Pregnancy and SSRIs

An article in Internal Medicine News reported that SSRI use during pregnancy raises a newborns risk of Persistent Pulmonary Hypertension. It even said that the risk doubled for use during late pregnancy. In the study, Dr. Kieler and her associates included six SSRIs in the analyses: fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox), and escitalopram (Lexapro).

In a baby with PPHN, the fetal circulatory system doesn’t “switch over,” and the baby’s blood flow continues to bypass the lungs. You can read more about Persistent Pulmonary Hypertension in a newborn here.

If you are freaking out reading this, about to throw your bottle in the trash, you need to know one thing: You can not get off of your SSRIs for anxiety and/or depression all by yourself. 

If you are on SSRIs like Prozac, Celexa, Paxil, Zoloft, Luvox, and Lexapro, you must do it under the supervision of a doctor. There are very serious consequences for some of these medications for stopping without a game plan that has been discussed with your doctor.  If you are currently on an SSRI and trying to become pregnant or are already pregnant, please discuss with your doctor what your individual risks are for both getting off and staying on your medication. Provided you aren’t taking an SSRI for a personality disorder, often doctors will help you wean yourself off under their guidance. It’s likely though that the anxiety and depression will just come back though.

If you are on an SSRI, ask your doctor about getting your Vitamin D level checked. Chances are good, if you are like most Americans you are at least mildly deficient. Vitamin D isn’t just for bone health, and unless your doctor lives in the Dark Ages, he knows that. There are strong links inditing Vitamin D deficiency with a number of issues including anxiety and depression.

A friend with perfect timing shared this video with me today, I think you will find it very useful:

 

 

Further reading on Vitamin D and Anxiety and/or Depression:

Depression: Patient friendly summary

Vitamin D deficiency is associated with anxiety and depression in fibromyalgia.

The Need for Vitamin D

Vitamin D3 enhances mood in healthy subjects during winter.

Calcium and Vitamin D Intake and Risk of Incident Premenstrual Syndrome

8 Comments

  1. leanne

    🙂

    Have you seen the research on the short and long term effects of chronically elevated cortisol during pregnancy on a child? I would like to see a prospective study matching subjects on key confounding variables, then into treatment groups (1) with medications, (2) with treatment other than medications, (3) declining participation in any treatments. For effects short and long term on the children’s development. As with everything, I think there need to be a weighing of individual risks for all potential choices, based on what we factually know about group risks within each potential choice. There will be no situation that results in no impact on the developing fetus – period – for a mother with depression and/or anxiety significant enough to require treatment. The research on placebo with psychological therapy versus medications only versus medications with psychological therapy alone versus placebo alone (with respect to severe depression and anxiety) are very interesting – but not completed on pregnant women, to my knowledge…

  2. leanne

    oh, this is something to consider taking along with your VitD:

    “Omega-3s improve depression during and after pregnancy. Low-dose DHA/EPA supplements lifted major depression for 15 pregnant women in a 2006 study published in Acta Neuropsychiatrica. Other research has found that women with higher intakes of omega-3s after pregnancy are at lower risk of postpartum depression.”

    “In a small 2006 study published in the January issue of Acta Psychiatrica Scandinavica, 16 new mothers with postpartum depression took 0.5 to 2.8 g of EPA/DHA daily for eight weeks. Depression scores dropped about 50% in all groups. The researchers say that lifting postpartum depression is good for mothers and their babies: “Children of affected mothers may experience impaired attachment, and [postpartum depression] may adversely affect behavioral and cognitive development. Some women refuse medications during pregnancy and/or breast-feeding because long-term effects of antidepressants on the infant are unknown. Omega-3 fatty acid supplementation is associated with health benefits and is an attractive potential treatment.” ”

    “Hibbeln (15) reported a cross-national ecological analysis of seafood consumption, DHA content of mothers’ milk, and the prevalence rate of postpartum depression. The prevalence varied nearly 50-fold, from 0.5% in Singapore to 24.5% in South Africa; the mean prevalence rate worldwide was 12.4%. Both higher national seafood consumption and higher DHA content in the mothers’ breast milk predicted a lower prevalence of postpartum depression. Furthermore, greater apparent seafood consumption predicted a higher DHA content in the mothers’ milk. ”

    “Omega-3s help menopausal depression. When 20 menopausal women with major depression took 2 g of EPA plus DHA daily for eight weeks, 70% found their mood improved, and 45% found their depression went into remission. Mean scores on the Montgomery-Asberg Depression Rating Scale fell from 24.2 to 10.7. And the study participants enjoyed a bonus—fewer hot flashes—according to researchers from Massachusetts General Hospital in the March 2011 issue of Menopause.”

    “the Omega-3 Fatty Acids Subcommittee organized in 2006 by the American Psychiatric Association.7 “That works out to about 500 mg per day, which you also can get from fish oil capsules or other products, ” Vannice says. People with mood disorders may benefit from 1,000 mg of EPA plus DHA daily from fish oil supplements”

    “EPA plus DHA can improve primary depression. When M. Elizabeth Sublette, MD, PhD, of the New York State Psychiatric Institute and her team of researchers reviewed 15 trials involving 916 participants, they concluded that supplements with at least 60% EPA improved depression symptoms. Their meta-analysis was published online in the September 2011 issue of the Journal of Clinical Psychiatry. A Canadian study published in the August 2011 issue of the same journal found that a similar 60/40 ratio of EPA/DHA eased depression somewhat in people with depression who didn’t have anxiety disorders.”

    “Omega-3 researcher David Mischoulon, MD, PhD, director of research in the Depression Clinical and Research Program at Boston’s Massachusetts General Hospital and an associate professor of psychiatry at Harvard Medical School, says EPA and DHA “are thought to be active as antidepressants” in the brain. ”

    http://www.ncbi.nlm.nih.gov/pubmed/16741195

  3. What this article doesn’t state is what the risk of PPHTN is in a neonate period, with out SSRIs. Perinatal depression is serious too. Even with a risk increased two fold it is EXTREMELY rare. It’s rarer in the absence of SSRIs but still very rare with them. Depression and anxiety have there own negative effects on a fetus. Always discuss risks and benefits with your doctor and seeing a perinatologist is a good idea when medications are in question.

  4. Heather

    This is the book that really helped me. http://thedepressioncurebook.com/ I have what they now call Major depression(used to be called clinical when I was first diagnosed) I followed the plan in here after weaning myself off of SSRIs. I don’t take any anymore. It is also what started me looking at natural cures for other things more seriously.
    It focuses on the Omega 3’s that someone above me mentioned and then some other small things that are pretty easy to change in your life if you really want to get of prescription meds. Oh and bonus no bad side effects : )

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