Gobsmacked at SSRI / pregnancy thing as reported on BBC today(62 Posts)
So a NICE Professor has claimed that for women who take SSRIs in early pregnancy, the risk of the baby being born with a heart defect rises from 2 in 100 to 4 in 100.
That is something that needs to be checked out, obviously.
What left me with my mouth hanging open was the scare-mongering approach which has been instigated by Professor Pilling, and his attitude towards women.
So first he compares taking anti-depressants, to smoking or drinking. While I am aware that tobacco and alcohol can be used by people with mental health problems, I really didn't get the feeling that he was making a point related to that. It came across as if taking anti-depressants was a lifestyle choice that women did for fun. The idea that women should be "discouraged" from taking SSTIs in pregnancy SSRIs is bizarre. Surely if there is risk, a warning should be issued to medical professionals to discuss options with women who are on these medications / thinking of starting a family etc.
The second was that he said that he flagged up this thing that right wing US types like about females being in a "pre-pregnant" state for their entire fertile lives.
"It's not just when a woman who's pregnant is sitting in front of you. I think it needs to be thought about with a woman who could get pregnant. And, that's the large majority of women aged between 15 and 45."
So what, he is saying that women and girls should not have access to these drugs, which are highly effective, no matter whether they are single or in a couple, trying for a baby or not, or what form of contraception they are using? That's a really concerning attitude and a dangerous road to go down.
The third was the huge risk he has taken saying this that lots of women on ADs are going to suddenly stop taking their medication. A woman with anxiety on SSRIs and in her first trimester might react very strongly to this. What with having anxiety and all. From this POV I find his comments irresponsible.
Nowhere in the article does it say, if you are worried don't stop taking your tablets but go and talk to your doctor. So that is a fail by the BBC as well.
All in all I was just really shocked by this. The way the Professor has approached this seems to have a total disregard for women's health or happiness. And implies that they take ADs as a lifestyle choice. He seems to feel that if women are aged 15-45, and "only" mildly or moderatly depressed, then they should just suck it up and get on with it, just on the offchance that they get pregnant.
Did you see this? What do you make of it?
I agree with you.
I have a lifelong history of depression. The first time I had PND I refused to take anti-depressants because I didn't want it to affect DD through my milk. As a result I was in a bad way for a long time and planned my suicide several times. If pregnant women who are depressed are discouraged from seeking help by this professor they may end up in the same state I did, or worse.
As for "pre-pregnant" women he can take his misogyny and shove it somewhere unpleasant. Would he recommend that pre-pregnant diabetics stop taking insulin? Or that pre-pregnant epileptics stop taking their meds? No. What a twat.
I'm sorry to hear that, puddle. I have also suffered with anxiety/depression although they were triggered by pregnancy and I finally have just come off the drugs (DD1 is nearly 6).
There is enough stigma around this already esp. with pregnancy and young children and stuff - I didn't go to the doc about it until DD2 was 2, I just struggled on as I was scared what impact me telling the doc I was ill would have on the children. This man obviously just hasn't considered the actual effect that his words could have on pregnant women who are depressed / anxious - whether they are on medication or not.
I think that the way he has equated ADs with booze and fags, and said that women should be "discouraged" from taking them is bizarre. And the whole "pre pregnant" thing is just a revolting attitude, so utterly controlling and putting the tiny chance of something going wrong for a hypothetical baby before the health, happiness and autonomy of all females for much of their lives. Makes me spit.
I saw that this morning. Found it disturbing on several levels. Lets make women even more responsible for their own mental health. Let them make impossible choices through pregnancy so we can blame it all on them rather than actually looking at what is wrong with the society that this is actually so much of a danger for pregnant women. And don't get me started on the pre-pregnancy guff. Are women to be permanently in a state of pre-pregnancy when they reach puberty? It is controlling and sinister.
I think it also ties in with the PND thread. Lets not sort out any support for women I this position lets just lay it back on them.
I have had one baby with a congenital heart defect while not on SSRIs, and two heart-healthy babies while on SSRIs. Those drugs saved my life, and I would hate to have been discouraged from being on them when I needed them. It was definitely not a 'lifestyle choice'.
