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Gobsmacked at SSRI / pregnancy thing as reported on BBC today

(62 Posts)
NiceTabard Mon 24-Jun-13 19:29:10


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?

working9while5 Thu 15-Aug-13 18:20:29

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.

Jane4155 Thu 15-Aug-13 14:42:26

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.

Josie8123 Sun 11-Aug-13 23:03:58

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??

HoleyGhost Sun 14-Jul-13 19:03:06

I was gobsmacked that Nice and the BBC would be so irresponsible

theorchardkeeper Sat 13-Jul-13 13:13:36

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 hmm

HoleyGhost Sat 13-Jul-13 12:31:33

Here is an excellent blog on this subject:

NiceTabard Thu 04-Jul-13 21:04:05

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.

NiceTabard Thu 04-Jul-13 21:02:04

Blog post on this as well here

edam Wed 03-Jul-13 22:44:39

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.

Ragusa Wed 03-Jul-13 14:24:58

That really is terrible, opensesame.
What was the programme like and what evidence did they cite in it?

WoTmania Wed 03-Jul-13 14:20:14

Gosh sesame, that's terrible.

opensesame74 Wed 03-Jul-13 14:08:05

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.

Oinkypig Wed 26-Jun-13 23:17:11

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.

Ragusa Wed 26-Jun-13 13:43:11

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.

Ragusa Wed 26-Jun-13 13:36:25

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?

Josie1974 Wed 26-Jun-13 11:01:22

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 hmm

Josie1974 Wed 26-Jun-13 10:58:39

I con

NiceTabard Wed 26-Jun-13 00:43:53

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.

SunshineBossaNova Tue 25-Jun-13 23:40:33

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 Tue 25-Jun-13 22:16:55

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 smile

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.

HeartsTrumpDiamonds Tue 25-Jun-13 14:34:50

Oh FFS I just realised I'm actually 43!!! Clearly getting older not wiser.

HeartsTrumpDiamonds Tue 25-Jun-13 14:34:10

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.

WoTmania Tue 25-Jun-13 14:06:05

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....

LurcioLovesFrankie Tue 25-Jun-13 14:03:03

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.

LurcioLovesFrankie Tue 25-Jun-13 14:01:15

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.

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