Risk to baby from anti-depressants for mums-to-be: Prozac and rival Seroxat can increase chance of some birth defects by up to three and a half times
- Problems include heart defects, brain problems and irregular skull shape
- Findings highlight concerns over increasing use of antidepressants
- Paroxetine and fluoxetine account for 8million UK prescriptions in 2014
- But experts have stressed the risk to the unborn baby is still small
Two of the most-commonly prescribed antidepressants increased the risk of some birth defects by up to three and a half times
Women who take certain antidepressants during pregnancy are more likely to have a baby with a birth defect, research suggests.
Two of the most-commonly prescribed antidepressants – fluoxetine, sold under the brand name Prozac, and paroxetine, sold as Paxil or Seroxat – increased the risk of some birth defects by up to three and a half times.
Problems include heart defects, brain problems and irregular skull shape.
Experts stressed that the absolute risk is still small – heart defects among babies whose mothers took paroxetine, for example, increased from just 10 per 10,000 births to 24 per 10,000.
But the findings highlight concerns that the increasing use of antidepressant drugs could be having a detrimental effect on patients and their children.
The findings, published last night in the British Medical Journal, come after NHS figures released this week revealed that the use of antidepressants has nearly doubled in the last decade, from 29million prescriptions in 2004 to 57million last year.
Paroxetine and fluoxetine are among the most commonly prescribed, between them accounting for 8million prescriptions in 2014.
British experts last night insisted that antidepressants remain important – and that harm is far more likely to befall a baby if a depressed or anxious mother stops taking their medication.
Researchers in the US focused on selective serotonin reuptake inhibitor (SSRI) antidepressants, which they said are increasingly being used by women during pregnancy.
The team said that while they found reassuring evidence for some types of SSRI drugs, others significantly increased the chance of a baby being born with a defect.
The research, led by the National Centre on Birth Defects and Developmental Disabilities in Atlanta, Georgia, looked at the health records of 28,000 pregnancies between 1997 and 2009.
They recorded use of the SSRI drugs citalopram (Celexa or Cipramil), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Seroxat or Paxil), and sertraline (Zoloft) at least once in the period from one month before conception through to the third month of pregnancy.
The two most commonly used SSRI drugs in England – citalopram and sertraline which together account for 22million prescriptions – were not associated with any increase in birth defects.
But fluoxetine and paroxetine – the third and fourth most widely used SSRIs – were linked to a significant increase in problems.
Fluoxetine was linked with heart wall defects and irregular skull shape.
But experts have tressed that the absolute risk is still small – heart defects among babies whose mothers took paroxetine, for example, increased from just 10 per 10,000 births to 24 per 10,000
Mothers who took paroxetine were more likely to have babies with brain and skull formation problems and abdominal wall defects.
The chance of brain and skull problems associated with paroxetine increased from two per 10,000 to seven per 10,000, and for heart defects from 10 per 10,000 to 24 per 10,000.
The authors wrote: ‘Although our analysis strongly supports the validity of the associations that were observed, the increase in the absolute risks, if the associations are causal, is small.
‘Continued scrutiny of the association between SSRIs and birth defects is warranted, and additional studies of specific SSRI treatments during pregnancy and birth defects are needed to enable women and their healthcare providers to make more informed decisions about treatment.’
But Dr Michael Bloomfield, a clinical lecturer in psychiatry at University College London, said that doctors in the UK generally prescribe lower doses of psychiatric medicines to patients than in the US and warned that no one should stop taking treatment without talking to their doctor first.
However the findings highlight fears the increasing use of antidepressants could be having a detrimental effect
He added: ‘Whilst common, depression can be a potentially life-threatening illness. Any decision around treatment in pregnancy needs to weigh up the potential small risks of birth defects against the benefits of treatments including helping a mother get better from depression.
‘In addition, there is evidence to suggest that a baby whose mother had depression during pregnancy may be more likely to have mental illnesses themselves during later life.’
Dr Patrick O’Brien, spokesman for the Royal College of Obstetricians and Gynaecologists, added: ‘Our advice for pregnant women suffering with depression would be that generally the benefits outweigh the risks, however, all pros and cons should be discussed and weighed up by a woman, together with her obstetrician.’