It is estimated that 17% of women take antidepressants. A key part of treating depression, for many years there have been concerns about the effect these medications have on a growing baby. Currently, most guidelines recommend the use of SSRIs (e.g., fluoxetine and citalopram) or tricyclic antidepressants (e.g., nortriptyline) for depression during pregnancy.
A recent study in Nature Communications has uncovered how using antidepressants during pregnancy can affect a child’s brain development and increase the risk of mental health issues later in life.
Led by researchers from the University of Colorado Anschutz Medical Campus, the study focused on fluoxetine, found in medications like Prozac and Sarafem, used to treat depression. By studying how serotonin levels are affected by fluoxetine in the fetus, they discovered its influence on the prefrontal cortex.
“While it is known that serotonin plays a role in the brain development, the mechanisms responsible for this influence, specifically in the prefrontal cortex, have been unclear. The prefrontal cortex, the most evolved brain region, plays a central role in highest-order cognition, which is why we focused our study on finding the answer from this brain area,” said lead author Won Chan Oh, PhD, assistant professor in the Department of Pharmacology at CU Anschutz.
Their research highlighted how serotonin impacts synaptic connections in this area during early development, leading to potential mental health disorders later on.
“Our research uncovers the specific processes at the synaptic level that explain how serotonin contributes to the development of this important brain region during early-life fluoxetine exposure,” adds Oh. “We are the first to provide experimental evidence of the direct impact of serotonin on the developing prefrontal cortex when fluoxetine is taken during pregnancy, because fluoxetine not only crosses the placenta but also passes into breast milk.”
By studying the effects of serotonin levels on mice brains, the researchers revealed how serotonin influences individual neuron connections, aiding learning and adaptation processes crucial for brain function.
This new understanding could lead to early intervention strategies and novel treatments for neurodevelopmental disorders related to serotonin imbalance.
While it is known there could be developmental concerns, the issue of taking antidepressants while pregnant is incredibly complex because there is an extreme risk for the woman if she stops taking them. A study conducted in 2013 noted that the “benefits of antidepressant treatment of pregnant women with depression outweigh the possible risk to the fetus: (a) if the depression is severe (that is, with suicidal ideation or behavior, psychotic symptoms, or a complete loss of appetite), (b) if there is a family history of re-occurring mental disorders, (c) if the individual lacks family or social support, or (d) if moderate depression persists despite psychotherapeutic treatment.”
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