Affiliations: [a] Tufts University School of Medicine, Maternal-Fetal Medicine Attending Physician, Tufts Medical Center, Boston, MA, USA | [b] MetroWest Medical Center, Framingham, MA, USA
Correspondence:
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Correspondence to: Adam C. Urato, 115 Lincoln Street, Framingham, MA 01702, USA. Tel.: +1 508 383 1436; Fax: +1 508 383 1497; aurato@tuftsmedicalcenter.org
Abstract: BACKGROUND: Rates of antidepressant use during pregnancy are rising worldwide. It is, therefore, essential to determine the effects of these medications in pregnancy and on the developing fetus. OBJECTIVE: To review the two main explanatory models for understanding the effects of antidepressant use during pregnancy and compare the evidence to support them. METHODS: Review, synthesis, and discussion of the available literature. RESULTS: The preponderance of the basic science, animal data, and human studies supports the view that the Harmful Chemical Model is the best explanatory framework for understanding the effects of the SSRI antidepressants during pregnancy. They do not appear to be helpful medications that produce better outcomes for moms and babies. They are not like using insulin in pregnant diabetics. Their profile fits more with a harmful chemical exposure. CONCLUSIONS: The totality of the scientific evidence convincingly suggests that the SSRI antidepressants are chemicals that do cause fetal harm and that the FDA should strongly consider changing the FDA Category from C to D for the entire class. This move would provide appropriate warning to the public while still allowing for use in selected cases.
