May 30, 2019

A Closer Look at the Link Between Antidepressants and Birth Defects

Antidepressants are life-saving medications for many people who struggle with depression and anxiety. However, as with many prescription medications, there can be side effects that not only affect the mother but also a growing baby. If you suspect that your child’s birth defects are related to your antidepressant medications, it’s wise to seek the advice of a medical malpractice attorney.

While some pharmaceutical companies and doctors downplay the chances of babies being impacted by certain antidepressants, the reality is that between 6 -10% of children are affected by these antidepressants in utero. It’s a difficult decision for many women to make, especially if their symptoms of depression are severe. The decision to stop taking medication during pregnancy comes with its risks for the mother.

Types of antidepressants

There are several types of antidepressants, and each works with different chemicals in the brain to reduce the effects of depression and anxiety. For some people, they have to go through several different types of antidepressants before finding the one that works best for them. For pregnant mothers, if they are already taking an antidepressant linked to birth defects, other antidepressants may not work as effectively.

The most common antidepressants are selective serotonin reuptake inhibitors or SSRIs. These work with the serotonin chemical in the brain, which is a neurotransmitter responsible for many processes, including feelings of happiness and memory.

The next most common type of antidepressants is serotonin and norepinephrine reuptake inhibitors, or SRNIs. These work with both serotonin and norepinephrine. Norepinephrine is both a neurotransmitter and a hormone which is responsible for alertness, memory, and regulating functions such as blood pressure.

Tricyclic antidepressants, also called TCAs, work with three types of chemicals in the brain: serotonin, norepinephrine, and dopamine. Dopamine is a neurotransmitter that is responsible for motivation towards a reward or aversion from tasks that have unpleasant outcomes. It is also thought to be the “high” that the brain releases when good things happen, or the “runner’s high” that exercise can achieve. “Dope” is a popular nickname for heroin, and it’s derived from dopamine which is thought to be the primary chemical that is released in the brain when using heroin or other opiates.

Monamine oxidase inhibitors, or MAOIs, utilize the monamine neurotransmitter in the brain. Monamine is responsible for regulating emotions.

Finally, there are atypical antidepressants which don’t fit into any set category. These include trazodone, bupropion, and mirtazapine. Other medications used to treat depression, including benzodiazepines and valproic acid, can cause issues in developing babies. Benzodiazepines are tranquilizers, and if a dose is too high, it can lead to respiratory distress. Valproic acid has been linked to a 10% risk of neural tube defects, such as spina bifida and hydrocephalus.

While all antidepressants carry the risk of some side effects, certain antidepressants have a higher risk of causing birth defects. While SSRIs were once thought to carry less risk of birth defects than other antidepressants, such as tricyclics, in reality only sertraline hasn’t been linked to birth defects.

Exposure in the first trimester

According to this 10-year study of the Quebec Pregnancy Cohort, the birth defects risk from exposure to SSRIs, SRNIs, and some tricyclics during the first trimester of pregnancy were significantly increased. Children who were exposed to some of these drugs were “at risk of having a child with cardiac, musculoskeletal, craniofacial, digestive and respiratory defects as well as craniosynostosis.” Craniosynostosis occurs when the sutures of the skull plates close too early during development, limiting brain and skull growth, causing facial and skull deformities, and potentially causing pressure in the skull and brain.

Unfortunately, sometimes this exposure is inadvertent since many women do not realize they are pregnant during a significant portion of the first trimester. This study theorizes that serotonin is crucial to the development of embryonic cells, and a disruption in this process can cause defects in the development of the fetus.

Paroxetine, an SSRI drug, has also been linked to a significantly higher risk of cardiac defects, especially during the first trimester. Citalopram, an SSRI, is linked with craniosystosis while venlafaxine, an SRNI, is linked with respiratory defects. Amitrptyline, a tricyclic, is also linked with an “increased risk of malformations” in the first trimester.

Depression during pregnancy

For women who are diagnosed with depression during their pregnancies and don’t have symptoms before, many doctors prescribe antidepressants. However, this study shows that “antidepressant medications do not reduce the risk of depression relapse in pregnant women,” nor could they establish the effectiveness of using these medications during pregnancy.

