Feeling Blue… While Pregnant

Antidepressants during pregnancy appear to matter less than untreated depression

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Pregnant women with depression have tough choices to make. Do they treat the depression with medication or skip the meds? How might either choice affect their baby?

Researchers continue to try to tease out the answer to this riddle. The findings have sometimes been contradictory.

One recent study found only small differences between kids whose moms took antidepressants during pregnancy, compared to kids of non-depressed moms. This study found that children of mothers who were depressed while pregnant or after birth were more likely to have behavioral issues too.

"Discuss depression concerns with your doctor."

The study, led by Irena Nulman, MD, from the Motherisk Program within the Division of Clinical Pharmacology and Toxicology at the Hospital for Sick Children, University of Toronto, aimed to find out what effects, if any, antidepressants or depression in pregnant women had on their children's brain development.

The researchers compared four groups of women. One group of 62 women took venlafaxine, a type of antidepressant, while they were pregnant.

Another group of 62 women took medication from a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). These include drugs like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft), among others.

The other two groups did not engage in any mental health treatments during pregnancy: a group of 54 had untreated depression and a group of 62 were healthy and not depressed.

The children of all these women were assessed once for their intelligence and behavior between the ages of 3 and 7.

The researchers found that the children whose mothers were depressed but untreated and children whose mothers took either type of antidepressant all had similar IQs.

Children of the moms taking venlafaxine or SSRIs had an average IQ of 105, and the children of untreated, depressed moms had an average 108 IQ.

Meanwhile, the average IQ of the children of the nondepressed mothers was 112.

However, there was not evidence that the lower IQ in the other three groups were caused by depression or antidepressants. There could be other ways in which the groups of women and/or their children are different.

In fact, the dose of antidepressants the women took or how long they took them did not appear to show any association with the children's IQ or behavior.

Overall, the strongest predictor of the children's IQ was the mother's IQ and the child's gender.

In terms of behavior, the children of the depressed mothers (whether they were taking antidepressants or not) did tend to have higher rates of problem behaviors. However, the rates were not significantly high enough to rule out chance or coincidence. However, the mothers who had the most severe depression, while pregnant or after the children were born, were more likely to have children with problem behaviors.

One limitation of this study is that it is small – there were not large numbers of women in the four groups – and the women were reporting their own levels of depression during pregnancy.

The women were also the ones answering questions about their children's behavior, so it's possible that depressed moms answer these questions or judge their children's behavior differently than moms who aren't depressed.

Additionally, the children were not all assessed at the same age. Even though IQ should not change substantially between ages 3 and 7, variations may still occur in intelligence and certainly in behavior. But ultimately, the researchers did not find convincing evidence that moms who took antidepressants while pregnant were any more likely to have kids with significantly different IQs or behavioral outcomes than moms who didn't.

Instead, the researchers found that the moms whose depression wasn't treated were at a higher risk for developing postpartum depression after other family or mother factors were taken into account.

Exposure to untreated depression did appear possibly linked to child behavior problems.

The study was published in the November issue of the American Journal of Psychiatry. The research was funded by Wyeth-Ayerst Canada and the Motherisk Program. One author reported receiving funding for expert testimony, lectures and travel and has received funds from the Canadian Institutes of Health Research.

Reviewed by: 
Review Date: 
December 7, 2012
Last Updated:
December 11, 2012