March 23, 2012

Antidepressant Safety During Pregnancy

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Chris Galloway, M.D. By:

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SSRI antidepressant use during pregnancy associated with high blood pressure

(dailyRx News) Much is still uncertain about what drugs are safe while pregnant, so deciding what to take or avoid may require a tradeoff. Such may be the case for a common group of antidepressants.

A study reveals a link between taking selective serotonin re-uptake inhibitors (SSRIs), one of the most common classes of antidepressants, during pregnancy and increased blood pressure, which can increase the risk of developing pre-eclampsia.

"Talk to your OB/GYN about your medication if you take antidepressants while pregnant."

The link, however, does not prove that SSRI use while pregnant will cause high blood pressure. It simply means an association was found between the two that should encourage women to discuss their antidepressant use with their doctors.

Dr. Anick Bérard, director of the research unit of medications and pregnancy at CHE Ste-Justine's Research Center and a pharmacy professor at the Unviersity of Montreal in Canada, led the study looking at the use of SSRIs during pregnancy.

Bérard and her colleague studied the data from 1,216 women in the Quebec Pregnancy Registry who had been diagnosed with hypertension during pregnancy but who had no previous history of high blood pressure.

The group included women who both did and did not have pre-eclampsia, a pregnancy condition associated with high blood pressure which can put a mother and her baby at risk.

The researchers then matched these women to 12,160 other women. They selected 10 pregnant women for every one in the test group, matched to have babies at the same gestational age.

They found that approximately 2 percent of the women not taking SSRIs experienced hypertension during pregnancy, compared to about 3.2 percent of the women who were taking them. That translates to an approximately 60 percent increase in the number of women experiencing high blood pressure.

The researchers adjusted their results to account for socioeconomic status, depression, anxiety, other medication use, other chronic conditions, and how much healthcare the women sought and received.

"These results are an early indicator of risk attributable to antidepressant drug treatment above that which may be attributed to depression or anxiety disorders in the absence of drug treatment," Bérard said.

The SSRI paroxetine, whose brand name is Paxil or Pexeva, was associated with 3.6 percent of the women having blood pressure, or 81 percent more than those not taking SSRIs.

Other commonly used SSRIs include Lexapro, Prozac, Celexa, Cipramil, Luvox and Zoloft, among others.

Bérard's research, however, does not mean the SSRIs caused the hypertension or that women taking SSRIs should stop on their own if they are or become pregnant. Although high blood pressure during pregnancy can pose risks to the mother and baby, so can a mother's serious depression or anxiety.

Stopping antidepressant use requires consultation with a doctor and can lead to relapses in depression and a higher risk of post-partum depression.

"Individual decisions have to be made one woman at a time, and risks and benefits have to be evaluated carefully in consultation with a doctor," Bérard said. "There is no 'risk zero'."

She said this research adds more evidence to what's known about possible effects of taking antidepressants during pregnancy, and it should be taken into account while considering the risks and benefits of taking SSRIs while pregnant.

The research appeared online March 21 in the British Journal of Clinical Pharmacology. Information regarding the study's funding and potential conflicts of interest were not available.

Medications: 
Celexa Lexapro Paxil Prozac

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Reviewed by: 
Chris Galloway, M.D.
Review Date: 
March 20, 2012

Last Updated:
March 23, 2012