The Dilemma of the Depressed Mother-to-Be

For pregnant women taking antidepressants, balancing mental health and fetal health can lead to difficult choices.
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Eight years ago when I started taking antidepressants, having a baby was the furthest thing from my mind. I was 25, and desperately unhappy for reasons I had trouble explaining.

It wasn’t the first time I had felt this way—I’d experienced bouts of intense anxiety and depression since I was 19. It would always start with a nagging unwanted thought that would morph into a cyclical internal monologue that grew into a tornado of negativity inside me. I would wake up crying. Sometimes I couldn’t work.

I had difficulty identifying whether I was anxious about real events in my life, or whether I was legitimately ill and my brain wasn’t functioning as it should.

This confusion provoked agony. If I passed a hospital I would find myself wishing I had a disease more universally acknowledged as a physical ailment, so I could be treated and either get better or die.

Over the years, numerous doctors and psychologists suggested I try antidepressants. I resisted. To me, drugs were a cop-out, a Band-Aid solution for those too weak to recognize the source of their problems and tackle them head on. But this valiant and judgmental attitude gradually withered as my tactics failed to defeat my mental anguish. Finally, I faced an unwanted possibility: What if my problem was biological, buried deep in the dendrites and synapses of my brain? What if tackling my problems meant taking the antidepressants I had so readily dismissed?

My family doctor assured me the drugs were safe and non-habit-forming, and that for a lot of people, they helped. I left with a prescription for Effexor, and have been taking the drug ever since.

Now I’m 33, and life looks a lot different than when I gulped down the first of the roughly 2,800 peach colored pills I’ve since ingested. Something new is swirling inside my mind: the idea of a child.

So it was with a special kind of horror that, during an afternoon of aimless internet meandering, I happened upon the world of “Effexor Babies.” Typing in this search term reveals link after link to news reports, blogs, and forum discussions detailing a range of negative outcomes in the pregnancies of women on Effexor. Many studies reveal an increase in the risk of a range of birth defects, some of them potentially deadly. I was terrified—and shocked that no one had warned me of these outcomes when I started the drug.

In the U.S., lawsuits over these infants are common enough that there are lawyers who dedicate their practices to trying Effexor lawsuits. In 2011, the drug made Canadian headlines when two babies from British Columbia died mysteriously shortly after birth, both born to mothers who were taking high doses of the drug.

And it’s not just Effexor. In fact my drug, better known as Venlafaxine, belongs to a class of drug called SNRIs, which make up only a small proportion of antidepressants prescribed to women annually. The vast majority are prescribed SSRIs, which you may recognize by their brand names: Paxil, Prozac, Zoloft, Lexapro, and Celexa.

When it comes to these drugs and pregnancy, the data is abundant and conflicting. It seems that for every study finding SSRIs will endanger the unborn child, there is another concluding they will have no negative effect at all.

Perhaps the most comprehensive review of current research in the field to date was published in the journal Frontiers in Cell Neuroscience in May of 2013. After examining 181 studies of SSRI use during pregnancy, scientists found a small increase in the risk of congenital malformations like heart defects and in problems with infant neurodevelopment. Still, its frustratingly ambiguous final summary stated only that more research is needed before anything definitive can be said about the risks and benefits of SSRI exposure to unborn babies.

Further obfuscating this issue is the plentiful evidence that suggests depression left untreated could have as grave an impact on a pregnant woman’s child as antidepressants.

To me, a woman taking one of these drugs and already prone to mental distress, the data presented an agonizing conundrum. How was I to know which would be worse for my unborn child: a mother on antidepressants, or a potentially anxious and depressed mother?

More concerning still is how common this predicament is poised to become. Today, SSRIs make up the class of drug most prescribed to pregnant women for chronic disease. According to the American Pregnancy Association, some 13 per cent of pregnant American women are taking them.

*  *  *

One reason we don’t know more about the effects of SSRI use during pregnancy is because, for ethical reasons, we don’t allow pregnant women in clinical trials. This means that women using SSRIs during pregnancy must do so off-label. Hedging their liabilities, most drug companies advise would-be moms to carefully consider the “risks and benefits” of treatment during pregnancy.

“I was told the benefits far outweighed the risks,” Nicole Rawkins told me over the phone from her home in Kamloops, British Columbia. The mother of two explained that both her doctor and pharmacist told her it was safe to take 450 mg of Effexor—twice the general limit recommended by the drug’s makers—during her second pregnancy, so she did.

Her son Grayson was born on January 24, 2011 and had to spend five days in the hospital before he could be taken home because he was suffering breathing problems. Grayson weighed less than her first child and slept a lot, but Rawkins just thought he was a good baby. Then one night when he was two months old, Grayson went to sleep and never woke up. The official coroner’s report stated the cause of death only as Sudden Infant Death Syndrome, but an autopsy report notes that the Effexor Rawkins was taking was a risk factor in the death.

“Nothing is more devastating than losing a baby, and nine months of being depressed is better than that,” says Rawkins. When she became pregnant again in 2012, she went against her doctor’s advice and stopped taking her medication completely.

“I felt one hundred percent better than when I was pregnant with Grayson,” says Rawkins. Her daughter was born healthy. “Women should understand that even if it is small, that risk is there.”

I began sifting through the existing scientific evidence in the hopes of better understanding these “risks and benefits.” Researchers have explored whether the drugs increase the risk of a wide range of negative outcomes, including miscarriage, cardiac malformation, preeclampsia, preterm birth, decreased birth weight, and major congenital malformations.

Some studies show a very moderately elevated risk; others show no elevation at all.

Some of these outcomes have the potential to be fatal. I learned that heart defects are a serious concern, though studies in this area again conflict. At least one drug, Paxil, now carries a warning that states use during pregnancy may elevate the risk of certain birth defects, particularly heart malformations. The warning is based on studies that found women who took Paxil during the first three months of pregnancy had a 1.5 to 2 percent risk of having a child with a heart defect compared to 1 percent in the general population—an elevation, but a small one.

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Lia Grainger is a journalist based out of Toronto, Canada, and Seville, Spain.

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