By Bruce E. Levine, AlterNet
June 9, 2008
Today in the United States, 11 percent of women take antidepressants, the use of antidepressants by pregnant women has dramatically increased, and postpartum depression -- rare in those cultures in which women receive high levels of social support following childbirth -- has become so staggeringly common among U.S. women that Congress is legislating increased medical treatment.
Increasing Use of Antidepressants by Pregnant Mothers
Receiving little attention in 2007 was the study "Increasing Use of Antidepressants in Pregnancy," published by the American Journal of Obstetrics and Gynecology. Medical records of 105,335 pregnant women enrolled in Tennessee Medicaid from 1999-2003 revealed that antidepressant use during pregnancy increased from 5.7 percent in 1999 to 13.4 percent in 2003.
Among Tennessee Medicaid-treated women in 2003, 10 percent took antidepressants during the first trimester, 6.4 percent used antidepressants during the second trimester, and 5.9 percent used them during the third. White women were four times more likely than nonwhite women to have used antidepressants during pregnancy, and older women and those with greater schooling were also more likely to have used antidepressants while pregnant.
In another study of pregnant women treated at seven health maintenance organizations (HMOs), American Journal of Obstetrics and Gynecology reported in February 2008 that "antidepressant use in pregnancy nearly quadrupled from 1996 to 2005" and that nearly 8 percent of pregnant women used antidepressants in 2005.
Effect of Antidepressant on Newborns
To the delight of antidepressant manufacturers, the U.S. Centers for Disease Control (CDC) recently told Americans that we need not worry about the effects of Prozac, Paxil, and Zoloft and other antidepressants on newborns. In June 2007, the CDC issued a press release stating "New Study Finds Few Risks of Birth Defects from Antidepressant Use During Pregnancy." CDC epidemiologist Jennita Reefhuis concluded, "Overall, our results are generally reassuring with respect to the use of antidepressants during pregnancy."
This CDC press release was trumpeted by many U.S. newspapers with headlines such as "Antidepressants Not Big Risk for Defects" (Associated Press) and "Reassurance on Antidepressants in Pregnancy" (The Wall Street Journal). However, the actual research findings are the opposite of reassuring.
We have all heard about "crack babies" (newborns addicted to crack cocaine because their mothers were using it during pregnancy). What about "Paxil babies"? In 2006 the Archives of Pediatric & Adolescent Medicine reported that 30 percent of infants who had prenatal exposure to antidepressants experience some withdrawal symptoms, with 13 percent of them experiencing severe ones, most notably tremors, respiratory distress, gastrointestinal problems, sleep disturbances, and high-pitched crying. Other withdrawal symptoms include rapid heart beat, irritability, feeding difficulties, and profuse sweating.
There are several other serious problems that newborns are more likely to suffer when exposed in utero to antidepressants. A 2006 U.S. Food and Drug Administration (FDA) alert stated, "A recently published case-control study has shown that infants born to mothers who took selective serotonin reuptake inhibitors (SSRIs) after the 20th week of pregnancy were 6 times more likely to have persistent pulmonary hypertension (PPHN) than infants born to mothers who did not take antidepressants during pregnancy." In persistent pulmonary hypertension of the newborn, the newborn's arteries to the lungs are constricted, this limiting the amount of blood flow to the lungs and therefore the amount of oxygen into the bloodstream. The FDA alert also noted, "Neonatal PPHN is associated with significant morbidity and mortality."
It turns out that the CDC based its approval of antidepressant use during pregnancy on studies in which women were taking antidepressants the month before they became pregnant or in the first three months of pregnancy. But is it even in fact safe for newborns if mothers use antidepressants only in the first trimester?
Antidepressant use in first trimester, according to The New England Journal of Medicine in 2007, is associated with more than double the risk of anencephaly (birth without forebrain), omphalocele (the child's abdomen does not close properly allowing intestines and other organs to protrude outside the body), and craniosynostosis (premature closure of the connections between the bones of the skull before brain growth is complete).
The Rationale for Antidepressants for Pregnant Mothers
What then is the rationale of those medical authorities who encourage antidepressant use among depressed pregnant mothers? Their claim is that while antidepressants might present some risks, the stress of not receiving medication for depression is more risky for the newborn and mother. However, the research simply does not back up this claim.
