Influence of the Media on Women Taking Antidepressants During Pregnancy

Influence of the Media on Women Taking Antidepressants During Pregnancy

Adrienne Einarson, RN

Many more women than men suffer from depression, with up to 20% of women of childbearing age diagnosed with the condition, most often between 25 and 44 years of age.1 Approximately 10% to 15% of these women experience depression during pregnancy and the postpartum period.2 Prior to late 2005, there was no evidence that the newer antidepressants, as a group, increased the incidence of major malformations above the expected 1% to 3% in the general population.3,4 At that time, physicians and their pregnant patients appeared to be relatively comfortable with prescribing and taking these drugs (personal experience from The Motherisk Program). However, in December 2005, GlaxoSmithKline (GSK) published on their Web site preliminary results of a study documenting an increased risk for cardiac malformations (2 per 100 versus 1 per 100) in infants whose mothers took paroxetine in early pregnancy.5 These data were supported by 2 other studies,6,7 presented at meetings and at that time published only in abstract form. Subsequently, on the basis of these 3 preliminary reports, the US Food and Drug Administration (FDA)8 and Health Canada9 posted warnings (which have not been updated, despite several large studies that have been published in the past 5 years) on their Web sites advising women to avoid paroxetine if possible during pregnancy. This information was quickly picked up by the media and widely published in the print media, on television, and on the Internet. In the 7 days following the release of these advisories, The Motherisk Program received 49 calls for information from anxious women, currently pregnant or planning a pregnancy and taking paroxetine. 10

In December 2006, the American College of Obstetricians and Gynecologists published a similar advisory (not yet updated with the new information), which also quickly made it to the media, causing further concern among women and their health care providers.11 Warnings such as these, describing adverse effects of exposures in pregnancy, are almost always widely cited by the media and subsequently make their way to the Internet. A recent Google search (June 23, 2009) using the keywords "antidepressants, pregnancy" revealed 1,420,000 results, many describing how "dangerous/harmful" antidepressants are to take in pregnancy with many sites warning women not to take antidepressants if they are pregnant. Studies that do not find evidence for harm12 more often than not are ignored by the media, such as in the recent Vogue article that focused only on studies that reported adverse effects.13 In addition, a number of Web sites have been developed that invite women to join a class action suit against GSK if they took Paxil in pregnancy and delivered a baby with a cardiovascular birth defect.14

A survey of community pharmacists in 3 countries reported that pharmacists do not always use evidence-based information, but instead, often refer to the product monograph, which is not an appropriate resource to dispense information regarding the safety of drugs during pregnancy and breastfeeding.15 For example, the 2009 product monograph information on Prozac states the following: "The safety of this drug during pregnancy and lactation has not been established, therefore it should not be administered to women of childbearing potential unless the benefit clearly outweighs the possible hazards to the fetus or child."16 This despite evidence based on thousands of women exposed to this drug during pregnancy with no evidence of harm to the fetus.17

Currently, even though mental illness is more widely accepted, especially owing to famous people talking about their disease, there continues to be a certain amount of stigma, which was documented in a Canadian survey conducted last year that reported 1 in 4 Canadians is fearful of being around those who suffer from serious mental illness.18 In addition, a group who conducted a worldwide study regarding perceived stigma among people with mental disorders confirmed this general fear and stigma surrounding mental illness.19 Another group reported that less personal exposure to depression equaled higher personal stigma.20 Another group who used the same questionnaire used by Griffiths et al20 reported the same results for some of the statements but, for others, found the opposite, ie, that there was a trend between more exposure and higher personal stigma.21

For women who require pharmacologic treatment for depression during pregnancy and their health care providers, it is understandable that after reviewing all, or even some of this information, making the decision to prescribe or continue taking an antidepressant during pregnancy would be very difficult. However, somehow amid all of this conflicting information and continued stigma surrounding mental illness, as well as previous information a woman has received, a psychiatrist is expected to assist the pregnant woman in making a decision as to whether she should take an antidepressant and, if so, which one. In conclusion, any decision to take an antidepressant in pregnancy should be made between the woman and her physician after weighing the risks and benefits of the medication using evidence-based information. This standard of care will ensure the best outcome for both mother and infant, which should be the primary endpoint.

References

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Author affiliation: The Motherisk Program, The Hospital for Sick Children, Toronto, Canada. Financial disclosure: None reported. Funding/support: None reported. Corresponding author: Adrienne Einarson, RN, The Motherisk Program, The Hospital for Sick Children, Toronto, Canada ([email protected]).

doi:10.4088/JCP.09com05478

© Copyright 2009 Physicians Postgraduate Press, Inc.