Thing is if he had said that it looks like there's more of a risk and so HCPs should consider what is the best medication for the siutation as there are alternatives available etc etc then that would be one thing.
As it is he baldly states that SSRIs for all women with mild / moderate depression / anxiety aged 15 to 45 are "not worth the risk" to a hypothetical baby. No mention of the risk to the girls and women of not having this treatment available, no mention of weighing up the risk to the hypothetical baby against the risk to the actual woman who actually has actual mental health problems. No mention of alternatives.
His idea seems to be that ADs are a lifestyle choice that irresponsible women make, for fun. That is really strongly the impression he gives.
This man is a Professor working for NICE FFS not some random on the street. Presumably his area of expertise is mental health / pregnancy. And he comes out with this.
Sorry I am repeating myself it just made me so angry, glad it's not just me. It's wrong isn't it. His attitude, reporting it this way, everything.
Appalling... and hot on the heels of the report suggesting that women shouldn't clean or use shower gel while pregnant. If there is evidence of SSRIs increasing the risk of heart defects then absolutely research it further and explain it to women when prescribing anti-depressants. But this scaremongering is unforgivable.
As a 'pre-pregnant' woman I also get incensed that these articles take it for granted that most women of childbearing age a) are having regular PIV and b) would keep an unplanned baby.
YY mooncup I was just thinking about that and looking for a link.
The advice IIRC was that women who are pregnant, or thinking or becoming pregnant, should not eat, drink or touch anything, ever. Or near enough.
I suppose I'm also "pre-pregnant" even though have 2 children and would not contemplate having another child. Due to the MH issues I suffer when pg and afterwards. According to him I shouldn't have been given the SSRIs that made just such a huge, amazing difference.
Hmph. Had honestly not realised that I was "pre-pregnant" and that state should inform how HCPs treat me.
His idea seems to be that ADs are a lifestyle choice that irresponsible women make, for fun. That is really strongly the impression he gives.
Yes that was the impression I got. It is very wrong.
I am really pissed off at the moment with the amount of dos and don'ts women are being subjected to during pregnancy. It has gone way beyond concern and information sources for pregnant women to downright speculation and misinformation.
It seems to me that the onus of reproduction is being firmly put on the woman and not on society. These thpe of articles are not asking the right questions and tackling symptoms rather than causes.
Why are we making products that are harmful to reproduction? I am not just thinking of SSRIs here but the other week it was cleaning products and non-stick frying pans FFS. Why are we not supporting pregnant women or women in general when they are depressed and looking at some of the clear links as to why depression is occurring in the first place (yes I am thinking of abuse, isolation, lack of support etc)? Why are fish so toxic that pregnant women shouldn't be eating them? The list goes on.
Raising child is a societal issue. But you wouldn't think it.
I've never had to take ad's, but wholeheartedly agree he can fuck the fuck off. I'm technically pre pregnant and there is no way I would have another child, if it were necessary I cold be refused ad's because I'm a woman. That's what it boils down to!
The state can fuck off. I'm fuming about this state sanctioned misogyny.
Cross-post with mooncup. Yes I was thinking of the same report. So vague you could probably put any household goods in there <rolls eyes>
You should SUFFER, NiceTabard, for the sake of your hypothetical unborn child.
Given that women have a childbearing life of, on average, about 30 years it is an extraordinarily brutal sentence.
scallops yes and another interesting point comes from that.
It seems (although may be selective reporting) that when there are potential problems with babies, it is the mother's behaviour that is exclusively focussed on.
Like them banging on for years about how older mothers = crappy eggs = how selfish poor babies. When actually older fathers = poor sperm quality = possible problems for babies / problems carrying to term but that is rarely mentioned.
With the chemicals thing - AND the prescription drugs/ booze / fags - isn't it entirely possible that these things will have an adverse effect on sperm leading to problems? Of course it is entirely possible - and with smoking there have been studies showing it. Yet all of the focus in these things is on the woman.
