One out of every 8 expectant mothers in the U.S. is taking an SSRI antidepressant. Yet concerns about the use of these drugs by pregnant women has been voiced since the early 1980s. “There’s clear and concerning evidence of risk with the use of these medications by pregnant women,” says Adam Urato, a chairman of the dept. of Obstetrics & Gynecology at Metro West Medical Center in Framingham, Mass., who has studied the subject. (Weintraub, 10-31-2012) Just about anything a pregnant woman puts into her body is shared with her baby, and studies have found that using an SSRI antidepressant during pregnancy may increase the risk for a number of adverse outcomes, including things like heart defects, premature delivery, low birth weight, behavioral problems, or withdrawal symptoms.
In 2005 the U.S. Food & Drug Administration admitted that babies born to mothers who took paroxetine during their first trimester (sold as Paxil and Seroxa) were up to twice as likely to exhibit fetal heart defects. (Wenner, 2010)
A study published September 26 in the British Medical Journal used data from nearly 500,000 Danish children and found that women who take Sertraline (Zoloft), citalopram (Celexa) and fluoxetine (Prozac) are more likely to give birth to babies with heart defects, though the overall risk is relatively low. (ibid)
A recent study by the CDC (N=28,000) found that SSRIs were linked to birth defects, though it found uneven results for different drugs. Both Paxil and Prozac were found to be linked with a number of birth defects (such as heart or brain deformations) whereas other antidepressants such as Zoloft, Celexa and Lexapro were found to have no effect on birth defects. In some cases these risks doubled or tripled, though the overall risk was still relatively small. For example, the risk of giving birth to a child with anencephaly (a heart deformation) rose from 2 in 10,000 to 7 in 10,000 when mothers were taking Paxil. (Painter, 7-9-2015)
A handful of studies have found that mice and rats exposed to antidepressants shortly before or after birth grow up to be more anxious and depressed. In line with this finding, a recent study shows children exposed to these drugs prenatally are more likely to appear sad or withdrawn at age three. (Gaidos, 6-5-2010)
A study published in the Oct. 2009 issue of the journal Archives of Pediatric and Adolescent Medicine suggests that women taking SSRIs are twice as likely to have preterm births as women from the general population. These babies were also more likely to spend time in neonatal intensive care. (Wenner, 2010) Because pre-term birth is a lot more common than are birth defects, a twofold increase in risk in this area is substantial.
A 2005 study published in the medical journal Lancet found that some newborns born to mothers taking paroxetine suffer from withdrawal symptoms such as convulsions or abnormal crying, which can last for several days. (ibid)
Another study linked antidepressant use among pregnant mothers during the first trimester to a 3-fold increase in the risk for autism. (Week, 7-22-2011)
How SSRI antidepressants affect breast milk production
For those of you who plan on nursing, recent studies have indicated that mothers using SSRI antidepressants may have difficulties with breast milk flow and production. (Seppa, 2010) Animal studies have shown that serotonin plays a key role in regulating lactation, and human studies find that women on SSRIs have a longer time between birth and first copious milk secretion and may have trouble with milk production or flow. “Serotonin interprets signals that a breast is full and shuts off milk synthesis and secretion,” says Nelson Horseman, an endocrinologist with the University of Cincinnati College of Medicine. (ibid) Therefore SSRIs, which dump extra serotonin into the body, may interrupt breast milk production. It’s something else to keep in mind for the future.
The habituation problem: How antidepressants could alter your baby’s brain & biology
In addition to the health risks just discussed, an equally concerning factor from our standpoint (and something far less studied and discussed) is how these drugs might alter an infant’s brain structure and natural chemistry. After all, a fetus is busy building its brain and body according to its environment. So if he or she is building this brain and body within an environment that has artificially elevated levels of serotonin, it has the potential to throw these symptoms out of balance, causing them to develop in an abnormal way. The fact that some infants show withdrawal symptoms after birth is extremely worrisome, because it shows that their physiology was forged in an environment that relied on this artificial imbalance.
Most antidepressants in use today are SSRIs, which means they work on the neurotransmitter serotonin. SSRI stands for Standard Serotonin Reuptake Inhibitor. Whenever a nerve impulse within a neuron reaches the branches at its endings, known as dendrites, the neuron passes along its message by releasing serotonin into the synapse, which is the tiny space between one neuron and the next. Within a fraction of a second, the neuron that released this serotonin sucks it back up again, an action referred to as reuptake. Antidepressants in the SSRI category block this reuptake process by blocking a protein known as 5-HTT. The brain is then left with excess serotonin. Since serotonin is a mood-altering chemical, linked to feelings of calm and contentment (excess amounts are normally released during times of pleasure or bonding), the hope is that this extra serotonin will alter a person’s brain in a way that lifts the depression. (That’s the theory at any rate; there are many problems with it which are beyond the scope of this book, but you can read more about them in our book Truth In Medecine.)
