that she needed an immediate heart and lung transplant. She was to be placed on a ventilator until a donor could be found. However, the process of placing her on the ventilator was unsuccessful and she died during the procedure. She was fifteen months old.

Another baby, born September 2005 in Toledo, Ohio lived only one week. She had a congenital heart defect called hypoplastic left heart syndrome, a condition where the left side of the heart -- including the aorta, aortic valve, left ventricle and mitral valve -- is underdeveloped. The baby underwent open-heart surgery to place a shunt in her heart. After the surgery, she was placed on Extra-Corporeal Membrane Oxygenation ("ECMO"). ECMO is a life support system that is used when a baby or child has a condition which prevents the lungs from working properly, i.e. transferring oxygen into the blood and removing carbon dioxide. It is also used to support patients who have heart failure. After a week on ECMO, her condition had improved enough that she was taken off of ECMO. Unfortunately, she was not strong enough to survive on her own and she died a few hours later.

Both mothers had taken SSRIs during their pregnancy.

In late 2005 the FDA and Health Canada issued two warnings regarding first trimester exposure to paroxetine, an SSRI, and the increased risk of cardiac malformation in newborns. A study in Reproductive Toxicology published in April 2006 showed a two-fold increased risk of cardiac malformations in women taken this anti-depressant during the first trimester. This conclusion agreed with earlier unpublished reports performed in 2005 by GlaxoSmithKline, which also showed a doubled risk of cardiac malformations. Why were these reports unpublished?

Recently, investigators from the University of British Columbia, Vancouver, reported an increased risk of omphalocele (a congenital malformation in which variable amounts of abdominal contents protrude into the base of the umbilical cord) associated with first-trimester exposure to SSRIs. Using information from the National Birth Defects Prevention study, they compared data on 5,357 infants with selected major birth defects with 3,366 normal controls and interviewed mothers about exposures during pregnancy and other possible risk factors. (Children with chromosomal anomalies or known syndromes were excluded.) They found a 3 to 1 association between exposure to any SSRI during the first trimester and omphalocele.