However, pregnant women will experience a fluctuation of their hormones, which can affect their emotional regulatory process. This can lead to increased feelings of depression or anxiety, even when they have had no previous symptoms of these mental disorders. Likewise, postpartum depression is an increased risk for women who experience symptoms of depression before and during pregnancy.

Women and their doctors will have to weigh the potential benefits and side effects of using antidepressants during pregnancy. Some birth defects, such as some cardiac defects, can be corrected shortly after birth with surgery. Other defects, including musculoskeletal deformities or craniosystosis, can lead to lifetime complications and medical care. These defects can also result in mental disorders, mood disorders, and lower IQs.

While some doctors will downplay the risks, the reality of the Quebec Pregnancy Cohort study is that women who use antidepressants during pregnancy are twice as likely to have children with birth defects.

Pre-term births and underdeveloped lungs

In this study, there is a definitive link between women who took SSRIs during their pregnancies and pre-term birth rates. There are many complications related to pre-term births, some of which can persist into adulthood.

One of the most common complications of pre-term birth is the lungs are not fully developed yet. This causes a host of problems and challenges for the baby, and even into adulthood, they may be more susceptible to issues such as pneumonia, bronchitis, and asthma. Babies whose lungs still need to develop will usually be kept in the neonatal intensive care unit (NICU) for several days, weeks, or months until their lungs are fully developed. During this time, babies may experience:

  • Pneumonia
  • Apnea
  • Bradycardia (low heart rate)
  • Bronchopulmonary Dysplasia (deterioration of the lungs)
  • Respiratory Distress Syndrome (RDS)

Babies may need to be put on a ventilator to support their breathing. If they are on a vent for a month or longer, it significantly increases the risk of developing Bronchopulmonary Dysplasia, or BPD. BPD is almost like emphysema, or “Swiss cheese” lungs. Unlike emphysema, most babies can recover from BPD with time and treatment.

Pre-term births and digestive disorders

Another common risk for premature babies is digestive disorders. Underdeveloped digestive and gastrointestinal systems mean the baby cannot absorb nutrients at first. The baby may also be unable to suck or swallow yet. They are fed intravenously at first, and then switched to tube feedings until they are able to suck and swallow on their own.

Necrotizing Enterocolitis (NEC) occurs when a portion of the intestine does not have any blood supply, leading tissue of that section to necrotize or die. The necrotized portion of the intestine needs to be surgically removed, and then the two healthy sections are reattached. Sometimes, the baby may have a temporary ileostomy or colostomy openings, depending on the location of the NEC.

Other complications of pre-term births

Babies are also at risk for developing other kinds of health complications when they are born at 34 weeks or earlier. Some of these complications can be present at the same time, and along with underdeveloped lung issues. These include:

  • Infection
  • Jaundice
  • Intraventricular hemorrhage (IVH)
  • Patent Ductus Arteriosus (PDA)
  • Retinopathy of Prematurity (ROP)
  • Sepsis
  • Anemia
  • Inability to maintain body heat
  • Hearing loss
  • Delayed tooth growth and discolored teeth

IVH, or intracranial hemorrhage, is bleeding the brain due to blood vessels that cannot withstand circulation changes during labor. The risk of bleeding in the brain can last into adulthood and create health conditions that must be monitored 24 hours a day. Some of these conditions include long-term brain injuries, intellectual disability (ID), cerebral palsy, and development disabilities.

ROP is an eye disorder that can potentially lead to blindness. It’s caused by high levels of oxygen which are given to the baby to save their lives if they are in respiratory distress. Between 400 and 600 infants become legally blind due to ROP. There are several stages and classifications of ROP, and milder cases are easier to cure than later stages which include partially or completely detached retinas.

PDA occurs when the patent ductus in the heart doesn’t close on its own and usually needs to be surgically corrected.

Antibiotics used to treat infections such as pneumonia, sepsis, and other issues also carry some risk of side effects. These include gastrointestinal upset, rashes, and stomach pain. Use of antibiotics in babies has also been linked to a 6% increase of developing inflammatory bowel disease (IBD), also known as Crohn’s disease or ulcerative colitis. This is a lifelong condition.