Yet as Susan Gaidos notes, “In developing brains, serotonin has a much broader role. During brief but critical periods of early development – before and after birth – the 5-HTT protein shows up in various parts of the brain. Scientists believe that some nerve cells temporarily draw on serotonin to help guide the growth and connections of other young cells, a process that lays down circuits crucial for touch, vision, smell, thought and memory.” Because serotonin has so many uses in the body, it also happens to be a sensitive system: “neurons producing serotonin would have their own receptors that sense how much of the neurotransmitter is out there and adjust accordingly.” (Gaidos, 2010, p. 23)
Neuroscientist Barry Condron, who himself has studied this topic, states that “What (the research is) indicating to us is that the serotonin system goes through a critical period of development where the level of serotonin is gauged, and the neurons determine their sensitivity to serotonin in order to self-regulate the system. …If you change that level of serotonin in some artificial way, by taking drugs or experiencing stress, then those circuits could be forever altered.” (ibid, p. 24) His research on fruit flies found that those incubated with excess serotonin showed degeneration around the release sites and swellings in the dendrites that resembled that seen in Alzheimer’s patients or ecstasy users. The drug had damaged their brain.
All drugs also result in habituation: after being continually exposed to a certain chemical, the brain makes adjustments in its own chemistry. This is why users eventually need the drug just to feel normal. The fetal brain will do the same thing. So if a baby develops in an environment of artificial serotonin abundance, their brain will habitualize in a way that might make it difficult to manufacture enough serotonin on their own later on. In layman’s terms, they may find it harder to feel calm and content on their own once they enter this world. In the worst case scenario, it’s setting a child up for a lifetime of depression and dulled positive emotions (less joy and excitement) before they’re even born.
It’s not all bad
There are a couple of reassuring things in the research as well. Studies have generally found that if the environment after birth is positive, whatever deficits the drug might have created in terms of a child’s temperament can be overcome. A couple of studies have even found SSRI exposed babies have slightly lower cortisol levels (less stress reaction) after birth than babies born to depressed mothers who weren’t taking any medication.
There are also a number of factors that can alter the serotonin levels of the baby, such as a mother’s mood or individual genetics. This is probably why the effects of SSRIs seem to vary, with some babies showing a sensitivity and others seeming to show no ill effects. Just how high of a dose your fetus ends up receiving depends a lot on your own unique biology.
So what should expectant mothers do?
The catch 22 in all of this is that maternal depression during pregnancy isn’t exactly healthy for the baby either. It can alter her hormonal balance and result in elevated stress, and a number of studies have linked depression during pregnancy to adverse outcomes for the baby. (See our book: Child Maltreatment: A Cross-Comparison.) So doctors are left with a “damned if you do, damned if you don’t” scenario.
Exposure to SSRIs can cause…
- Blunted movements
- Lower reactivity & health scores
- Lower birth weight
- Higher rates of pre term birth
- Birth defects
- Habituation & withdrawal to the drug
- Abnormal development
- Reduced serotonin
- Lower task persistence in childhood
- Behavioral problems later in childhood
- Poor psychomotor development in infancy
- Altered activity of the hypothalamus, pituitary and adrenal glands
But being born to a mother who is overly stressed or depressed during pregnancy can cause…
- Lower birth weight
- Higher rate of preterm birth
- Withdrawn or depressed behavior in the infant
- Increased instability/emotional outbursts
- More negative affect with mothers
- Elevated cortisol
- Anxiety and depressed mood
- More withdrawn and disruptive behaviors
What you should do depends a lot on why you’re taking the drug and whether or not it’s actually working to cure you of depression.
If you are taking an SSRI for a reason other than depression, you might want to check with your doctor to see if there are safer drugs you could be using. You also might consider stopping altogether, depending on the problem. The cost versus benefit ratio may be fairly equal when treating a serious psychological disorder like depression, but the baby will almost certainly benefit by you quitting if you’re taking them for lesser conditions.
If you are currently on an SSRI for depression and it seems to be working, go ahead and continue taking the drugs. You might talk to your doctor about switching to a lower dose, but it’s better than being depressed.
f you are depressed and considering an SSRI, or if you’ve been taking one but haven’t really seen a lot of benefits from it, we would strongly encourage you to look into other options of managing your depression. Based on our own inquiries into these drugs, we view them to be little more than potent placebos – and dangerous placebos at that. We have yet to see research that convincingly shows they actually work to treat depression, especially over the long term. They are a cash cow for the pharmaceutical industry, and there may be individuals here and there who benefit from them, but studies repeatedly show they do not work for the vast majority of people who take them. Other things such as cognitive therapy, lifestyle enhancements, exercise programs, or other stress reduction and relaxation or coping strategies all have benefits that are just as impressive as the claims made by drug manufacturers, and they can be realized without dumping a poison into your body. Try these first, and resort to antidepressants only when all else fails and you’re literally so glum that it’s a matter of life or death.