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

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KateMumsnet · 03/07/2013 14:38

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."

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Openyourheart · 03/07/2013 16:09

I take SSRIs and they have transformed my life. Depression is an illness which needs to be treated. It is good to have the information in order to make a choice BUT depression is life threatening. Epilepsy is life threatening.

IMO Prof Pilling's remarks are damaging and play down the seriousness of depressive illness.

Frankly, I'm fed up with men telling women what they can and can't put into their mouths during pregnancy. I think it has all become way out of proportion.