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Guest blog: pregnancy and antidepressants - a woman's right to choose

(55 Posts)
KateMumsnet (MNHQ) Wed 03-Jul-13 14:38:54

Official advice to women who are taking anti-depressants is to be updated, in response to research which suggests that the use of SSRIs during pregnancy may double the risk of a child being born with a heart defect.

In today's guest post Anna Hedge, who blogs over at Economista Dentata, argues that this is a potentially dangerous step which adds to a 'growing atmosphere of moral judgment' about the choices women make.

"Women, being autonomous adults, have a right to medical treatment to treat any illness they may have on the same basis as men. It seems obvious, doesn't it?

Monday night's Panorama, called 'Pills and Pregnancy', is being described as worrying viewing for women. Not for people, note, but women. Worrying because drugs used to treat epilepsy and depression respectively had been found to have a correlation with an increase in birth defects.

I don't know about epilepsy, but I do know about depression - both during pregnancy and afterwards. My partner was killed when I was 3 months pregnant with our son, and I was tipped from a really-rather-happy-albeit-unplanned pregnancy into utter, bewildering despair which lasted for years. I was recommended, and took SSRIs. Without them I'm not sure I would have survived.

Would I have still taken them had this new research been available then? Probably, yes: I was ill, I needed the treatment: every treatment has risks. But there is a growing atmosphere of moral judgment around women who choose to take prescribed medication where there is any risk to the foetus.

Partly this is down to the explosion in 'lifestyle advice' to pregnant women: eat broccoli if you want a genius, play them language tapes to help linguistic development in utero, this or that food will/won't ensure healthy development and of course, the never-ending breast-feeding discussions.

But illness and medical treatment are not 'lifestyle' choices - and yet women are being encouraged to feel guilty and ashamed, as though recommended medication in pregnancy is an unnecessary luxury, akin to a self-indulgent half-glass of wine once a week. Feelings of guilt, shame and unworthiness are key features of any sort of depression and certainly was in mine.

The already flourishing view (not least in the media) that a Good Mother is she who puts herself last, coupled with the intrinsic guilt associated with depression could prove, literally, fatal.

Professor Pilling, the expert advisor to NICE, describes the use of medication in mild-to-moderate depression as 'in most cases, not worth the risk' of a 'doubling of the risk of a birth defect'. But early intervention may prevent mild-to-moderate depression from worsening into something far worse - a crisis whose treatment may well present more of a risk to both mother and foetus than continuing with the initial medication. And while a doubling of risk sounds terrifying, it is in fact an increase from two births per hundred being affected, to four.

Terrifyingly, it's not only pregnant women who must worry. Professor Pilling suggest warning all women who 'could [my emphasis] get pregnant' about the dangers of SSRIs - so, that's the vast majority of women between the ages of 15 and 45. Under this scenario, women could shun potentially beneficial medication due to a risk to a child they haven't even yet conceived, and have no intention of conceiving.

We are sleepwalking towards a situation where women are no longer thought of as autonomous individuals and patients, ie as equal to men, but to a greater or lesser degree as ante-chambers to another life (there are echoes of the broader issues of choice in pregnancy here: I note that can of worms but leave it unopened).

What does this approach tell girls about their primary purpose in life, and their importance as people in themselves to society? Women shift from 'People who live in the world on an equal basis' to 'Perpetual mothers-in-waiting'. A woman's right to appropriate treatment becomes eroded by the fact of her potential for motherhood, bolstering already-existing biases faced by women in the wider world, and making our well-being of lesser worth than men's.

Ironically, a paper published last month in the Journal of Psychiatric Research suggests there may be a possible test for ante and postnatal depression which would identify women at greater risk. This is great news - but only if we can agree an approach which is based on two maxims: that women, whether pregnant or not, are morally equal to men; and that they have a right to make their decisions on the basis of clear, unbiased information.

There needs to be more information about depression generally, and in/after pregnancy in particular (I commend the Royal College of Psychiatrists for this excellent leaflet, 'Mental Health in Pregnancy'). There is still a tendency amongst healthcare professionals (at least in my experience), to try to jolly depressed pregnant women out of it: 'You'll feel better when the baby comes', or 'when baby is here, you won't have time to be depressed'. But depression is an illness. It finds the time, even if you don't have it to spare.

