All along I'd been watching Abie, wondering if his chin failed to drop forward at 7 weeks' gestation when it should have because of the medication I was taking, wondering if his failure to latch on to my breast was a sign of something deeper and more profound. I'd googled the words "hirsute" and "birth defect." I'd cupped his sweet, long foot in my hands and worked his little ankle, trying to figure out how its deformity could be blamed on womb positioning as the doctor said, and if, somehow, the drugs that make me feel so good could have caused my baby to hover uncomfortably in the very place in which he should have been most secure. Now, here was the Lancet telling me that I may have made a terrible mistake. In seeking to spare my other children and myself nine months of unhappiness, had I put my child in harm's way?

The medical community is far from unanimous in its view of the ramifications of the Lancet study. Dr. Lee S. Cohen, the director of the perinatal psychiatry program at Massachusetts General Hospital, has expressed reservations, calling into question both the methodology, in which adverse outcomes may tend to be overreported, and even the use of the term "withdrawal syndrome." He said that what SSRI-exposed babies experience has so little in common with acute heroin or methadone withdrawal, for example, that to use the same terminology is confusing at best. Cohen's concern is that mothers who are at risk for severe depression will avoid SSRIs not just in the immediate peripartum period (the third trimester), when exposure may carry the most risk for their newborns, but throughout their pregnancies.

Recently, I asked my own obstetrician, Dr. Arzou Ahsan, if in light of the Lancet study, she would still advise me to stay on Celexa through a pregnancy. Her answer was immediate and clear. Yes, she would still recommend a low dose of any SSRI other than Paxil. She said she had concerns about the Lancet study, saying it was difficult to determine its clinical significance. The conclusions drawn from a study that mines large databases for instances of drug reactions are less clear than those that could be made from, say, a double-blind study where researchers have more information on individual patients. Unless and until there is more convincing evidence of harm, the benefits of SSRI use are so great that she feels comfortable recommending them to her patients who really need them.

My psychiatrist, on the other hand, was less sure that his advice would remain the same given the recent study. He reminded me that the decision to take any medication during pregnancy, indeed my decision to take Celexa during my pregnancy with Abraham, involves a risk-benefit analysis. Does the benefit to the mother outweigh the risk to the baby? The Lancet study pushes that analysis further in one direction. My psychiatrist pointed out that Sanz and his colleagues did not study the prevalence of neonatal withdrawal syndrome, how common it is among infants exposed to SSRIs. From their study we know that it occurs in some number of cases, but we know nothing about how frequently. Further, no one has yet determined if there is a consequence to the child beyond the initial exposure, or if it is an effect that passes with the withdrawal syndrome.

So many of us in our 30s and 40s have photographs of our mothers, a Doral burning merrily between their index and middle fingers, a martini glass balanced on their pregnant bellies. Now, those pictures seem absurd, even shocking. Most of us don't smoke when we are pregnant, we don't drink or take drugs. We modify our diets, sometimes drastically. But to a woman who suffers from depression, even minor depression, and realizes relief from medication, the thought of forgoing it can be daunting. Withdrawal syndrome necessarily means that the infants exposed in utero to SSRIs have undergone some physical changes, but as my psychiatrist perhaps facetiously pointed out, we don't know for sure that those changes are negative. It is conceivable, albeit unlikely, that it does a developing fetus good to be bathed in a steady stream of extra serotonin. At the very least, so far no studies have shown any long-term harm beyond the period of withdrawal.

Still, I feel for the pregnant women facing a decision that is suddenly much more complicated. It's hard enough to be either pregnant or depressed, let alone both, without having to make sense of conflicting medical research and objectively evaluating the quality and seriousness of your own despair. Had the Lancet study been published before I became pregnant with Abraham, I think I would have tried harder to do without my medication, at least in the last trimester, that peripartum period that the study deemed the most crucial. I would have tried, knowing the toll it would have taken on my older children, my husband and myself, in order to spare Abraham any potential harm. I would have done this, whatever my doctors' considered sound advice, bracing myself for months of upheaval and unhappiness and strapping my family in for a very bumpy ride. But the very idea makes me queasy.

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