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Differing Views On Antidepressants During Pregnancy

The question of taking antidepressants during pregnancy is extremely intimate and complicated. Research studies evaluating the risks and benefits are mixed. There are documented harms, like an elevated risk of pre-term birth. But there are also the documented harms of untreated depression. In other words, it’s a deeply personal health decision that requires judgement based on a body of data that offers no easy answers.

The latest on this fraught debate comes from Andrew Solomon who wrote a long piece published in last Sunday’s New York Times Magazine, “The Secret Sadness,” with this basic message: “Pregnant women who are depressed often fear taking the medication they rely on. But not treating their depression can be just as dangerous.”

Solomon, whose own depression is well documented in his powerful book, “The Noonday Demon: An Atlas of Depression,” (The Times piece will be added as a new chapter in the book) begins the magazine article with an anecdote about Mary Guest, “a lively, accomplished 37-year-old woman” who “fell in love, became pregnant and married after a short courtship.”

Struggling with depression for much of her life, Mary took various antidepressant and anti-anxiety drugs, Solomon writes, but decided to discontinue the meds during pregnancy. But Mary’s mood and behavior “spiraled downward” so, “near the end of her fifth month of pregnancy, she finally, reluctantly, resumed taking an antidepressant,” he writes.

Then, at six-and-a-half months pregnant, and convinced that something was wrong with her fetus, Mary “went to the 16th floor of the building where her parents lived and jumped to her death.” Solomon quotes Mary’s mother saying: “We feel, rightly or wrongly, that if Mary had stayed on her medications, or even gone back on them sooner, it’s possible she would have survived.”

It’s an intense, moving story.

But Dr. Adam Urato, an assistant professor at Tufts University School of Medicine in Boston and a maternal-fetal medicine physician at Tufts Medical Center and MetroWest Medical Center in Framingham, says he’s got an important story to tell too: that antidepressants can also cause harm. Urato writes and lectures on this topic frequently, and says he feels that Solomon’s piece didn’t offer the complete picture. (Here’s Urato’s full rebuttal to Solomon’s article on the website Mad In America, published by journalist Robert Whitaker.

Solomon quotes Urato in the Times story (in fact, some of the quotes come from a post Urato wrote for CommonHealth). But Urato says his views weren’t fully reflected. Here, edited are a few of Urato’s points:

1. Anecdotes Have Limitations

No one wants a pregnant woman to kill herself. An article in which pregnant women stop their medications and kill themselves while others continue on their meds and have happy outcomes is sure to push readers in an obvious direction. However, such anecdotes are limited.

For example, the author could have told stories of women who stayed on their medications, weren’t counseled regarding the risks, and had severely impaired babies. Continue reading