Prozac is the most commonly prescribed antidepressant in the United States. So why don't we know more about whether it's safe to take during pregnancy?
Photo-Illustration: Photo-Illustration: The Cut; Photos: Getty Images I’ve lived much of my life secretly following rules and compulsions. Some rules I made up as a child, like tapping my heels or counting down before I left the shower; others I picked up as a teenager, like not eating salt or standing up to do jumping jacks at specific times of day.
For weeks, I pored over the studies cited by these articles. I sank deeper into fear each time I read words like double the risk and severe and difficulty breathing. The abbreviations and numbers began to jump around the page, and I struggled to pin them down or interpret their meaning. Between work meetings, I would scroll through Ovia, the popular pregnancy-tracking app I’d downloaded onto my phone, to see if other people were as confused as I was.
Prozac hit the market the year I was born, in 1988. It quickly became the most commonly prescribed antidepressant in the United States; today, nearly 8 percent of women in the U.S. use SSRIs like Prozac during pregnancy. Tens of millions of pregnant women have taken these medications while pregnant, and hundreds of published studies have evaluated their safety.
Untreated depression during pregnancy, according to a clinical review published in The BMJ in 2016, has been associated with risks like preterm birth and childhood emotional difficulties as well as risks for the mother. Pregnant women with depression are more likely to develop postpartum depression and to engage in high-risk health behaviors like smoking and illicit-substance use.
In other words, many published studies essentially compare women like me with my friends who have no histories of anxiety and OCD and don’t take medication. Of course, those women are more likely to have various better outcomes, and of course I wish I were like them. But … I’m not. Vigod says if you want to isolate the effects of SSRIs, you really need to run more rigorous trials that compare women like me with other women like me who are not given SSRIs.
Like I said, reassuring … but also completely exhausting to digest. Absorbing so much conflicting, ever-changing information is frustrating for pregnant women desperate for immediate and definite answers, and for the psychiatrists who are supposed to counsel them. The intention is good, but the challenge of connecting women who screen positive with specialized care can be daunting. Both Dhami and Vigod point out that compared with the number of women who need help, there are few programs, therapists, or psychiatrists available who accept health insurance. It’s estimated that, on average, only one in five women who are identified as being depressed end up having at least one mental-health visit, due to factors like cost, stigma, and availability.
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