Depression during pregnancy

The risks posed to developing babies in the womb by antidepressants, between birth defects and pre-term birth complications, should give doctors serious pause before they prescribe them to their pregnant patients. However, some doctors do not view the risk as significant enough to warrant too much concern.

Women who are depressed during pregnancy are less likely to seek out quality neonatal care and are more likely to engage in risky or damaging behavior including smoking, drinking, and drug use which can cause low birth weights, pre-term births, and cognitive development problems. Depression during pregnancy can also lead to poor nutrition choices, which can impact the baby’s development and health after birth.

There are ways to manage the symptoms of depression for the pregnancy, and antidepressants can be prescribed after the baby is born to manage postpartum depression risks.

A change in diet, an increase in exercise, and activities such as meditation or yoga have been shown to be effective in managing the symptoms of depression. Women can also seek out a counselor, support group, or therapist to help them work through emotional and outside issues that may be contributing to their pregnancy depression.

Mothers with histories of depression

Women who are trying to get pregnant should consult with their doctor or psychiatrist before going off of their antidepressants. Doctors and psychiatrists can help women plan how they will manage their depression while pregnant, and this may include switching to a less risky medication or a lower dose. Mothers with histories of depression are more likely to experience depression while pregnant or postpartum depression, and these can be serious. In severe cases, women can develop postpartum psychosis.

The pros and cons of taking antidepressants during pregnancy will have to be weighed carefully, especially for women who already suffer from depression. If your doctor does not outline the potential risks of antidepressants for your baby, you may have grounds to contact a medical malpractice attorney.

Seeking damages for birth defects caused by antidepressants

If your baby has been affected by antidepressants during pregnancy, you’re right to want to seek out justice for your baby and to ensure their medical bills will be taken care of. If your child will experience lifelong complications, you will also want to ensure that those future care expenses are included in damages you seek from your medical malpractice claim.

In Michigan, you have two years from the diagnosis of birth defects to file a malpractice claim. There is a cap in Michigan on non-economic damages such as pain and suffering, and you cannot seek punitive damages. Medical costs, lost wages, and costs of care are all viable and calculable.

Lawyers specializing in medical malpractice like Cochran, Kroll & Associates, P.C. will first send your child’s case, including medical records, to a doctor or team of doctors who will determine if your child’s birth defects are related to use of antidepressants. They will also examine the circumstances of the case to see if your claim warrants a complaint of medical malpractice. If they approve, your claim will move forward. In Michigan, all medical malpractice claims must follow this system before a claim can move forward.

Medical attorneys are skilled and well-versed in the law and medical matters. This ensures they will understand the many facets and complications that come along with medical malpractice claims and can navigate through the complexities of the law to help you receive justice and monetary compensation for your child’s birth defects.

Cochran, Kroll & Associates, attorney, and partner, Eileen Kroll is a former Registered Nurse who leads our firm’s malpractice team. She is primarily focused on women and children’s health care issues.

Eileen is supported by our paralegal team and who have more than 20 years of nursing experience. Our law firm recently recovered $900,000 on behalf of a baby born with Down’s Syndrome and $1.2 million on behalf of a baby born with Spina Bifida.

Final thoughts

Depression is a serious disorder, and it should be taken into consideration during pregnancy. However, some medications may not be worth the risk, and women have the right to choose how they will treat their symptoms. If your doctor does not allow you the opportunity or provide information for this choice and your child is born with linked birth defects, it’s important to seek out a medical malpractice attorney as soon as possible.

If you suspect you are a victim of medical malpractice contact our law firm immediately. Due to the statute of limitations, for your unique case, you have a limited time to file your claim.

Our experienced legal team at Cochran, Kroll & Associates, P.C. is dedicated to fighting for justice for you and your baby. Please call us on 1-866-MICH LAW (1-866-643-4529) for a no obligation case evaluation. We never charge a fee unless a recovery is made.

Tim is a writer and editor who earned his Bachelor of Arts in Journalism from the University of Maryland and calls Washington, D.C., home after spending most of his adult life in the country’s capital. Although Tim spent most of his post-college years in the restaurant industry, he became interested in writing about legal matters after he recently moved to Colombia. Today, Tim writes professionally about medical malpractice, drug policies, and workplace injuries. Tim is focused on curating his freelancing career and plans to work remotely for as long he can.

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