By Christiane Manzella, PhD, FT, clinical director of the Seleni Institute, a nonprofit mental health and wellness center for women and mothers in New York City.
We are extremely disappointed with the New York Times article "Pills May Put Babies at Risk" published on September 2, 2014 (and online here). Not only did the piece omit several large, reliable studies on antidepressant use during pregnancy and fail to include views from experts in the field of reproductive mental health, but the tone of the article is demeaning to women facing the difficult choice of taking medication to treat mental illness during pregnancy.
At the Seleni Institute, we help women prioritize their mental health during pregnancy and parenting. We have already heard from women who, after reading the column, experienced significant anxiety about their very carefully considered decision to treat a mental illness during pregnancy. Here's a closer look at some of the significant limitations of the column.
Failing to give the big picture
The article cites an April study conducted at Johns Hopkins which, limited by small sample size and based on participant recall (which can be very unreliable), found "that boys with autism were nearly three times more likely to have been exposed to S.S.R.I.s before birth than typically developing boys." However, the researchers offer significant caveats in their conclusion that are not mentioned in the piece, including the fact that research on SSRIs and autism spectrum disorders "continues to be inconsistent," that larger studies are needed to replicate their results, and that "because maternal depression itself carries risks for the fetus, the benefits of prenatal SSRI use should be carefully weighed against potential harms."
Another cited study associating antidepressant use with an increased risk of ADHD actually found no increase in autism risk when maternal mental illness was taken into account and concluded that the increased ADHD risk was "modest in absolute terms... and must be balanced against the substantial consequences of untreated maternal depression."
As the researchers carefully note, these studies are preliminary findings that have substantial limitations. Namely, they do not show a causal link between antidepressants and developmental delays, require further study to have greater meaning, and must be considered in the context of other research.
That last point is key. The author asserts "studies have found" that "babies exposed to S.S.R.I.s prenatally are more likely to be born with congenital heart defects..." but fails to mention a large cohort study, funded in part by the National Institutes of Health and published in June in the New England Journal of Medicine, which found that the use of antidepressants during pregnancy was not associated with an increased risk of cardiac defects. This is only one of several recent studies that reached the same conclusion.
And any analysis of the choice to use antidepressant medication during pregnancy must also include the significant body of research associating untreated maternal mental illness with poor neonatal outcomes.
Demeaning women who face important medical decisions
Comparing the choice to treat a medical illness during pregnancy with the decision to abstain from alcohol and unpasteurized cheese is specious. Making a decision about taking medication during pregnancy requires serious and knowledgeable consideration of the risks and benefits.
That is, a woman and her health care provider need to weigh the potential risks of untreated mental illness on her own health and the health of her developing fetus against the potential or known risks of taking medication.
The article claims (with no supporting citation) that "[women] rarely wean themselves from popular selective serotonin reuptake inhibitors." On the contrary, researchers have found that nearly 50 percent of women receiving antidepressant therapy for depression discontinue their medication during pregnancy -- sometimes abruptly -- putting their physical and mental health in danger for fear of harming their developing children.
For women facing these important choices while working through depression and anxiety, an article based on an incomplete analysis that excludes insight from experts in the field of maternal mental health, and insensitively compares the newborn children of mothers who have taken antidepressant medication to "babies of drug addicts" is not only irresponsible but does a disservice to the well-being of women and families.
We need less fear mongering and more accurate information so women and healthcare practitioners can make these decisions with care and confidence. Every day at Seleni, we help women carefully approach decisions about taking medication during pregnancy. We see engaged, concerned women working hard to make the best choices for themselves and their children. In turn, we hope to see more balanced, evidence-based, and compassionate reporting on maternal mental health from the Times in the future.
This article was originally published on the Seleni Institute website. Seleni is a nonprofit mental health and wellness center providing clinical services, research funding, and online information and support for women and mothers.