Antidepressants and pregnancy: ‘Surprising’ lack of clear evidence

08/05/14  Portland, Ore.

OHSU study underscores gaps in critical mental health research

Scientists at Oregon Health & Science University have found there is no strong evidence to guide the use of antidepressants by women during pregnancy and just after birth.

The findings come from a team led by Marian S. McDonagh, Pharm.D., professor of medical informatics & clinical epidemiology in the OHSU School of Medicine, and are published online in the September 2014 edition of the journal Obstetrics & Gynecology. They show that despite evidence that many women suffer depression during pregnancy and after giving birth, existing research shows no clear consensus on how best to treat that depression.

The researchers reviewed 21 randomized trials and observational studies of pregnant and post-partum women with depression receiving antidepressants, including selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor, selective serotonin norepinephrine reuptake inhibitor, tricyclic antidepressants and norepinephrine reuptake inhibitors trazodone and nefazodone.

There is no clear evidence to guide recommendations about the use, effectiveness or potential side effects of the use of antidepressants either during pregnancy or post-partum, the team reports.

“We were very surprised that the existing research allows no clear consensus,” McDonagh said. “After all, depression during pregnancy is common, with estimates ranging from 5 to 30 percent of all women who become pregnant. And there is evidence that depression during pregnancy is associated with adverse outcomes for mother and child.”

That the team could find only 21 studies that met the criteria for evidence-based research and practice also surprised them, she said. “While there are a number of observational studies of pregnant women on the effects of medications typically used to treat depression, those studies are flawed in that they compare depressed women to healthy, non-depressed women. With the evidence that depression itself can have negative outcomes in pregnancy, this comparison group does not allow us to draw meaningful conclusions about the risks (or benefits) of treatment in depressed women.”

“We have heard in the popular press for many years about the concerns over depression, especially in the post-partum period,” McDonagh said, “so it was very surprising to find so few studies, and that those studies were very small and flawed.”

The study has potential impact for other researchers as well as for pregnant women. More and better research is needed across treatments, drug vs. drug as well as drug vs. non-drug choices, McDonagh explained, in populations of women with depression.

For pregnant or postpartum women who are experiencing depression or have concerns about potential side effects of antidepressants, McDonagh said: “They need to know that they have options, and that they should have detailed discussions about all of these with their providers.”

Other OHSU School of Medicine researchers who contributed to this work include: Annette Matthews, M.D., M.C.R., associate professor of psychiatry; Carrie Phillipi, M.D. Ph.D., associate professor of pediatrics; Jillian Romm, R.N., L.C.S.W., adjunct clinical associate professor of obstetrics and gynecology; Kim Peterson, M.S., research associate in medical informatics; Sujata Thakurta, M.P.A.:H.A., research associate in the OHSU Biomedical Information Communications Center; and Jeanne-Marie Guise, M.D., M.P.H., professor of obstetrics and gynecology.

The project was funded under Contract No. HHSA 290200710057I by the Agency for Healthcare Research and Quality (AHRQ) with the U.S. Department of Health and Human Services.

About OHSU

Oregon Health & Science University is a nationally prominent research university and Oregon’s only public academic health center. It serves patients throughout the region with a Level 1 trauma center and nationally recognized Doernbecher Children’s Hospital. OHSU operates dental, medical, nursing and pharmacy schools that rank high both in research funding and in meeting the university’s social mission. OHSU’s Knight Cancer Institute helped pioneer personalized medicine through a discovery that identified how to shut down cells that enable cancer to grow without harming healthy ones. OHSU Brain Institute scientists are nationally recognized for discoveries that have led to a better understanding of Alzheimer’s disease and new treatments for Parkinson’s disease, multiple sclerosis and stroke. OHSU’s Casey Eye Institute is a global leader in ophthalmic imaging, and in clinical trials related to eye disease.