Pregnancy has historically been viewed as a time when depression lifts. Women of reproductive age have the highest prevalence of major depressive disorders, with the American College of Obstetricians and Gynecologists www.acog.org experts estimating that about 1 in 10 will experience a bout of major or minor depression sometime during pregnancy or the postpartum period. Some women choose to keep taking antidepressants like Paxil throughout pregnancy.

The FDA www.fda.gov has strengthened its warnings about possible birth defects in babies born to women taking Paxil during pregnancy. www.fda.gov/bbs/topics/NEWS/2005/NEW01270.html. The question then is “Is it safe for women to stop taking Paxil?” The answer may be “No”.

Those who stopped taking antidepressants or altered their doses were more likely to have a relapse of major depression during pregnancy. www.fda.gov/bbs/topics/NEWS/2005/NEW01270.htmlwww.fda.gov/cder/drug/advisory/SSRI_PPHN200607.htm. A study published in the Journal of the American Medical Association (JAMA, February 2006) found that discontinuing the medication had an impact on the risk of a relapse. Lee Cohen, MD and colleagues studied 201 pregnant women whose depression had been lifted by antidepressant drugs for at least three months before their last menstrual period. About six in 10 women who stopped taking antidepressants or lowered their doses due to their pregnancy started taking antidepressants again while still pregnant. They still reported more depression than those who never quit taking antidepressants, the study showed. ACOG, in the news release, while stating that women who are pregnant or planning on becoming pregnant should avoid the use of Paxil when possible because of the high risk of birth defects, including PPHN, also acknowledged that the potential heightened risk for birth defects must be weighed against the risk of relapsing into depression for pregnant women who discontinue their antidepressant medication. "Untreated depression has its own risks, including low weight gain, alcohol and substance abuse, and sexually transmitted diseases, all of which have negative maternal and fetal health implications," the statement said. www.forbes.com/forbeslife/health/feeds/hscout/2006/11/29/hscout536339.html

The risk of relapsing into depression is also a serious cause for concern, leaving expectant mothers to decide whether the benefits of Paxil outweigh the risks associated with it. Unfortunately, one of the risks that has been identified is damage to the unborn baby. GlaxoSmithKline should warn women who are pregnant or may become pregnant of these risks so that they can seek informed health care.