Can you imagine if it were suggested that all "pre-inseminating" men - so all males aged, what, 12 to dead, should not be prescribed SSRIs, should not be drinking alcohol, smoking, should be avoiding most thing that normally are used / consumed in day to day life?
Brutal is the right word. Expecting women to be in a state of pre-pregnancy is just treating us like breeders. Not people with a right to a life.
Fuck. The. Fuck. Off.
bloody hell. Pre pregnant? He can fuck off
Pre pregnant? Only if he can fucking sort my DH's sperm out!
When we were TTC I specifically changed SSRIs on the advice of my gynae to ensure that any hypothetical babies were not harmed. No kids are forthcoming (aforementioned sperm problem) and I should be able to take whatever I fucking like.
The irony is that our fertility issues triggered HUGE depression for me - but yeah, I was only taking them for fun. <mutter mutter mutter>
SSRI's quite literally saved my life at one point, luckily (according to Prof Pilling) I had already been talked into getting myself sterilised, so never pre-pregnant again.
What a very dangerous and mother blaming piece of reporting as NiceTabard rightly pointed out, can you imagine the outcry should men be classed as pre-inseminating unless they are pre-pubescent or dead, and therefore should avoid the various things that women do?
Actually there is some evidence (am not medic so can't judge it) that SSRIs can cause sperm quality problems in men that can be potentially linked to a higher risk of birth defects.
Bafflingly, I have yet to see an article on the BBC warning pre-inseminating men who are suffering mild to moderate depression not to use SSRIs for this reason.
I assume that Prof Pilling has commented on that research though, mooncup?
I expect there is a piece on the BBC somewhere.
CaptChaos hold your horses there.
According to NHS, female sterilisation carries risk of 1 woman becoming pregnant out of every 200 procedures.
Meanwhile condoms can be 99% effective.
And being celibate, or being a lesbian, and not wanting a child, is to all intents and purposes 100% effective.
I didn't see him giving exemptions for any of those groups, so think you are being a bit presumptious there. I reckon the Prof would put you in a "pre pregnant" category without a second thought...
OR maybe he has insight that women who are a. not involved with men and/or b. not having PIV sex and/or c. don't have or want children have a ZERO chance of mental health problems!
Could that be it?
Good deduction, NT. I await a BBC headline saying 'Heterosexuality is bad for you.'
This gives me the RAGE.
This makes me sad.
The idea of calling the next fuckwit who uses the phrase pre-pregnant a pre-inseminator makes me happy, though.
Well, if I hadn't had SSRIs in my early thirties I would not have been alive to give birth to children in my 40s.
I share the annoyance and concern about this, but let's face it, women are routinely spoken to and about like this. Only recently they were subjected to messages telling them to avoid any number of everyday chemicals, foods and other stuff while pregnant, due to an unquantified risk of harm to the unborn child.
All responsibility and blame is placed on the pregnant woman, not on wider society to make changes that benefit and protect pregnant women and small children. This latest scare fits neatly into that pattern.
So what does he suggest?
I hate to sound all Apprentice, but I'm sick of these reports 99% aimed at women, that highlight these things but never a solution.
How many women will have gone on to have serious clinical depression with these meds?
Or does that not matter?
Silly me of course not they're only women..............
I stand corrected NiceTabard and I, for reasons of being pre-pregnant at all times for the next few years, promise not to drink, eat brie/paté/peanuts/whatever today's no-no is, take any kind of SSRI or any kind of hormonal contraception.
Do you think that we, as women, should inform doctors and pharmacists that we are pre-pregnant when they write or fill an Rx for us? Should I only buy maternity clothing as a sort of 'just in case'?
Honestly, the more I think of the concept of pre-pregnancy, the more I fume!
The more I think about this the more annoyed I feel. Two things really irk me:
1) 'mild to moderate' <-- what if mild to moderate gets caught early, medicated and treated effectively rather than going on to develop into really bad.
Also, how do they guage it? Last time I went to the Dr with depression I didn't end up on a massively high dose but it helped. I also didn't tell the dr exactly how bad I was (suicidal thoughts. My 3 yo had walked in on me self harming) so probably got put down as mild to moderate. Had I gone when I first started getting low things wouldn't have got as bad iyswim but if this professor had his way I wouldn't have been prescribed anything.
