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?

[WoTmania]

Gosh sesame, that's terrible.

[Ragusa]

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

[edam]

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.

[NiceTabard]

Blog post on this as well here

[NiceTabard]

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.

[HoleyGhost]

Here is an excellent blog on this subject:

healthydoseofskepticism.blogspot.co.uk/2013/06/antidepressants-in-pregnancy.html?m=1

[theorchardkeeper]

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

[HoleyGhost]

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

[Josie8123]

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??

wp.rxisk.org/the-dark-is-for-mushrooms-not-for-women/

[Jane4155]

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.

wp.rxisk.org/the-dark-is-for-mushrooms-not-for-women/

[working9while5]

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.