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Two common anti-depressants 'increase birth defect risk', study finds

Babies born to women taking some commonly prescribed anti-depressants are at risk of being born with birth defects, new research has found.

The report, published in the BMJ, has suggested that birth defects occur 2-3.5 times more frequently among infants of mothers treated with two of the most commonly used selective serotonin reuptake inhibitors (SSRIs), paroxetine and fluoxetine, when taken in early pregnancy.

The findings confirmed previous observations about the two drugs, including linking fluoxetine to heart wall issues and irregular skull shape, and paroxetine to heart defects, problems with brain and skull formation and abdominal wall defects.

The US study, which surveyed 18,000 mothers of babies with birth defects and 10,000 mothers of babies born without birth defects between 1997 and 2009, also looked at sertraline, citalopram and escitalopram, finding no significant association with birth defects.

The report said: ‘Some birth defects occur 2-3.5 times more frequently among the infants of women treated with paroxetine or fluoxetine early in pregnancy… No association with maternal use of citalopram or escitalopram monotherapy was found, except for a marginal association between citalopram and neural tube defects.

‘For sertraline, the most commonly used SSRI in our study, the findings for all five defects assessed were not significant.’

Readers' comments (6)

  • Interesting! Is this compelling enough for us to be advised to change women who *might* conceive from fluoxetine (previously, I believe, regarded as a good option in pregnancy) or paroxetine to one of the "safer" antidepressants?

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  • Vinci Ho

    There is some interesting thinking to choose SSRI from now on:
    (1) only SSRI proven to be safe in under 18 years old is fluoxetine with regard to suicidal risk
    (2) now child bearing age women is better off with sertraline . Only setback is it requires dose titration with respect to responses.
    (3) responses to SSRIs in elderly appeared to be variable in my experiences .
    Of course, there is still a school of thought that antidepressant is probably not as effective as being proclaimed in many cases.

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  • Can I big up the UK teratology information service's "BUMPS" (Best Use of Medicine in Pregnancy) leaflets?
    Well written, sensible real world advice, easy to print and hand out.

    No conflict of interest, just think they're great.

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  • This debate of course assumes that these drugs work in the first place. There is no solid evidence that serotonin levels are related to depression in the first place. Also the best available met-analysis of trials on ssri drugs basically says they are no better than placebo. Its great that there is a new scare story at last about these drugs. They take up so much of primary care time but unfortunately the myth that these drugs actually work is now part of the DNA of the average doctor - until the next wonder mood altering drug comes along of course.

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  • Might be worth the risk if they actually worked. In my experience SSRI is no better than placebo in depressed patients and rarely improve chronic anxiety either.

    Scandal that this class of drugs takes up so much spending and medic time.

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  • Edoardo Cervoni

    I would be most cautious with the interpretations of the results. The Authors say: Sertraline was the most commonly reported SSRI, but none of the five previously reported birth defects associations with sertraline was confirmed. For nine previously reported associations between maternal SSRI use and birth defect in infants, findings were consistent with no association. High posterior odds ratios excluding the null value were observed for five birth defects with paroxetine (anencephaly 3.2, 95% credible interval 1.6 to 6.2; atrial septal defects 1.8, 1.1 to 3.0; right ventricular outflow tract obstruction defects 2.4, 1.4 to 3.9; gastroschisis 2.5, 1.2 to 4.8; and omphalocele 3.5, 1.3 to 8.0) and for two defects with fluoxetine (right ventricular outflow tract obstruction defects 2.0, 1.4 to 3.1 and craniosynostosis 1.9, 1.1 to 3.0).
    First point: I am taken back by the fact that the Bayesian analysis did not take into consideration use of alcohol, or folic acid. Needless to say, all the drugs taken by the patients should have been likewise considered, particularly in the first trimester.
    Second point: there are countless number of genes that may be involved in the process and we know only very few of them. Surely we are not sure if we are comparing and associating apples with pears or if we are not. I do feel that the study has very low power and it would be interesting to know if a similar study reporting a negative association (reduction of the odds of malformations) would have been published. I am herein referring not only to SSRI, but anything, including H20...My position remains that in pregnancy avoiding medications/drugs unless strictly required should be the best course of action.

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