Pregnant women being treated for depression can heave a collective sigh of relief

If you are pregnant and suffering from depression, take your medication.
Recent chilling evidence that taking the antidepressant paroxetine during
pregnancy may increase the risk of heart defects appears to be unfounded,
according to a newer and better designed study.

going to have heart defects,” says Einarson.
the manufacturers of paroxetine under thetrade name Paxil, reviewed their databases WHY THE DIFFERENCE?
and found a two-fold increased rate of heart Why the conflicting result? “Regrettably, studies on first trimester exposure to parox- been prescribed the drug. But in a prescription etine or other antidepressants have a high database study like that one, it is impossible to tell who actually took their medication. “Too methods used,” says Fishell. “This leads to often women stop their treatment abruptly conflicting results, even if some of the stud- when they find out they are pregnant, which ies’ designs are similar. This is the largest can lead to a quick relapse of symptoms, pos- prospective controlled study [conducted on sibly leading to adverse effects on the fetus,” this topic].” It is also unique in that it directly says Alicja D. Fishell, MD, FRCPC, an expert in confirmed at the time that the women in the women’s health, psychiatry and pharmacology paroxetine group were actually taking the drug and that the infants identified as hav-ing heart defects really had these defects.
Other studies have relied on people’s mem- FEARS UNFOUNDED
To evaluate this potential risk more rigor- “Because of this study’s [rigorous] design ously, Adrienne Einarson, RN, of the Motherisk and the fact that the results are so reassur - Program at the Hospital for Sick Children in ing, it is a helpful tool in discussions with Toronto, and her team obtained health infor- risk/benefit of treatment of severe depres- around the world who were taking paroxetine sion or anxiety disorders with paroxetine dur- during the first trimester of their pregnancy, when the fetus’s heart is developing. The out- That’s Einarson’s key goal. “We do this re- search here at Motherisk so that people can whether they are going to take these drugs in pregnancy or not. That is the bottom line for us.” They also evaluated 2,061 published cases “There’s no evidence to date that taking anti- of babies whose mothers took paroxetine dur- depressants in pregnancy increases the risk ing pregnancy and obtained more detailed in- for birth defects, including heart defects,” says formation about the nature of each case.
Einarson. “In fact, recently it’s being found that being depressed during pregnancy and in the postpartum period may actually have its own paroxetine: 0.7%. This is on par with the gen- eral rate of heart defects in newborns. “Inevery pregnancy, about 1 in 100 babies are BY ALISON PALKHIVALA Ref.: Einarson A, Pistelli A, Desantis M, Malm H, Paulus WD, Panchaud A, Kennedy D, Einarson TR, Koren G. Evaluation of the risk of congenital cardiovascular defects associated with use of paroxetine during pregnancy. American Journal of Psychiatry 2008;165(6):749-752.


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