Motherhood, mental illness and beyond

Posts tagged ‘risk’

Depression, SSRIs and pregnancy

Today the BBC has reported that according to an adviser for NICE (the National Institute for Health and Care Excellence) women who are fertile should be discouraged from taking SSRIs, a class of anti-depressant. The rather aptly named Professor Stephen Pilling was quoted as saying:

“The available evidence suggests that there is a risk associated with the SSRIs. We make a quite a lot of effort really to discourage women from smoking or drinking even small amounts of alcohol in pregnancy, and yet we’re perhaps not yet saying the same about antidepressant medication, which is going to be carrying similar – if not greater – risks”.

Professor Pilling claims that there is evidence that taking SSRIs in early pregnancy increases the risk of a baby being born with a heart defect from 2 in 100 to 4 in 100. If this is true then of course new guidelines need to be considered. (Having said that, in my experience doctors are already extremely cautious when prescribing any kind of medication to a woman who is pregnant or breastfeeding.) However it is other quotes attributed to him that have infuriated me. According to the BBC article :

He says that women not suffering from the most severe depression who become pregnant whilst taking the drug are taking an unnecessary risk.

“You’ve got double the risk. And for women who are mild to moderately depressed, I don’t think that those risks, in most cases, are really worth taking” he said.

“It’s not just when a woman who’s pregnant is sitting in front of you. I think it needs to be thought about with a woman who could get pregnant. And, that’s the large majority of women aged between 15 and 45.”

First of all the diagnosis of depression is extremely subjective, often relying on the individual answering a multiple choice questionnaire that has points assigned to each answer. If you score above a certain number then bingo! You’re depressed. But what one person interprets as mild depression may be what another person feels is moderate depression. Someone who is severely depressed may not believe they are because they’re not considering suicide.

I’ve had episodes of depression since my early teens, including 2 bouts of post-natal depression (PND) and 1 bout of ante-natal depression (AND). The first time I had PND I refused to take any medication because DD was breastfed and I was scared that the anti-depressants would affect her through my milk. As a result I was severely depressed for a very long time despite various other therapies and I planned my suicide on multiple occasions. I am concerned that if Professor Pilling’s reported opinions become guidelines the same may happen to women who are pregnant.

If, through the media sensationalising this or through poorly worded new guidelines, a pregnant woman is made to feel the way I did it’s entirely possible that she may consider taking her own life (and therefore that of her unborn child). If a woman suffers from depression that requires a particular treatment then she should be given that treatment. At the end of the day, uncomfortable though it is for me to say, the life and wellbeing of the woman is more important than that of her foetus.

Any suggestion otherwise removes a woman’s bodily autonomy, her right to decide what happens to her body. This is dangerously close to a number of anti-abortion laws that have been proposed in the United States, where the supposed rights of the foetus (usually a non-viable foetus) would outweigh the rights of the mother, who is reduced to the status of a mere incubator.

As for Professor Pilling’s apparent suggestion that “pre-pregnant” women (so any woman who is capable of conceiving, and therefore presumably including pubescent girls) might be refused access to SSRIs, it’s ludicrous. Would a doctor refuse a diabetic woman her medication? Or an epileptic woman? Both of these conditions often require medications that can be risky for a foetus yet I doubt that many doctors would recommend their patients stop taking them merely because they might conceive a child.

What are your thoughts?

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