“Are antidepressants safe during pregnancy?” read an article in the online version of the Sept 1 New York Times.
I will not attempt to answer that question. Rather, I will address some complex issues concerning the pitfalls of medical reporting and the public interest.
But first let’s get this out of the way: As someone who reports on mental health issues, I have attended numerous seminars devoted to the safety issues surrounding psychiatric medications and pregnancy. The bottom line from scores of expert presenters:
No decision is one hundred percent safe. Regardless of one’s choice - whether to stay on your meds or go off - there are risks. These risks vary from medication to medication, situation to situation. Women and their partners need to do their research and discuss their options in full with their physicians.
Let’s begin ...
The New York Times piece, by freelance journalist Roni Caryn Rabin, opened with these two paragraphs:
Pregnant women often go to great lengths to give their babies a healthy start in life. They quit smoking, skip the chardonnay, switch to decaf, forgo aspirin. They say no to swordfish and politely decline Brie.
Yet they rarely wean themselves from popular selective serotonin reuptake inhibitor antidepressants like Prozac, Celexa and Zoloft despite an increasing number of studies linking prenatal exposure to birth defects, complications after birth and even developmental delays and autism.
Let’s not mince words. This is fear-mongering and shaming women at its worst. What mother-to-be doesn’t want the best for her baby? The catch is that antidepressants are hardly a guilty pleasure like Brie. The health - even the life - of a mother-to-be may depend on staying on her antidepressant. But you will not find mention of that in the article.
Complaints - many from doctors - flooded the email box of the paper’s public editor, who acts as a sort of reader ombudsman. In a Sept 11 piece, the public editor, Margaret Sullivan, acknowledged that the article’s “breezy” beginning was “unfortunate.”
She also addressed complaints about the author “cherry-picking” her studies. She talked to the editor in charge, who defended the piece. Unfortunately, she concluded: “I’m no scientist and can’t judge the validity of the studies, or those that are being cited to rebut them.”
Therein lies the rub. In a highly specialized field such as medical journalism, there is no competent chain-of-command to assess the quality of the reporting, even in that most august of august news organizations.
Thus, this provocative passage drew no censure:
Babies exposed to SSRIs prenatally are more likely to be born with congenital heart defects ...
I went to the study in question, which I am almost positive the author of the article never did. Had she actually read the study, she would have come across this finding:
... SSRIs were not associated with major malformations overall ...
Which sort of contradicts the author’s whole article.
The study did find a statistical blip concerning babies with septal heart defects, which it reported in the arcane statistical language of odds ratios. Digging deeper for the raw numbers and doing one’s own math, one finds that - based on the researchers’ data-mining of eight years of records of Danish births - about one in 250 babies of mothers not on antidepressants were born with septal heart defects.
For babies born of mothers on antidepressants, that figure was about one in 130.
Digging a bit further, we find that the culprit SSRIs were Zoloft and Celexa, but not Paxil or Prozac.
In short, this study does not exactly justify the sensationalist theme of the New York Times article. But maybe a study involving the risk of autism does, and we have that study, hot off the press. To the author’s credit, she cites another study, also hot off the press, in support of a different conclusion.
In other words, the autism issue is far from resolved.
To conclude ...
The issue of medications and pregnancy hardly lends itself to once-over-lightly journalism. Publishing Ms Rabin’s piece was not exactly the New York Times’ finest hour.
Certainly, there is a major public interest in reporting the risks of taking antidepressants during pregnancy, but this needs to be done in the context of educating prospective mothers (and dads) and empowering them to make their own choices.
I could go on and on. Another time ...
Published On: September 30, 2014