Antidepressant Use and Miscarriage

 A large study out of Canada, that was performed over a 5 year time period came out with some surprising statistics related to the use of SSRI's (selective serotonin reuptake inhibitors) and miscarriage rates.  The specific drugs that were found to have a higher rate of miscarriage, 68% higher risk (than those who have never used antidepressants ever), were Prozac, Paxil, and Effexor.  Paxil actually has a 75% higher risk of miscarriage, specifically. It was originally found that in pregnant rats, there were high numbers of miscarriages, thus the study moved to humans because a few years ago, the medical community, for the most part, advocated for the use of antidepressants in pregnant women because the benefit to the mother outweighed the risk to the fetus.

The study, from the Canadian Journal of Medicine, looked at just shy of 70,000 Canadian women from ages 15 to 45, of which some took antidepressants, some just had a history of depression, and some had none of the risk factors.  To make things a little clearer, the risk of miscarriage compared to those on Antidepressants versus women who have never used them is 68%, the risk for women who have a history of SSRI use versus those on them during pregnancy is 61%, and the risk factor of having a history of depression is 19%. But, in the US out of the roughly 2 million pregnancies per year, there are approximately 600,000 miscarriages within the first trimester (20 weeks), so the baseline risk of miscarriage in the US is about 20-31% anyway.

Now, this is not to say, that if you are pregnant, you should stop taking antidepressants because the risk factor is there, based on this large study, but it is unknown why exactly the rate of miscarriage is higher.  It is theorized that the change in serotonin levels can put pressure on the uterus in an early stage of pregnancy, and possibly cause the miscarriage.  But, despite this study being rather large and appear to be non-biased, it doesn't take into effect some of the risk factors that are associated with depression in pregnancy, such as smoking, obesity, and older age.  It is also theorized that the stress related to depression itself on your body, may be the cause of the increased rate of miscarriage; much more research needs to be done in this area.

Thus, you need to speak with your HCP about your specifics needs related to depression and the health of your baby.  It wouldn't be healthy for you to stop taking the medications, go into withdrawal and a severe depression because of it, so there may be behavior modifications that you can do, or switch to a different medication, that may have a decreased risk.  Plus, if you are more in tune to the fact that you are at a higher risk for miscarriage, you may be more likely to notice different changes in your body, perhaps take it easy the first few months of your pregnancy, and follow-up with your OB/GYN more closely at first.

What are some non-medication treatments for depression used in Pregnancy?
Most of these have not been well studied, but are used by some HCP's with positive responses from their patients, so again, talk to your HCP and don't start any of these therapies without their approval!
-Addition of Omega-3 fatty acids to your diet
-Bright light therapy which can help with Seasonal Affective Disorder (30-40 minutes of bright light per day either out in the sun OR using specific light bulbs)
-Exercise can keep endorphins up and make you feel better about yourself
-Psychotherapy; talking to a licensed therapist can alleviate stress and depression symptoms
-And behavioral cognitive therapy can reduce symptoms of depression (a type of psychotherapy that emphasizes the role of thinking in what we do and how we feel- so you think and make active choices in your life)

If you have depression, and whether or not you are being treated for it, you should talk to your Primary Care Provider (PCP) and OB/GYN (and possibly Psychiatrist) before getting pregnant about the risks, possibly change medications or decrease doses, and your other options for treatment during pregnancy.  And if you get pregnant and it was unplanned, go to your HCP ASAP and discuss your options and risks. DO NOT take yourself off of your medications based on these few studies!  There are many different options, and you will just need to be watched closer, and try to de-stress any way you can, such as go out with friends for a walk, go to the spa for a facial, get your nails done, spend time with your significant other...whatever helps you to relieve stress, do it!  Make time for yourself and pay attention to your body.  And, don't feel horrible if you call your HCP every time you are worried...it is YOUR body and your baby, and you know how your body feels.

Yours in Good Health
B