Mental Health services need urgent attention, both in terms of resources and education. Yes, talking therapies can help with mild-to-moderate depression: but the waiting lists are horrendously long. CMHS have long been chronically underfunded.

And the media can do their part by avoiding sensationalist reporting of medical research into mental health diagnoses and their treatment (and a prize to the first newspaper to embed links to the original research).

The most crucial point is this: that women, mentally ill or not, pregnant or not, deserve to be treated with the same care and respect for their status as individuals as any other patient. This may involve our being faced with tough choices - see the examples above - but it is their very toughness that makes it so important that it is our choice. Give us the information, then let us make the decision, because as with any other decision involving our health, we are after all the people most intimately concerned with the outcome. Our bodies, our minds, our conscience."

NiceTabard Mon 08-Jul-13 19:22:02

Have you all read the BBC item linked and watched the interview with the Prof.

You are giving him a vast amount of leeway & benefit of the doubt.

Do you agree that him comparing taking ADs (note he refers to both SSRIs and ADs generally on this point) to smoking and drinking in pregnancy is appropriate. Do you think his stance that women should be "discouraged" from taking ADs in the same was as they are discouraged from drinking or smoking.

Do you think it is appropriate for the BBC to report this piece without any of the usual things they put in this type of piece re if you have any concerns please talk to your doctor. Especially given that the group at risk of reacting here is women who are pregnant and depressed and/or anxious.

If he has said, some studies show there is an increased risk associated with SSRIs, guidance is changing for HCPs, women who are on these drugs / in a situation where they may go on these drugs should have the risks explained to them. Any women who are worried should see their doc and not just stop taking drugs without seeing the doc. Then fine. That is not what he said though.

link to BBC piece including interview

edam Mon 08-Jul-13 19:42:38

It's not the Prof's fault that the BBC web story doesn't include the usual caveat about 'if you have any concerns, please see your doctor'. That's an error by the BBC.

He doesn't say 'stop taking the drugs immediately' or 'no women should take ADs just in case she gets pregnant'. He's raising a legitimate area of concern. About new evidence on the risk of certain medicines for pregnant woman. What do you expect him to do, bury the evidence? That's what the manufacturers did with Seroxat and IMO people's lives were put at risk as a result.

Certainly once the evidence had been made public - by Panorama, jointly with a print publication - the warnings were eventually changed so that it is no longer prescribed to young people due to the increased risk of suicide. Draw your own conclusions about what happened before then.

Panorama does deserve credit for (jointly) revealing the Seroxat scandal. Which may even have saved a few lives - by encouraging people to go back to their docs and ask about the medicine they were taking.

NiceTabard Mon 08-Jul-13 20:35:41

Yes. From the top, I have said I have a major issue with the scaremongering way this was reported by the BBC (and probably other publications).

I also have a problem with the interview linked on the BBC. This is a professional man, a Professor, who works for NICE. He should not be doing things like using "SSRI" and "anti-depressant" interchangeably. He should not be saying that women should be "discouraged" from taking anti-depressants as they are drinking and smoking, in pregnancy. He should be saying that guidance is changing and women who are prescribed anti-depressants for their mental health problems should be made aware of the risks, and HCPs should follow the new guidance, which may include changing their medication. These are pretty basic mistakes for a highly qualified person to make, in an interview which he knows will be shown to the public.

And this "He doesn't say 'stop taking the drugs immediately'" - but the audience directly affected by this news piece will be pregnant women with anxiety and depression it's not a stretch to imagine how some of them might react to reading this / seeing the interview.

There is a middle ground between what has happened (scaremongering) and burying it. And this has not struck the middle ground. The BBC piece was irresponsible as was the interview that this man gave.

Woofers Wed 10-Jul-13 23:38:21

Has anyone actually complained to the beeb or panorama about this?

SuffolkNWhat Fri 12-Jul-13 20:29:06

Message withdrawn at poster's request.

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