Donders Wonders Blog

Is taking antidepressants during pregnancy safe for the baby?

The risk of depression is increased during pregnancy. Prescribed antidepressants are transferred to the fetus and, as recent research indicates, affect the development of the baby’s brain.

This post is also available in Dutch.

The risk of depression is increased during pregnancy. Prescribed antidepressants are transferred to the fetus and, as recent research indicates, affect the development of the baby’s brain.  

The American Academy of Pediatrics (AAP) released a policy statement in December 2018stating that doctors should screen mothers for depression during pregnancy to protect the health of the baby. Between 14-23% of womenstruggle with some symptoms of depression during pregnancy. A recent study published in the high-impact scientific journal PNAS indicated that one of the most commonly used antidepressants may not be safe for babies’ brain development. 

Higher risk of depression during pregnancy

Pregnancy is associated with hormonal changes that affect the brain and in this way are thought to make pregnant women more vulnerable to stressors. This is thought to explain the increased prevalence of depression among pregnant women. Depression during pregnancy (antepartum) or after giving birth (postpartum) is a mood disorder like clinical depression. Antidepressants like Fluoxetine (the active agent in Prozac) are often prescribed as a remedy to increase the transmission of serotonin in the brain. Serotonin is a brain chemical that regulates mood and social behavior, but also appetite and sexual desire. 

Antidepressants taken by the mother are transferred to the fetus 

The fetus’ brain is still maturing during pregnancy, which makes it particularly sensitive to any changes that may influence its development. During brain development, serotonin acts as a neurotrophic factor, meaning that it supports the growth of neurons and neuronal connections. Serotonin also acts on the brain’s stress system: the hypothalamic-pituitary-adrenal (HPA) axis, which regulates all reactions to environmental challenges and stress. 

A very recent study in zebrafish embryos determines the effects of antidepressants

The embryos of zebrafish develop outside of the mother and can therefore be easily exposed to antidepressants like Fluoxetine.The study showed that exposing the embryos to Fluoxetine,with concentrations that were comparable to human doses, changes the stress system of those same zebrafish later in life. The adult zebrafish that were exposed to the antidepressant as embryos showed reduced cortisol levels in general, but also in response to stressors. 

High cortisol is often associated with high stress, so it’s not desirable, but low cortisol is not beneficial either. Cortisol is a stress hormone that helps us to cope and counteract stress. In humans reduced cortisol concentrations are associated with less efficient stress coping and psychological and health problems such as burnouts, chronic fatigue, fibromyalgia, immune disorders, and post-traumatic stress disorders.

What exactly these results mean is not yet certain. The findings in zebrafish are consistent with earlier studies showing reduced cortisol levels in children who were prenatally exposed to antidepressants via maternal treatment. It may seem odd that research in zebrafish may tell us something about human conditions; however, physiologically and genetically, zebrafish are very comparable to us, explaining why much research that is viewed as unethical in humans is done in this species. 

What the findings in zebrafish tell us is that exposing an embryo to antidepressants while the brain is still developing changes the fetus’ stress system in a way that, in humans, is associated with less effective stress coping and health problems. However, leaving depression during pregnancy untreated is also associated with risk factors to the mother and to the baby. It is possible that nonmedicinal approaches like psychotherapy and social support from families and friends during pregnancy may constitute a safer option for the baby, although these options are not always helpful for those that suffer from depression. 

Written by Mahur. Edited by Marisha. 

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