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August 5, 2020

The Association Between Antidepressant Exposure and Birth Defects—Are We There Yet?

Author Affiliations
  • 1Northwestern University School of Medicine, Asher Center for the Study and Treatment of Depressive Disorders, Chicago, Illinois
  • 2Northwestern University School of Medicine, Department of Psychiatry, Chicago, Illinois
  • 3Northwestern University School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
  • 4University of British Columbia, School of Population and Public Health, Department of Pediatrics, Vancouver, British Columbia, Canada
  • 5Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Psychiatry. 2020;77(12):1215-1216. doi:10.1001/jamapsychiatry.2020.1512

Few moments are more concerning to parents than learning that their infant has a birth defect. Compounding this news is the possibility that the medication used to manage the mother’s mood disorder may have increased the risk for her infant developing a birth defect. As health care professionals, we have an enormous obligation to get the science right. In 2007, an editorial was published in response to 2 large case-control studies, “Teratogenicity of SSRIs: Serious Concern or Much Ado about Little?”1 What have we learned over the ensuing 13 years?

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    1 Comment for this article
    Acceptable antidepressant risks? Really?
    daniel campagne, Ph.D. | Universidad Nacional de Educación a Distancia - Madrid - Spain
    Authors' standpoint is known from their many publications, but it disregards valid options. Antidepressants are well proven to be risk-laden for mother and child, and alternative proven remedies should have preference, always but not exclusively. As I defended elsewhere:
    "The argument that pregnancy mishaps such as birth defects also may – and do - occur because of other causes, or that negative effects associated with antidepressants will be small, does not liberate the physician from the duty to avoid doing harm. The woman should be offered valid options. Neither does it liberate the pregnant woman from concern over nocive effects
    on her child. Depression in pregnancy harms both, and that should not be ignored.
    Study design on this subject has lacked rigor in some cases. Scientifically, research comparing treating a pregnant woman with antidepressants or not treating her at all - as do the studies cited by authors - should include control groups on alternatives such as early screening methods, non-pharmaceutical and psychological treatments (O’Connor, 2016). If it does not, the comparison is incomplete and its results must be valued accordingly. Also, consequences as to maternal effects and fetal effects are phenomena in different universes and, as such, incomparable and without any “benefit-risk ratio” (Koren, 2012). Avoidable negative effects on offspring can hardly be “compensated” by beneficial effects on maternal depression."
    Mothers and babies would benefit from a synergetic medicine/psychology approach, where antidepressants are not the preferred option.