2) I am a crap mother when depressed. I'm in my early thirties so would be counted as 'pre-pregnant'. Given the choice, and it should be my choice, between being a really awful mother and damaging my relationship with my children (and very possibly them emotionally) and not taking ADs or taking them and possibly harming a potential child I know which option I woudl go for.
OK, I too fumed at this article, because of the assumption that women's mental health was trivial and unimportant compared to that of their hypothetical unborn baby, thus making us seem like incubators on legs (once more).
However, I didn't see him use the phrase "pre-pregnant" anywhere. And it seems to me a reasonable part of informed consent to tell a woman that certain drugs are contra-indicated in pregnancy. After all, you don't have a statement in your medical notes saying "I intend to get pregnant in the next 6 months/ I hate the whole idea and never intend to get pregnant." So the doctor has an obligation to consider the possibility and inform you that hypothetically, were you to get pregnant, there could be problems. I didn't have a problem with the endocrinologist I saw telling me this about my thyroid medication many years back, and I don't see a problem with a doctor discussing the issue with a woman presenting with depression - depression does not remove your capacity for informed consent, nor for the need for the information required in order to give or withhold that consent.
The important issue is to tell women that SSRIs change the risk of congenital heart defects from (if I read the article correctly) 2 in 100 to 4 in 100, and ask her how she feels about that increased risk balanced against the risks posed to her of not having her depression treated.
The issue for feminists is to make sure that the decision making process is not taken from the women and handed over to the doctor, in the form of a blanket ban on SSRIs for pre-menopausal women (and I've seen nothing in the press coverage to suggest that this was being proposed). After all, even if it increased the risk from 2 in 100 to 98 in 100, it's perfectly acceptable for a woman to say "give me the SSRIs, if I become pregnant and the 20 week scan shows a heart defect, I will have an abortion secure in the knowledge that I made the right decision for my own mental health." (By the way, I am not saying that this is the only decision, or the decision which is right in absolute terms - I have close friends who have chosen to carry a baby with a serious heart defect to term, and that decision was right for them; I just believe very strongly that only the woman who is pregnant can make the decision about her own pregnancy).
From the NICE website
NICE Public Board Meeting (Annual General Meeting)
Every two months the NICE Board holds its meeting in a different venue; moving from region to region to ensure that all those interested in our work can come along to hear about the latest developments at NICE and question the Board about policy.
NICE Question Time
A question time session is held before the main Board meeting. This session offers a great opportunity for you to raise any questions you have about our work and is open to the general public.
Attendees will have an opportunity to put their questions to David Haslam, Chairman of NICE.
NICE Question Time is open to the general public
Agenda and papers (to follow)
NICE Question Time - Stockport
Lunch is provided from 12 noon.
Lurcio I agree with a lot of what you said (wrote?). Isn't it sad that pregnant women are only faced with what seems to be a litany of Don'ts and Mustn'ts with no real consideration of alternatives.
Wouldn't it be better if NICE could say, look, SSRI's are not ideal in pregnancy but look, here is another AD that is just as effective and will not cross the placenta.
One of my favourite rants is "if men got pregnant they would have solved it by now". In spades.
(also applies to periods and the menopause).
Lurcio while I agree with most of what you wrote, some of us on long term meds (not just ADs) talk to our doctors before TTC. It's galling that, yet again, women seem to not be considered as sensible enough to talk with their GPs prior to pregnancy...
According to this report one in three women and girls are on antidepressants at some point in their lives.
I wonder what would happen if all
pre pregnant fertile women stopped taking them. I suspect the country might grind to a bit of a halt
Hearts - my mum had an even better version of that: "If men got pregnant, abortion would be a sacrament" (and lest anyone think she was joking, just think of the mental hoops theologians are prepared to go through over the concept of the "just war").
Sunshine - I totally agree - it's when medics think that women somehow can't be trusted with something as complex as informed consent and need to be told what to do, with a blanket ban in case we somehow damage the precious bundle of cells that might or might not be present, that the trouble sets in. And they tend to do that a hell of a lot.
