Gobsmacked at SSRI / pregnancy thing as reported on BBC today

[NiceTabard]

here

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?

[SunshineBossaNova]

This gives me the RAGE.

[TheDoctrineOfAllan]

This makes me sad.

The idea of calling the next fuckwit who uses the phrase pre-pregnant a pre-inseminator makes me happy, though.

[EldritchCleavage]

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.

[vintagecakeisstillnice]

PRE-PREGNANT

WHAT

THE

FUCK???????

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..............

[CaptChaos]

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!

[WoTmania]

The more I think about this the more annoyed I feel. Two things really irk me:

1. 'mild to moderate'

[LurcioLovesFrankie]

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).

[HeartsTrumpDiamonds]

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

Board Papers

Agenda and papers (to follow)

NICE Question Time - Stockport

Time: 12.30-1.30pm

Lunch is provided from 12 noon.

[HeartsTrumpDiamonds]

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).

[SunshineBossaNova]

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...

[PlentyOfPubeGardens]

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

[LurcioLovesFrankie]

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.

[LurcioLovesFrankie]

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.

[WoTmania]

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....

[HeartsTrumpDiamonds]

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.

[HeartsTrumpDiamonds]

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

[Ragusa]

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.

[SunshineBossaNova]

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).

[NiceTabard]

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.

[Josie1974]

I con

[Josie1974]

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

[Ragusa]

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?

[Ragusa]

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.

[Oinkypig]

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.

[opensesame74]

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.