Two major studies comparing the health of newborns from depressed mothers who took antidepressants versus newborns of depressed mothers who did not take antidepressants show that newborns are better off with mothers not taking antidepressants. In 2007 the American Journal of Psychiatry reported that the preterm birth rate of antidepressant exposed newborns was 14.3 percent as compared to 0 percent for newborns of depressed mothers who did not use antidepressants; and the rate of admission to the special-care nursery is more than double for antidepressant exposed infants compared to infants of depressed mothers who did not use antidepressants. These findings echo those reported in a 2006 Archives of General Psychiatry study using health data from a large sample of infants in British Columbia, Canada during a 39-month period.
Moreover, there is no evidence that antidepressant use by depressed pregnant mothers lowers their likelihood of suicide, and there is a great deal of evidence that antidepressant use can make some people manic, agitated, and violent. And while millions of people swear by their antidepressants, there is increasing evidence that antidepressants do not work much better than placebos. In 2002 Prevention & Treatment reported an analysis of forty-seven studies that had been sponsored by drug companies on Prozac, Paxil, Zoloft, Effexor, Celexa, and Serzone. Many of these studies had not been published but all had been submitted to the FDA, so researchers used the Freedom of Information Act to gain access to the data. They discovered that in the majority of the trials, the antidepressant failed to outperform a sugar pill placebo.
Postpartum Depression and the Mothers Act
For politicians, a much safer issue than pushing antidepressants for pregnant mothers is promoting the expansion of medical treatment for postpartum depression. In 2007 the U.S. House of Representatives overwhelmingly passed the "Melanie Blocker-Stokes Postpartum Depression Research and Care Act" and sent it to the U.S. Senate, which renamed it the Mothers Act. The stated goal of The Mothers Act, currently in committee, is to "ensure that new mothers and their families are educated about postpartum depression, screened for symptoms, provided with essential services, and to increase research at the National Institutes of Health on postpartum depression."
But will the Mothers Act merely ensure that federal dollars are used to identify more pregnant and postpartum women as depressed and then convince them that antidepressants are safe and effective? After all, while psychiatry authorities and antidepressant manufacturers admit that antidepressants used by nursing mothers do in fact enter breast milk, they maintain that antidepressant concentration in breast milk is too low to be terribly concerned about (though they do acknowledge that there are no long-term studies to confirm this).
In the "Findings" section of the Mothers Act we are told that postpartum depression is a "devastating mood disorder" and that "postpartum depression is a treatable disorder if promptly diagnosed by a trained provider." But inconvenient truths about postpartum depression are omitted. Not many in Congress would vote for legislation that stated the following: The U.S. could eliminate much of postpartum depression by transforming American values, culture, and economics.
The Mother Act states that "postpartum depression occurs in 10 to 20 percent of new mothers." It should state that postpartum depression occurs in 10 to 20 percent of American mothers. A 2004 BMJ (formerly known as the British Medical Journal) cross-cultural review reported that postpartum depression is rare in Fiji and in traditional African and Chinese populations. The BMJ authors concluded that "structured social supports after childbirth are described in groups of women with low rates of postpartum depression." Structured social supports for women after childbirth are decidedly missing from American culture.
The Mothers Act findings also neglects the 1996 British Journal of Psychiatry finding that postpartum depression is associated with unemployment of the mother (no job to return to), unemployment of the head of the household, unplanned pregnancies, and not breast-feeding.
And the Mothers Act omits relevant truths about Melanie Blocker-Stokes, the woman for whom the initial House bill was named for. Blocker-Stokes was a pharmaceutical sales manager who began suffering severe symptoms of depression after the birth of her child, and she did in fact receive extensive psychiatric treatment. She was hospitalized three times in seven weeks, given four combinations of anti-psychotic, anti-anxiety, and antidepressant medications, and underwent electroconvulsive therapy (electroshock). But despite her psychiatric treatment -- or because of it -- Melanie Blocker-Stokes jumped to her death from the twelfth floor of a Chicago hotel.
Postpartum depression could be dramatically reduced in the United States with a political will to transform American society from one that is dominated by money, productivity, and consumption to one that has vital communities which put energy into caring about the well being of new mothers -- as do cultures where postpartum depression is rare.
The rate of U.S. depression has increased more than tenfold in the last fifty years. During that same time, Americans have received increasing medical treatment for depression, especially antidepressants, which currently gross more than $13 billion annually in the U.S. Nowadays, drug companies, psychiatry officialdom, and U.S. governmental authorities recommend antidepressants even for pregnant women, and an increasing number of American newborns discover that their first worldly challenge is withdrawing from Zoloft.
When exactly will be the appropriate time to challenge mental health professional pretensions and rebel from cultural craziness?
Bruce E. Levine, Ph.D., is a clinical psychologist and author of Surviving America's Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green Publishing, 2007).