Plenty - I've always wondered how much of the higher prevalence of mental illness in women could be blamed on the patriarchy. For instance, my sister's GP put her on SSRIs. Giving her leaflets about WA and the support of an authority figure saying "actually, violence is never OK", and helping her to leave her abusive husband would have been far more effective in my opinion.
Lurcio - he doesn't use the exact phrase 'pre-pregnant' but what he does say is:
"You've got double the risk. And for women who are mild to moderately depressed, I don't think that those risks, in most cases, are really worth taking" he said.
"It's not just when a woman who's pregnant is sitting in front of you. I think it needs to be thought about with a woman who could get pregnant. And, that's the large majority of women aged between 15 and 45"
To me that's basically the same as saying all women are pre-pregnant....
Oh, well that's a relief then. I don't need to come off my mood stabilisers even though I'm only 42, because I already went through early menopause when I was 38. Phew.
Oh FFS I just realised I'm actually 43!!! Clearly getting older not wiser.
I completely agree with lots of the stuff on here about his comments being ill-judged, and seemingly anti-women.
I am on SSRIs, have been for many years, believe they have sorted me out. Generally, I am a big defender of pharmacological agents for depression. I have practically rattled at times
However.... and I just can't shake this 'what if' feeling... SSRIs have been linked to higher rates of heart defects. Presumably the studies demonstrating this have been adequately controlled for other comorbid factors.
WHileI l believe his comments are careless, he may have a point that other drugs may confer more benefit and less risk. SNRIs for example have been shown to be more effective for treating depression than SSRIs.
I think it's important to keep in mind that big pharma doesn't have a glowing record on showing its workings and being honest about potential side-effects. Ditto its data on the effectiveness of marketed medicines.
Ragusa I'm on an SNRI. It works brilliantly for my anxiety and depression, but the withdrawals... I wouldn't recommend them to anyone on that basis (google FDA discontinuation syndrome cymbalta).
Ragusa that's all well and good but you're giving the benefit of the doubt with no reason.
if you watch the interview, read the piece, there is no mention of alternatives.
Maybe he thinks that is taken as read (?) or maybe not, I don't know, it's not been reported. What is in the news, that interview he gave, is going to prompt a real response in some women in stopping their meds NOW.
If he didn't mean to come across like that, if the BBC reported wrong, there would be changes to the article, right?
But there aren't. And importantly there is still nothing at the end / elsewhere which says please don't just stop taking meds please talk to your doc first etc.
So that to me says he has no qualms. If he was being misquoted etc he would have said (not like he wouldn't have checked himself out on BBC) and they would have corrected. Not happened. Ergo Prof not arsed.
I know that many people want to see the best in people but seriously, watch the interview (clip in in BBC link above) and read the link.
Sorry! I completely agree with you OP. I read the story and thought exactly the same as you.
The underlying message seemed to be that fertile women are baby-making machines who should live their entire lives to minimise any potential risks to a foetus they might possibly conceive regardless of the effects on them
Well, that was just daft, then, if he didn't even refer to other possible treatments. And careless. I couldn't watch the interview.
Why not write directly to the prof concerned?
Oh, I see there is going to be a panorama prog about this on 1 July 2013. It'll be interesting to see what's said on that.
I'm a little confused by this, where has he got this evidence from? I have done a very quick search and it's not obvious. Also even if a few studies have been done they will most likely be poorly designed and a low standard of evidence. There could be some evidence it's associated I suppose. Sometimes there might be a gut instinct one thing causes another but his interview just made me think he had a while other agenda to be honest.
Thank God for this thread. I saw this and was so appalled I contacted the programme producer. My son was born with a heart defect and I was taking SSRIs. I was assured by Great Ormond Street that my sons heart defect has nothing to do with the fluoxetine I took early in pregnancy then came off. I suffered a huge depression following 20week scan and blamed myself for everything after reading a daily mail article that made same claims. After finally being reassured by the cardiologist and one of UKs leading perinatal psychiatrists that there was no evidence to say fluoxetine caused by baby's condition Panorama has stirred the whole thing up again. The producer said their evidence was anecdotal so basically there is no hard proof. To all women out there worrying please speak to an expert. I work in media and sadly programmes these days are mostly based on ratings and grabbing headlines. I would like to spare anyone the self torture and anguish I went through and still am since watching Panorama. I saw the cardiologist at GOSH again today and he said to pay it no attention.
