Between 14 and 23 percent of women are estimated to experience depressive symptoms during pregnancy, and 8 to 19 percent say they experience frequent depressive symptoms during the postpartum period. Many turn to medication for help.
But a new review has found that research into the relative benefits and risks of common antidepressants is largely inadequate, despite the fact that new studies on the topic regularly make headlines.
The review, published in the journal Obstetrics and Gynecology on Tuesday, argues that there is a pressing need for better and larger studies exploring the topic.
"Our main finding is that the evidence is really insufficient to draw conclusions and make recommendations," study researcher Marian McDonagh, a professor in Oregon Health & Science University's Department of Medical Informatics and Clinical Epidemiology, told The Huffington Post. "Is that surprising? The answer for me is yes. Very."
The review, which was led by a team that included experts in psychiatry, pediatrics and obstetrics and gynecology, analyzed both randomized clinical trials and observational studies looking at antidepressant use in pregnant and postpartum women. Only 15 studies met the researchers' criteria for inclusion.
Of the studies that focused specifically on antidepressants during pregnancy, few compared outcomes among women who were confirmed to have depression. Instead, most of those compared outcomes among women taking antidepressants with women who may not have been depressed in the first place.
"You would never expect to draw treatment conclusions based on a study of a blood pressure medicine that made comparisons to healthy people, so why are we expecting women to do that here?" said McDonagh.
Furthermore, most of the studies included in the review focused solely on selective serotonin reuptake inhibitors, or SSRIs, which are the most commonly prescribed antidepressants. The majority of studies did not consider other classes of antidepressants.
Still, despite the shortcomings revealed in the new review, there were a number of findings that Dr. Samantha Meltzer-Brody, director of the perinatal psychiatry program at the University of North Carolina's Center for Women's Mood Disorders, called "reassuring."
There was no direct evidence that antidepressants in any way harm women during pregnancy, or that they lead to an increased risk of convulsion or preterm birth for babies whose mothers had taken the medication while pregnant, said Meltzer-Brody, who was not involved with the new review. Those concerns have surfaced in the past. In addition, the review found no direct evidence linking SSRI use with increased risk for autism spectrum disorders.
There was a slight increase in risk for respiratory distress in babies whose mothers took antidepressants, but those risks do not appear to be lasting or particularly serious, said McDonagh, and future studies could very well alter the finding in any case.
Overall, Meltzer-Brody said, the report should in no way change the current treatment recommendations for pregnant and postpartum women set forth by the American College of Obstetricians and Gynecologists and the American Psychiatric Association.
Antidepressants can be essential for women who experience severe depression during pregnancy and in the postpartum period. Untreated, depression can severely restrict women's abilities to care for themselves or their children, and has been linked to complications like lower birth weight, bonding issues and delays in language development.
Meltzer-Brody said the review reinforces the need for greater "collaboration between research centers and funding agencies" to conduct bigger, more definitive studies that can shed more light on the benefits and risks associated with antidepressant use and directly compare different medications.
"For patients, I think the most important thing to take out of this [review] is that there a lot of treatment options out there, and they need to have a really good discussion with their provider about what's known right now about the potential risks and potential benefits," said McDonagh. "There's still a lot of discussion that can happen based on what we do know."
"These results," she added, "should not be interpreted as 'treatment is bad.'"