Women of child-bearing age are, by far, the biggest consumers of antidepressants, in particular newer agents called selective serotonin reuptake inhibitors. So naturally one of the most frequent questions asked is: Are SSRIs safe to take during pregnancy?
The stock answer from most doctors is "yes."
Because research has shown that the babies of women who are depressed during pregnancy have worse outcomes - lower birth weight, premature births and so on - there is an assumption that depression itself is more harmful than drugs to treat the condition.
There are also studies that show that women who quit antidepressants when they get pregnant have high rates of recurrence.
But new research is challenging the assumption that drugs are better than no drugs for depressed mothers-to-be.
A large Danish study published last month showed that babies of mothers taking SSRIs have a higher rate of heart defects. Earlier studies indicated these babies also have higher rates of respiratory distress at birth.
Over all, however, exposure to antidepressants in the womb caused problems to only about 1 per cent of babies, according to the Danish study.
Canadian researchers have decided to approach the question in a different way: Instead of trying to figure out if SSRIs are harmful, they wondered if they are helpful - in other words, to see if babies of mothers being treated with drugs are born healthier.
"In a nutshell, we found no evidence that women taking antidepressants had better outcomes," says Barbara Mintzes, a research associate at the Therapeutics Initiative at the University of British Columbia.
In fact, there is some evidence that babies of women taking SSRIs during pregnancy have even worse outcomes than the babies of depressed mothers who refused drugs.
"I think there is a reason to be concerned and for hard questions to be asked about why women are being told to stay on antidepressants or start antidepressants during pregnancy," Dr. Mintzes says.
In Britain, guidelines recommend that depressed pregnant women be treated with cognitive behaviour therapy. If drugs are suggested, they are told to take tricyclics, an older form of antidepressants., and to use SSRIs only as a last resort.
André Picard