Many women who become pregnant while taking antidepressants face a difficult decision: Should they continue their medication to protect themselves against severe depression, or stop to avoid possible risks to the baby?
"We know that untreated severe mental illness can be dangerous for both the baby and the mother," says Professor Soili Marianne Lehto from the University of Oslo (UiO) and Akershus University Hospital (Ahus).
"Lack of appropriate treatment can increase the risk of relapse, suicidal thoughts, poor engagement with antenatal care and complications in pregnancy. For many, this choice feels like an ethical and medical dilemma when it comes to antidepressant medications," she adds.
Standard doses of antidepressants appear safe in pregnancy
In a new study, Lehto and colleagues examined the use of antidepressants during pregnancy and possible perinatal outcomes.
The results indicate that using antidepressants at standard doses during pregnancy appear to be safe, based on the outcomes examined after birth.
"Using a standard dose does not seem to be harmful to the baby based on the factors we have assessed after birth," says senior researcher Guro Pauck Bernhardsen at Ahus.
The researchers looked at several perinatal outcomes, including birth weight, placental weight, umbilical cord length, preterm birth, as well as Apgar score (a rapid assessment of newborn health) and whether the newborn was admitted to the neonatal intensive care unit (NICU).
High, long-term doses linked to increased risk
The size of the dose is critical, according to the study.
"We see that persistently high doses of antidepressants are associated with changes in the placenta," says Bernhardsen.
"Sustained high doses are also linked to an increased risk that the baby will need treatment in a neonatal intensive care unit."
For women taking medication for severe mental illness and who are worried about continuing during pregnancy, these findings are partly reassuring.
"Our findings support the view that use of standard-dose SSRIs during pregnancy may be safe. However, persistently high doses may carry extra risk. These women should be closely followed up by a doctor during pregnancy.", says Bernhardsen.
The study: SSRIs, dose, duration and patterns of use
The researchers focused on one common group of antidepressants: SSRIs (selective serotonin reuptake inhibitors), widely used to treat depression and anxiety.
"SSRIs are the most commonly used antidepressants in the Nordic countries, including among pregnant women," explains Bernhardsen.
Unlike many earlier studies that categorized use simply as "yes" or "no," this study examined dose, duration and usage patterns across pregnancy.