That really is terrible, opensesame.
What was the programme like and what evidence did they cite in it?
I think what he's trying to say is that doctors should explain risks to patients and should be aware of whether the patient in front of them is a. female and b. between puberty and menopause so potentially could become pregnant, accidentally or otherwise. Hence the doc needs to discuss the risks of pregnancy/choice of drug with the patient. Maybe the patient has no intention of ever becoming pregnant but you need to have that discussion so she can make an informed choice. Maybe the best option for that patient is to take SSRIs. But you need to think it through and the patient needs to be fully informed.
Paroxetine, the SSRI they mention in the report, is also known as Seroxat. It took years of dogged campaigning (and legal action) to make the manufacturers and the psychiatrists admit that Seroxat was actually linked to an increased risk of suicide in some patients, especially young people.
People were dying thanks to that drug and the manufacturers and medical establishment were denying it. It was a long and extremely sorry saga. Nowadays there are specific warnings against prescribing Seroxat to young people - but those warnings weren't put there because the manufacturer or medical establishment did their jobs, they were fought for in the face of dogged denials from those who should have had the best interests of patients at heart.
I have no inside info on heart defects and SSRIs but given the history of Seroxat it would not surprise me if something is going on that the makers or medical profession are, putting it mildly, being very slow to recognise.
Sadly, doctors don't always use their common sense - you'll see the same programme shows some are still prescribing Epilim to women of childbearing age. This should never happen unless the risks and benefits have been fully discussed and considered with the patient.
Blog post on this as well here
Sure edam but that's not what he says though.
Plus the way it is reported by the BBC.
There will be lots of women with anxiety for eg on these who will have ditched them after reading this. It was highly irresponsible. There aren't even any "talk to your doc before doing anything" type things on the article, or helplines or anything.
Here is an excellent blog on this subject:
Oh dear god. What an irresponsible way of handling this.
I'd much rather have taken the risk actually, than have possibly taken our lives .
Depression (when severe) isn't some lifestyle choice that you can magic your way out of without help
I was gobsmacked that Nice and the BBC would be so irresponsible
I know this thread was started a few weeks ago, but just wondering what the thoughts are on this recent post? Perhaps it's more about demanding all the facts rather than getting hung up on terminology??
Thank you Josie8123 for bringing common sense back to a thread of some astonishing reactions to a programme that, thankfully, set out to give us all warning of the neo-natal risks of taking antidepressants during pregnancy which, in so doing, gives us the knowledge needed to make safer and informed choices.
The link you left, which I will also include so that it doesn't get buried by my message, was very much worth reading.
I think this is an incredibly difficult subject.
I am eight, maybe nine weeks pregnant. I have been on SSRIs since the birth of my son fourteen months ago, having chosen not to take SSRIs during my last pregnancy when I developed serious anxiety and moderate depression.
I have made the decision to stop sertraline. I think that the evidence isn't amazing that it might harm my baby... but I also think the evidence isn't amazing it will protect me.
I've been told this increases my chance of relapse to 68%. This, by the way, is based on one study. Several doctors have told me there's 'no evidence' it causes harm, that it is 'totally safe'. This is untrue, they just don't know.
The NICE guidelines are pretty explicit about this and also that in the case of OCD and moderate depression psychotherapy is to be favoured. Guess what I haven't been told? Guess what is more expensive?
The irony is that SSRI s were never this effective for me. CBT worked. Yet still I am having studies quoted at me that just don't match my individual risk profile and that relate to broader resource issues and not my personal situation.
I came on here to post about my situation. I've been complaining about this... and repeatedly, told things like: 'well you're worrier/planner/would feel better if you had a safety net'. No. I had a significant illness for a whole year and I don't want it again so I'd like to access the right treatment as set out in national guidelines. This is not about my personality, it's about my health.
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