Some things are just not worth the risk, especially when there are so many effective natural alternatives for both depression and infertility.
If you or someone you know is considering having a baby, or having difficulty with conception, consider discussing alternative options with a knowledgeable complimentary and alternative medical practitioner. Orthomolecular treatment for depression is very effective and provides a much safer and longer-term solution to supporting and reversing the symptoms of depression than SSRI medications do. There are also many effective natural solutions for infertility that can have very quick results.
I have supported many couples with infertility with results in as little as one month from the onset of treatment.
We do have a no-return policy however so you better be ready!
SSRIs for Women Receiving Fertility Treatment
Posted on Medscape by Megan Brooks 11/13/2012
CLINICAL CONTEXT
Depression is a common condition in clinical practice, particularly among women with a history of infertility. The authors of the current study note that depression appears to increase the risk for infertility, and the estimated prevalence of depression among infertile women varies widely (11% – 73%).
Many women are considered for antidepressant therapy, even during treatment of infertility and during pregnancy. The authors of the current study aggressively question this practice. They state that, in general, the concept of a neurotransmitter deficiency promoting depression has not been proven. This creates doubt regarding the efficacy of antidepressants such as selective serotonin receptor inhibitors (SSRIs). Clinical trials of SSRIs also demonstrate a high degree of publication bias. Finally, the placebo effect in treatment of depression may be more than 50%, which also calls the results of antidepressant trials into doubt.
The current article by Domar and colleagues provides a more focused review of the use of antidepressants and other treatments of depression among women receiving treatment of infertility and among those who are pregnant. The authors’ findings are presented in the Study Highlights section.
STUDY SYNOPSIS AND PERSPECTIVE
There are risks associated with women taking SSRIs during pregnancy, and there is no strong evidence that these drugs lead to better outcomes for mother or baby, according to a comprehensive literature review.
The risks, the researchers note, include elevated risk for miscarriage, preterm birth, neonatal health complications, and possible longer-term neurobehavioral abnormalities.
“Women need to be made aware of the pros and cons of taking this class of medication prior to and during their pregnancy and need to have a conversation with their healthcare practitioner about their individual risk/benefit ratio,” lead author Alice Domar, PhD, from Beth Israel Deaconess Medical Center and executive director of the Domar Center for Mind/Body Health at Boston IVF, in Massachusetts, told Medscape Medical News.
Yet, the potential risks from untreated depression prior to or during pregnancy “should not be ignored,” Dr. Domar and colleagues emphasize in their article, which was published online October 31 in Human Reproduction.
“Ample Evidence of Risk”
Kimberly A. Yonkers, MD, professor in the Departments of Psychiatry, Obstetrics/Gynecology/Reproductive Sciences, and Epidemiology/Public Health at Yale School of Medicine in New Haven, Connecticut, who was not involved in the review, agrees.
“We have to consider the mental health of the mother independent of the offspring; depression is a horrible illness,” she told Medscape Medical News.
Depression and infertility often go hand in hand. As many as 11% of infertile women take an SSRI to ease depressive symptoms. Dr. Domar and colleagues focused their review on published scientific studies looking at the safety and efficacy of antidepressant use in women of childbearing age who were trying to get pregnant — in particular, they looked at the effects on fertility, pregnancy, neonatal health, and beyond.
Overall, they report finding “ample evidence of risk” with SSRI use in pregnancy.
For example, they note that there is mounting evidence that SSRIs may decrease pregnancy rates for women undergoing fertility treatment and may increase miscarriage rates.
There is also a “strong signal” of congenital abnormalities, the most noted of which is the association between the use of paroxetine (Paxil) and cardiac defects, which led to a label change noting this risk in 2005, as previously reported by Medscape Medical News.
The investigators note that in more than 30 studies, the evidence points to increased risk for preterm birth in women taking antidepressants.
Earlier this year, as reported by Medscape Medical News, a population-based study of pregnant women found that those who were depressed and who were treated with SSRIs showed fewer depressive symptoms than those who were not treated; but they also had a significantly higher risk of having fetuses with delayed head growth, and they were twice as likely to have preterm births as their healthy peers.
“It is true that we find associations between SSRI use and particularly the adverse birth outcome of preterm birth, but the actual number of days that SSRIs push up delivery is somewhere along the lines of 3 to 5 days. We found no effect in our dataset of early preterm (less than 35 weeks) and very preterm (less than 32 weeks),” said Dr. Yonkers
Hypertension, Preeclampsia
Dr. Domar and colleagues also found evidence that antidepressant use, especially beyond the first trimester, is associated with an increased risk for pregnancy-induced hypertension and preeclampsia.
For example, in a study published in January 2012 and reported by Medscape Medical News at that time, researchers found that infants born to women treated with SSRIs in late pregnancy had a 2-fold increased risk for persistent pulmonary hypertension compared with infants born to women who did not use SSRIs.
“Given the importance of the hypertensive disorders of pregnancy in terms of maternal and newborn morbidity and mortality, and the widespread use of antidepressants during pregnancy, further investigation into this area will be essential,” Dr. Domar and colleagues write.
A 2006 study showed that infants exposed to antidepressants in utero had a 30% risk for newborn behavioral syndrome, most commonly associated with persistent crying, jitteriness, and difficulty feeding (Levinson-Castiel et al,Arch Pediatr Adolesc Med. 2006;160:173-176).
Studies have also shown delayed motor development in babies and toddlers. And a Kaiser Permanente study showed a 2-fold increased risk for autism spectrum disorders associated with SSRI treatment during pregnancy, particularly in the first trimester, as reported by Medscape Medical News.
“There is enough evidence to strongly recommend that great caution be exercised before prescribing SSRI antidepressants to women who are pregnant or who are attempting to get pregnant, whether or not they are undergoing infertility treatment,” Dr. Domar said in a statement.
Interpret With Caution
Dr. Yonkers added that the authors have reviewed many of the “pivotal papers” on the topic, and although the data “do confirm” an association between SSRIs and some adverse birth outcomes, “it doesn’t mean it’s a causal association.”
“The major problem” in implicating antidepressants in adverse birth outcomes is the unmeasured effects like health and health habits, Dr. Yonkers said. “The group of people who take antidepressant medication are hopelessly confounded, and we can’t tease out those 2 effects. The sick people take medication, and the sick people are the group at greatest risk for a whole host of adverse birth outcomes,” she said.
Overall, Dr. Domar and colleagues report that they found “little evidence” of benefit from antidepressants prescribed for the majority of women of childbearing age. But Dr. Yonkers cautions that concluding that antidepressants “don’t work is just not supported by the evidence.”
For example, “in discontinuation studies, where we take individuals who have been successfully treated with antidepressants and then blindly substitute either placebo or continued antidepressants, the relapse rates are tremendous,” she said, “and the placebo effect is not enduring.”
Dr. Domar and colleagues stress in their article that depressive symptoms “should be taken seriously and should not go untreated prior to or during pregnancy, but there are other options out there that may be as effective, or more effective than SSRIs without all the attendant risks.” One alternative is cognitive-behavioral therapy (CBT), which has shown the most promise in clinical trials.
“There is overwhelming evidence that CBT is equivalent to antidepressant medication in the treatment of mild-to-moderate depression and more recent research indicates that it is effective in the treatment of severe depression as well,” write the authors.
“CBT is an option,” Dr. Yonkers said, “but that’s expensive, and there aren’t that many practitioners in a lot of places in the country to provide CBT.”
The study had no funding. The authors and Dr. Yonkers have disclosed no relevant financial relationships.
Hum Reprod. Published online October 31, 2012. Abstract