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By Nicholas Bakalar

The results of two new studies underscore the quandary that faces women taking antidepressants who are pregnant or plan to be.

In one, researchers report that pregnancy, contrary to widespread belief, provides no protection against emotional or psychiatric problems, suggesting that stopping antidepressants may be dangerous for both mother and child.

The other study confirms previous research showing that 30 percent of pregnant women who take antidepressants have babies who exhibit symptoms of drug withdrawal.

The first study, published last week in The Journal of the American Medical Association, found that women with major depression who stopped their medication relapsed more than two and a half times as often as women who continued to take antidepressants.

Dr. Lee S. Cohen, the lead author on the study and a psychiatrist at Massachusetts General Hospital, emphasized that this was an observational study of women who were already taking the drugs, and not a randomized trial.

Two of the authors have consulted for pharmaceutical companies that make antidepressants or have accepted research money from them.

The researchers found that 68 percent of 207 women who discontinued their medicine relapsed into depression while they were pregnant, but only 26 percent of those who continued their medicine through at least 16 weeks of gestation had a relapse.

According to the authors, these rates of relapse are similar to those of depressed women who are not pregnant and stop their medicine. Being pregnant, in other words, apparently provided no protection.

The second paper, published yesterday in The Archives of Pediatrics & Adolescent Medicine, reported that newborns exposed in the womb to Prozac and similar antidepressants, called selective serotonin reuptake inhibitors or S.S.R.I.'s, could develop neonatal abstinence syndrome.

This condition creates a physically uncomfortable withdrawal period of about 48 hours and can bring on crying, tremors, sleep problems and gastrointestinal disturbances, among other symptoms.

Israeli researchers tracked 60 infants exposed to S.S.R.I.'s during gestation, and found that 18 of them suffered the syndrome. None of a matched group of 60 infants whose mothers had not taken S.S.R.I.'s had the problem. The women had been taking various drugs, including Prozac, Zoloft, Paxil and Celexa.

The withdrawal usually does not require treatment and appears to have no immediate negative consequences, the researchers said. But, they wrote, "The long-term effects of in utero exposure to S.S.R.I.'s have not been demonstrated clearly."

The researchers acknowledged that their sample size was small and that they depended on mothers to report their own use of the drugs.

Yet stopping the medication also presents problems for mother and child, said Dr. Margaret G. Spinelli, an assistant professor of clinical psychiatry at Columbia, who was not involved in either study. One concern about depression in pregnancy is adverse outcomes to the baby, she said.

"Depressed mothers don't eat properly, they don't tend to their prenatal care and they're more likely to be smoking," Dr. Spinelli said. "Many physicians just stop the medicine without even thinking. We have to be aware of these things."

Dr. Gil Klinger, the lead author of the Israeli study and a neonatologist at Tel Aviv University, agreed. "Pregnant women should not stop treatment because depression during pregnancy has its own risks," he wrote in an e-mail message. "However, it should be kept in mind that prolonged S.S.R.I. exposure has at least a short-term effect on the newborn."

Dr. Cohen of Massachusetts General also stressed weighing the risks and said that the data helped to refine the risk-benefit decision of doctors and patients. "Hopefully those decisions can now be made in a more informed fashion so that we worry not just about the risks of exposure to antidepressants but also about risks to the patient from depression if they stop their medicine," he said.

"My hope is that it will be less of a reflex to stop the medicine and more a collaborative decision that weighs all the risks," he added.

* Copyright 2006The New York Times Company

 

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