Avoid SSRIs in Infertile Women Trying to Conceive

Selective serotonin reuptake inhibitors (SSRIs) should only be prescribed with extreme caution and with full counseling for women with symptoms of depression who are attempting to become pregnant, concludes a new review of published studies evaluating women with symptoms of depression who took antidepressants during pregnancy.¹

To better understand the implications of SSRI use in subfertile women with depressive symptoms, researchers reviewed all relevant published studies. Overall, the cumulative available evidence shows that SSRI use during pregnancy offers no benefits related to pregnancy outcomes and is associated with significant risks.

In a press release, lead author Alice Domar, PhD, stated that depression and infertility are complicated conditions that often occur together, and definitive treatment guidelines are lacking.² Most women undergoing fertility treatment will experience symptoms of depression during the process, especially after an unsuccessful treatment cycle, write the authors.

SSRI use because of depressive symptoms has been reported in up to 11% of subfertile women undergoing fertility treatment, according to the authors.¹ Many studies included in the review, however, showed that SSRIs are only slightly more effective than placebos or similarly effective in the treatment of depression.

For women undergoing fertility treatments, SSRI use may decrease pregnancy rates and increase miscarriage rates. More than 30 studies have shown that antidepressant use is associated with an increased risk of preterm birth. In addition, in utero exposure to antidepressants has been connected with a 30% risk of newborn behavioral syndrome, characterized by persistent crying, jitteriness, and difficulty feeding, and an increased risk of neurobehavioral disorders, such as autism. Also, antidepressant use after the first trimester increased the risk of pregnancy-induced hypertension and preeclampsia, the authors reported. Long-term use of SSRIs has been linked to increased rates of low birth weight (less than the 10th percentile) and respiratory distress.

Cognitive behavioral therapy (CBT) has shown the most promise for the management of mild to moderate depression in women undergoing fertility treatment, report the authors. Because the available evidence does not support any benefit to SSRI use during pregnancy, the authors recommend that alternative treatment options, such as CBT, be considered. “We want to stress that depressive symptoms should be taken seriously and should not go untreated prior to or during pregnancy, but there are other options out there that may be as effective, or more effective, than SSRIs without all the attendant risks,” said Domor.²

Pertinent Points:
- SSRI use during pregnancy is associated with significant risks.
- There is no evidence that SSRIs provide any benefit to or lead to better outcomes for mothers and babies.
- Patients who are trying to become pregnant or who are pregnant should be fully informed about all of the risks associated with SSRIs.

References:

1. Domar AD, Moragianni VA, Ryley DA, Urato AC. The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond. Hum Reprod. October 31, 2012. [Epub ahead of print.]
2. EurekAlert press release. Study suggests too much risk associated with SSRI usage and pregnancy. October 31, 2012. Available at: http://www.eurekalert.org/pub_releases/2012-10/bidm-sst102612.php. Accessed November 12, 2012.