Study Shows SSRIs Safe for Depression Treatment in Pregnancy

Depression during pregnancy affects about 12 percent of mothers. The fear of medication has led many to stop treatment. A special communication in JAMA Psychiatry argues that this fear of medication is largely misplaced.

Once the effects of depression itself are separated from the effects of the medication, SSRI treatment carries little or no risk for the most serious adverse outcomes.

The authors conclude that treating the depression is what protects both mother and child, including against the substance misuse risks that frequently accompany untreated depression.

What the Article Found

Dr. Katherine Wisner and her colleagues led the review. It examined how major depressive disorder and SSRI treatment each affect pregnancy outcomes.

About 5 to 6 percent of pregnant patients in the US take an SSRI. Psychiatric conditions are a leading cause of maternal morbidity and mortality.

Early studies linking antidepressants to heart defects and autism substantially weakened once researchers adjusted for the depression and its associated factors. The field, they write, has shifted toward treating the illness rather than avoiding treatment out of fear.

Why Treating Depression Is Important

Women with depression have higher rates of preterm birth, low birth weight, cesarean delivery and hyperemesis gravidarum. Depressive symptoms also compromise a mother’s capacity to manage complications, prenatal care and life after delivery.

The review identifies substance use among the behavioral risk factors that travel with untreated depression and independently harm pregnancy outcomes.

Addressing depression early removes one of the conditions that may fuel substance use during pregnancy.

The Costs of Stopping Treatment

In a study of women in a perinatal psychiatry program, those who discontinued their antidepressant relapsed significantly more often than those who continued, with a hazard ratio of 5.0.

A Danish national study found that women who stopped antidepressants during pregnancy had a higher risk of psychiatric emergencies.

A meta-analysis found relapse risk rose for women with severe or recurrent depression who discontinued.

The review calls expanding access to care, particularly in areas with limited access to maternity and psychiatric care, a public health imperative.

A Note on Substance Use in Pregnancy

For pregnant women experiencing depression and using alcohol, opioids, or benzodiazepines, stopping use without medical supervision can be dangerous.

Treating one condition while ignoring the other rarely works, which is why supervised withdrawal with clinical monitoring and coordination with prenatal care is the recommended standard.

The same principle the review applies to antidepressants applies here: the risks of the untreated condition deserve at least as much weight as the risks of treatment.

Finding Help

If you are pregnant and struggling with depression, substance use or both, integrated treatment exists. Ask any program you contact whether it treats co-occurring mental health conditions alongside substance use and whether it coordinates with prenatal care.

Search detox programs near you, or browse detox centers through Detox.com’s directory. Call 800-996-6135Sponsored to find a supervised program today.