Health

Pregnancy and antidepressants: reassuring news

On August 7, 2001, a Toronto woman who was eight months pregnant, Kimberly Rogers, took her own life. In the coroner's investigation, it was learned that Mrs. Rogers suffered from anxiety and was known not to keep up her prescriptions. When she became pregnant, she had stopped taking her antidepressant, amitripryline. Paradoxically, an overdose of the drug caused her death.

For epidemiologist Anick Bérard, holder of the Medicine, Pregnancy and Nursing Chair at University of Montréal, this scenario is typical. “Most women who become pregnant stop taking their antidepressants, often on their physician's recommendation. However, no research currently demonstrates a link between taking antidepressants and congenital deformities. And the consequences of coming off the drug are sometimes drastic.”

At the Centre for Information on Drugs in Nursing and Pregnancy (IMAGe) at Saint-Justine hospital, where a team of specialists responds to some 6,000 requests for information on drugs taken during gestation and breast feeding each year, the majority of questions are about antidepressants. “When a woman becomes pregnant, she should not stop taking her antidepressants,” Mrs. Bérard explains. “Unfortunately, most family doctors are not aware of this.”

Obstetricians, who are better informed, are in general less reluctant to have their patients continue their antidepressant prescription. But according to Anick Bérard, “no physician likes that.” She feels that this explains why more than 6 out of 10 women are following their physician's recommendation when they suspend their treatments.

The downside is that these indications don’t apply to antidepressants in the tricyclics family, which present undesirable side effects. When a woman takes this kind of drug, she should switch to a less toxic new-generation antidepressant.

The epidemiologist points out that the long-term effects of the use of psychotropic molecules on the child's later development are still poorly known. To establish any kind of link, long-term studies will have to be performed with a sufficient cohort of mothers and children. “In the present state of knowledge, the effects of suspending treatment during pregnancy are well measured. If the pregnant woman becomes depressive again, she could develop problems with sleep, anxiety, food, or even alcohol and cigarette usage. And the undesirable effects of these substances on the fetus, or teratogens, are well known.”

After completing her final examination in statistics at Laval University, and then a masters degree in clinical sciences at Sherbrooke University, Mrs. Bérard obtained her doctorate in epidemiology and biostatistics at McGill University. She was then awarded a post-doctorate position at Harvard University. When University of Montréal offered her a position, she was a professor at the Albert-Einstein College of Medicine in New York.