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Letter

Antidepressants and pregnancy

Adrienne Einarson
CMAJ March 22, 2011 183 (5) 585; DOI: https://doi.org/10.1503/cmaj.111-2028
Adrienne Einarson
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I thank Mintzes and associates for their comments. I should have stated that neither study by Nakhai-Pour and colleagues1 or Motherisk2 could make any definitive conclusions, although I stand by my comment that “if there is a true increased risk of spontaneous abortion caused by gestational use of antidepressants, it is very small.”3

The small risk referred to was the odds ratio (OR) of 1.68; it is well known among epidemiologists that ORs of less than 2 are problematic.3 Observational studies have inherent biases that cannot be removed with certainty. Although the authors addressed some of the issues, it is impossible to identify and remove the influence of all factors, since many remain unknown; there is still a possibility of a false-positive result.

In my commentary, I focused on antidepressants and spontaneous abortion and discussed Nakhai-Pour and colleagues’ study. I do not feel it is appropriate that Mintzes and associates mention other outcomes, quoting from a review that is no longer current.5 It is also inappropriate to talk about treatment efficacy, since I did not mention this in my commentary. At Motherisk, we conduct research to evaluate the safety and risk of a particular drug during pregnancy only, not to examine the efficacy of treatment. The latter should be left to the prescribing physician, who is frequently faced with an already pregnant woman taking an antidepressant and requiring treatment. Is it reasonable to advise such a patient to stop treatment and switch to psychotherapy?

I agree that women facing depression during pregnancy need accurate and unbiased information on the use of anti-depressants. After reviewing all the evidence, each woman, with her physician, needs to make an informed decision about whether to take the medication.

References

  1. ↵
    1. Nakhai-Pour HR,
    2. Broy P,
    3. Berard A
    . Use of antidepressants during pregnacy and the risk of spontaneous abortion. CMAJ 2010;182:1031–7.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Einarson A,
    2. Choi J,
    3. Einarson TR,
    4. et al
    . Rates of spontaneous and therapeutic abortions following use of antidepressants in pregnancy: results from a large prospective database. J Obstet Gynaecol Can 2008;31:452–6.
    OpenUrl
  3. ↵
    1. Einarson A
    . Antidepressants and pregnancy: complexities of producing evidence-based information. CMAJ 2010;182:1017–8.
    OpenUrlFREE Full Text
    1. Straus SE,
    2. Richardson WS,
    3. Glasziou P,
    4. et al
    . Evidence-based medicine: how to practice and teach EBM. 3rd ed. St. Louis (MO): Turtleback Books; 2005.
  4. ↵
    1. Tuccori M,
    2. Testi A,
    3. Antonioli L,
    4. et al
    . Safety concerns associated with the use of serotonin reuptake inhibitors and other serotonergic/noradrenergic antidepressants during pregnancy: a review. Clin Ther 2009;31 Pt 1:1426–53.
    OpenUrlCrossRefPubMed
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Canadian Medical Association Journal: 183 (5)
CMAJ
Vol. 183, Issue 5
22 Mar 2011
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Antidepressants and pregnancy
Adrienne Einarson
CMAJ Mar 2011, 183 (5) 585; DOI: 10.1503/cmaj.111-2028

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Antidepressants and pregnancy
Adrienne Einarson
CMAJ Mar 2011, 183 (5) 585; DOI: 10.1503/cmaj.111-2028
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