Pregnant women with a history of anxiety that’s often accompanied by depression can face difficult and confusing choices about treating their symptoms with antidepressants, such as Prozac and Lexapro, and other medications.
Little is currently known about how early exposure to these medications might affect their offspring as they mature into adults. But the answer to that question is essential to the more than 200,000 babies each year who are exposed to antidepressants during gestation via transmission from their mothers.
A new University of California, Los Angeles study sheds light on early developmental exposure to Prozac and Lexapro in a mouse model that mimics human third trimester medication exposure.
Both medications studied are in the same group of serotonin-selective reuptake inhibiting antidepressants (SSRIs), a first-line treatment for severe depression, and for the treatment of mild-to-moderate depression and anxiety disorders.
SSRIs work mainly by blocking serotonin transporter proteins in the brain.
The UCLA team found that, although these SSRIs were previously thought to work the same way, they did not produce the same long-term changes in anxiety behavior in the adult mice.
Study mice exposed to Lexapro had permanent changes in serotonin neurotransmission and were less anxious as adults than the mice exposed to Prozac, said study senior author Anne M. Andrews.
Andrews is a professor of psychiatry and chemistry and biochemistry. She is the Richard Metzner Endowed Chair in Clinical Neuropharmacology at the Semel Institute for Neuroscience & Human Behavior and California NanoSystems Institute.
“This was quite surprising, since these medications belong to the same drug class and are believed to work by the same mechanism, Andrews said. “The implications of these findings are that with additional investigation, it may be possible to identify specific antidepressants that are safer for pregnant women.”
Any treatment plan has risks and benefits, and for pregnant women, the risks are of particular concern, according to the Anxiety and Depression Association of America, a national nonprofit headquartered in Silver Spring, Maryland.
“Just as particular nutrients are passed to the fetus when food is eaten, so does some medication transfer from mother to unborn child.”
It is thought that serotonin levels affect mood and social behavior, appetite and digestion, sleep, memory, and sexual desire and function.
Although an association has been made between depression and serotonin, researchers remain unsure as to whether decreased levels of serotonin contribute to depression, or whether depression causes a decrease in serotonin levels.
“It’s important to recognize that major depressive disorders and anxiety disorders are serious medical conditions that often require therapeutic intervention. Prescribing the safest medication for mother and child is paramount,” Andrews said in a written statement.
Anxiety disorders are believed to be the most common mental illness in the United States, affecting about 40 million American adults (about 18%) age 18 years and older in a given year. These disorders cause sufferers to be filled with fearfulness and uncertainty, according to a 2005 study published in the Archives of General Psychiatry.
Anxiety and depression are more likely to affect women than men, and pregnant women are not exempt. In fact, symptoms can develop or worsen during or after pregnancy, though in some cases women notice fewer symptoms while pregnant, according to ADAA.
“Current antidepressant therapies are ineffective in treating anxiety and depression in large numbers of patients, and advances in predicting individual responses are hindered by difficulties associated with characterizing complex influences of genetic and environmental factors on serotonergic transmission in humans,” the UCLA study stated.
Another 2007 study found non-drug ways to increase body serotonin levels, including mood induction, bright light, exercise and diet.
However, experts caution if you are already taking medication for anxiety and or depression and become pregnant, stopping treatment should only be done under the supervision of your doctor.
The results of the six-year UCLA study appear early online Dec. 19, 2014 in the peer-reviewed journal Neuropsychopharmacology and was funded by the National Institute of Mental Health (MH064756, MH086108), the Brain and Behavior Research Foundation, the Shirley and Stefan Hatos Foundation, and the UCLA Weil Endowment Fund.
“Early exposure to antidepressants affects adult anxiety, serotonin transmission” UCLA Press Release via Science Daily 19 Dec. 2014.
“Perinatal vs. Genetic Programming of Serotonin States Associated with Anxiety.” Stefanie C Altieri, Hongyan Yang, Hannah J O'Brien, Hannah M Redwine, Damla Senturk, Julie G Hensler, and Anne M Andrews. Neuropsychopharmacology (19 December 2014) | doi:10.1038/npp.2014.331
Anxiety Disorders. National Institute of Mental Health. Accessed 5 Jan. 2015.
Pregnancy and Medication. ADAA. Accessed online 5 January 2015.
“How to increase serotonin in the human brain without drugs” Simon Young. J Psychiatry Neurosci. Nov 2007; 32(6): 394–399.
Reviewed January 6, 2014
by Michele Blacksberg RN
Edited by Jody Smith